Drug Overdose Mortality Update: Geography of Highest Death Rates, 1999-2022
Mater Dolorosa, Pray for Us
In a recent Washington Post article: Overdoses soared even as prescription pain pills plunged
The number of prescription opioid pain pills shipped in the United States plummeted nearly 45 percent between 2011 and 2019, new federal data shows, even as fatal overdoses rose to record levels as users increasingly used heroin, and then illegal fentanyl.
The data confirms what’s long been known about the arc of the nation’s addiction crisis: Users first got hooked by pain pills saturating the nation, then turned to cheaper and more readily available street drugs after law enforcement crackdowns, public outcry and changes in how the medical community views prescribing opioids to treat pain.
The drug industry transaction data, collected by the Drug Enforcement Administration and released Tuesday by attorneys involved in the massive litigation against opioid industry players, reveals that the number of prescription hydrocodone and oxycodone pills peaked in 2011 at 12.8 billion pills, and dropped to fewer than 7.1 billion by 2019. Shipments of potent 80-milligram oxycodone pills dropped 92 percent in 2019 from their peak a decade earlier.
Yes, people who had been legitimately using prescription pain pills may have turned to illicit drugs, and people who had been illicitly using prescription pain pills definitely would have done so.
Ranking states by rate of change vs rates
Turning back to my prior drug overdose post, legalizing the recreational use of drugs like fentanyl is probably tied to the relatively large increase in Oregon’s drug overdose death rate:
But if you look at Oregon’s death rate ranking, you can see that it really isn’t all that high compared to, say, South Carolina.
I was mainly looking at which locations had the largest increase in their drug overdose death rates from 2019 to 2022. But which states have the highest death rates in 2022? And what did those look like in 2019?
Only one state, South Carolina, appears on both of these ranking tables. You can see that back in 2019, it was ranked 20th. To be sure, many of the states had similar death rates in 2019
Perhaps these were the locations you were thinking of when you were thinking of top drug OD death rates. Which states are on the lowest end, and what do their rates look like?
You can have a ranking table, after all, with the top and the bottom being very close in values.
Before and After
States with the lowest drug overdose death rates
They’re not all that close. However.
Some of these states just have low density. The opportunities of supply may be lower (or, perhaps, people stick to the very traditional drug of choice: alcohol.)
But even with relatively low drug overdose death rates, the percentage increase in only a few years has been tremendous in many of these states.
Except Utah.
That one doesn’t surprise me.
Not many good choices
Many of the counties with the highest fentanyl death rates — in hard-hit states such as West Virginia, Kentucky and Ohio — started out with alarmingly high doses of prescription pills per capita, according to a Washington Post analysis of the DEA data and federal death records.
Counties with the highest average doses of legal pain pills per person from 2006 to 2013 suffered the highest death rates in the nation over the subsequent six years.
Annual overall overdose deaths reached a grim milestone in 2021, surpassing 100,000 for the first time in U.S. history. More than 110,000 people died of drug overdoses in 2022, two-thirds of whom succumbed to synthetic opioids such as fentanyl, according to estimates by the Centers for Disease Control and Prevention.
I really hate the “grim milestone” language, even though I count dead people, too.
Cities and states involved in the sprawling federal litigation based in Ohio have long alleged that drugmakers, distribution companies, pharmacies and other companies fueled the public health crisis through marketing, shipping and sales of the pills, despite glaring signs that they were feeding insatiable addiction. The companies have denied wrongdoing and, in the past, blamed physicians who overprescribed painkillers, doctors and pharmacists who worked in “pill mills,” and users themselves.
More than 300,000 people have died in the United States from prescription opioids since 2000.
Despite the recent decrease, the United States remains awash in pain pills. The new data shows that 45 billion pain pills were shipped between 2015 and 2019. Deaths attributed to prescription opioids — in some cases, mixed with other drugs — still averaged 16,400 annually during that five-year window.
