Opioids over-dose deaths
Overall, opioid related deaths have been trending upwards since 2010. In 2016, there were more than 63,600 drug overdose deaths in the United States. The CDC further estimates that 42,249 of those deaths involved some opioid. More importantly synthetic opioids continue to contribute larger proportion of opioid overdoses and related deaths ( top graph) . The synthetic opioid, the very potent fentanyl, illicit fentanyl, has overtaken prescription opioids in causing overdose dose deaths in the U.S.A. Synthetic opioid overdoses alone were 19,413, or 22.7% of overall overdose deaths. In a research letter published in JAMA, of opioid overdose related deaths in 2016, illicit fentanyl was involved in 19,413 deaths surpassing deaths from prescription opioid overdose, 17,087. About 15,469 deaths involved heroin. The easily manufactured, available and highly potent synthetic opioid seems to find its way into many other recreational drugs of abuse. The implication of which is that the unsuspecting drug user who sets out to use ends up consuming a substance significantly more potent and easier to overdose on, with fatal consequences.
Role of the Primary Care Physician
There are clear implications of this trend for primary care providers among many of which is continued adherence to the Prescription Monitoring Program. In addition there is need for renewed effort on education of patients and the public on the dangers of drug use particularly highlighting the fact that the recreational drug they are about to consume maybe "cut" with highly potent and dangerous synthetic opioid. Prevention and treatment plans to double current efforts to address this public health epidemic with greater emphasis on addiction treatment and rehabilitation remain a priority. Many would agree that the ROI for addiction treatment and its comorbidities is higher than any other known disease state in the USA.
The synthetic opioids bypass opioid production “from farm to street " - process time (inherent in cultivating and harvesting the natural product), making the 100 times more potent, dangerous and deadly synthetic product readily available.
References:
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
https://jamanetwork.com/journals/jama/article-abstract/2679931