Questions for Lead Author Merianne Spencer, M.P.H., Health Statistician, of “Drug Overdose Deaths Involving Fentanyl, 2011-2016.”
Q: Why did you decide to do a report specifically on drug overdose deaths involving fentanyl?
MS: Fentanyl, a synthetic opioid, is of interest to public health officials because of its increased involvement in drug overdose deaths and contributing role in the opioid epidemic. Understanding trends in drug overdose deaths involving fentanyl by demographic and regional characteristics can provide insights to better target interventions for populations at risk and to inform agencies working to combat this public health problem.
Q: Do you have any data that is more recent than 2016?
MS: Mortality data for deaths occurring in 2017 are currently available for research use. However, these data were not available at the time of the analysis for this study, and the text analyses required for preparing this report are time intensive.
Q: How did drug overdose deaths involving fentanyl vary by age, sex and race?
MS: The rates for drug overdose deaths involving fentanyl varied by age with the largest rates among adults aged 25-34 and 35-44. Exponential increases occurred in all age groups, with the greatest increases per year among adults aged 35-44, 25-34 and 15-24.
The rates for males and females were similar in 2011, 2012 and 2013. In 2013, the rates for males and females began to diverge such that by 2016, the rate for males (8.6 per 100,000) was roughly 2.8 times the rate for females (3.1).
For race/ethnicity, non-Hispanic whites had higher rates than non-Hispanic blacks and Hispanics for the entire study period. However, the annual percentage changes were greater among non-Hispanic blacks and Hispanics.
Q: Was there a specific finding in your report that surprised you?
MS: I was surprised to see how high the average annual percentage change in rates was for teenagers and young adults aged 15-24. While the death rate for this age group was not as high as the rates for persons aged 25-34 and 35-44, the average annual percentage increase in the rate was among the greatest, increasing an average of almost 94% each year from 2011 through 2016.
Q: What is the take home message for this report?
MS: The rise in drug overdose deaths involving fentanyl was noticeable in certain subpopulations and regions. Overall, death rates, which were stable in 2011 and 2012, significantly increased from 2013 through 2016.
Death rates for males and females were similar in 2011 and 2012, but then diverged, with rates for males increasing faster than the rate for females starting in 2013. Non-Hispanic whites had the highest death rates; however, the rates for non-Hispanic blacks and Hispanics increased at a greater pace than those for non-Hispanic whites. All age groups had increasing rates, but the greatest increases were among those aged 15-24, 25-34 and 35-44. There were also regional differences, with the highest rates and greatest increase in rates occurring in the East Coast and Upper Midwest regions.
A new NCHS report examines changes over time in the percentage of adults aged 18–64 who were prescribed medication and reported using these selected strategies to reduce their prescription drug costs in the past 12 months.
- Among adults aged 18–64 who were prescribed medication in the past 12 months, the percentage who used selected strategies to reduce their prescription drug costs in the past 12 months decreased from 2013 through 2015 and then remained stable from 2015 through 2017.
- In 2017, among adults aged 18–64 who were prescribed medication, women were more likely than men to use selected strategies to reduce their prescription drug costs.
- In 2017, strategies for reducing prescription drug costs were most commonly practiced among those who were uninsured compared with those with private insurance or Medicaid, as 39.5% asked their doctor for a lower-cost medication, 33.6% did not take their medication as prescribed, and 13.9% used alternative therapies.
Questions and Answers from the authors of the recently released 2017 mortality data. The data can be found in the following reports, “Mortality in the United States, 2017, ” “Drug Overdose Deaths in the United States, 1999–2017, ” and “Suicide Mortality in the United States, 1999–2017.”
Q: Why did life expectancy decline in 2017?
A: Mortality rates increased for 7 out of the 10 leading causes of death in the U.S., including a 5.9% increase in the flu/pneumonia death rate, a 4.2% increase in the accidental/unintentional injury death rate, and 3.7% in the suicide rate. Many of the accidental/unintentional deaths were from drug overdoses, which continued to increase in 2017.
Q: Isn’t this the third straight year that life expectancy declined?
A: Estimated life expectancy at birth in 2017 was 0.3 years lower than in 2014 and 0.1 years lower than in 2016. The 2016 life expectancy estimate was revised to 78.7 years, up from an estimated 78.6 years, which was reported a year ago. This means that the 2016 life expectancy estimate is the same as the 2015 estimate, which also was revised to 78.7 years, down from an estimated 78.8 years, originally reported two years ago. As a routine matter, for the highest degree of accuracy, NCHS blends Medicare data for people ages 66 and over with our vital statistics data to estimate life expectancy. However, the two data sets are released on different schedules. When Medicare data for a year aren’t available at the time we release our final mortality statistics, we use the most recent Medicare data available at the time. We later revise life expectancy estimates when updated Medicare data become available.
Q: How many deaths in 2017 were attributed to opioids?
A: In 2017, 47,600 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids, representing over two-thirds of all overdose deaths (68%).
Q: Why is the 70,237 number of overdose deaths smaller than what CDC has previously reported for 2017?
A: The 70,237 number is a final, official number of overdose deaths among U.S. residents for 2017 whereas the previously reported (and slightly higher) numbers were provisional estimates. In August of 2017, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level. These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc). These counts also do not include deaths that are still under investigation. As a result, the monthly numbers are provisional or very preliminary, and the final 2017 number of 70,237 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.
Q: Does this mean that the 70,237 total does not include deaths to undocumented immigrants here in the U.S.?
A: We don’t get immigration status off the death certificates, so we wouldn’t know how many of the deaths were to undocumented immigrants.
Q: In comparing the 2017 numbers with 2016 and past years, is the crisis of drug overdose deaths growing or about the same?
A: From 2016 to 2017, the number of drug overdose deaths increased from 63,632 deaths to 70,237, a 10% increase, which is a smaller increase compared to the 21% increase from 2015 to 2016, when the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths. Over a longer period of time, from 1999 through 2017, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 16% per year from 2014 to 2017. So the trend is continuing, although the increase in 2017 was not as large as in previous years.
Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?
A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased 45% in one year, from 6.2 per 100,000 in 2016 to 9.0 per 100,000 in 2017. In 2017, 40%(?) of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.
Q: Has fentanyl overtaken heroin as the major cause of overdose death?
A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased 45% 2016 and 2017 whereas the overdose death rate from heroin did not change (4.9 deaths per 100,000).
Q: There is a lot of stark news in these three reports. Are there any positives to report?
A: The cancer mortality rate declined between 2016 and 2017, and although estimated life expectancy declined in 2017, life expectancy for people at age 65 actually increased. Also, regarding drug overdose deaths, the rate of increase in drug overdose deaths slowed between 2016 and 2017, although the increases that occurred were still very significant.
QuickStats: Age-Adjusted Death Rates for Drug Overdose by Race/Ethnicity — National Vital Statistics System, United States, 2015–2016April 2, 2018
During 2015–2016, the age-adjusted death rates from drug overdose for the total population increased from 16.3 per 100,000 standard population to 19.8 (21.5%).
The rate increased from 21.1 to 25.3 (19.9%) for non-Hispanic whites, from 12.2 to 17.1 (40.2%) for non-Hispanic blacks, and from 7.7 to 9.5 (23.4%) for Hispanics.
Source: National Vital Statistics System, Underlying cause of death data, 1999–2016. https://wonder.cdc.gov/ucd-icd10.html.