Let me show you a graph. It’s figure 2 on the linked page, but I’ve blown it up and annotated it.
It may be hard to see in their original figure, but the prescription opioid death trend, which absolutely looked horrible compared to the other drug deaths before, was horribly surpassed by the fentanyl drug death trend starting in 2016.
The rates of growth differed greatly.
With prescription pain medication, there are no real good choices, alas. Let’s break it down.
There are people in pain, and if you cut off their supply, they may go for hard stuff, especially if they’re in excruciating pain
There are people who had been in pain, got addicted to the pills when they got legitimate pain relief after surgery, etc. It happens.
There are people who had no legitimate medical use for the pills — just wanted some happy time
And there are some nuances in between.
The personal side
My husband Stuart has had incurable metastatic prostate cancer (though treatable) since 2017. He has prescription opioids, but he knows they don’t really give him much. He doesn’t always take them when he’s in pain, because he wants to make sure he has some for when he has really bad pain. Because he may not get pills. Because they’re so concerned a cancer patient may get addicted.
I have chronic nerve pain (since 2010). They had tried giving me these pills (of various sorts), but I hate them because my brain doesn’t work properly when I take them. I like being able to think. So I’ve tried all sorts of other things, the latest one being Botox.
But I have known friends and family who have been addicted, and know one person who died of a drug overdose, and another who may have (the circumstances are murky).
It’s easy enough to go all Dread Pirate Roberts…
But life isn’t only pain.
Our Lady of Sorrows, Pray for Us
It is fitting I post this today, September 15, the memorial of Our Lady of Sorrows.
The traditional iconography of Our Lady of Sorrows is 7 swords piercing Mary’s heart, representing 7 specific events in her life with respect to Jesus.
As I often do, I went to Mass this morning, and there are two possible Gospel readings for this day, the one I heard from the Gospel of John, in which Jesus tells Mary, “Woman, behold your son” and tells John, “Behold your mother”.
But the other is where the imagery of the sword comes from: Gospel of Luke, Chapter 2, in which Simeon says:
And thy own soul a sword shall pierce, that, out of many hearts, thoughts may be revealed
While people do go on about supposed “Catholic guilt”, “Catholic suffering” is more to the point. A single sword was insufficient to represent the amount of suffering Mary underwent in her life. So we added 6 swords to the one Simeon mentioned.
More than enough suffering to go around
There is a lot of suffering in the world, and the gigantic jump in drug overdose deaths during the pandemic is part of the worst things I have seen:
The deal with fentanyl, of course, is that it can kill quickly (and it’s not just fentanyl at this point). The pandemic and the level of despair it has engendered in many people, not only cutting off support systems for many people, has been a disaster. And then, sometimes, it really does take legal intervention to stop people from killing themselves.
Yes, I know not everybody agrees with providing such intervention, but let us move on from that point for right now.
There are other drugs, like alcohol, that have also seen an uptick in killing people during the pandemic.
Look, I know not everybody or even a plurality of the people reading this will agree with my values, forget about my Catholic faith, but all I’m asking for is a little compassion for your fellow humans.
Compassion comes from “com” = with and “passion” = suffering — it’s suffering with others.
In the Catholic tradition, we have the idea of “offering it up”, but it doesn’t necessarily require that. I’m not even asking for literal suffering with others. Just a recognition of common humanity. (Yes, even for that person you really don’t like.)
I’ve seen a lot of callousness around drug overdose deaths, that “they deserve it” yadda yadda. To be sure, if you take a lot of fentanyl, it’s not a surprise that you die of an overdose.
But you don’t know how people started down that path. And there is a lot of pain out there, and I can tell you, sometimes you just want to escape that pain.
Alternatively, it’s not helpful to let people think it’s just fine to kill themselves via drugs. That’s not very compassionate, either. “I won’t judge”… well, I will judge that yeah, you’re going to kill yourself by taking too much of the drugs.
Basically, sometimes, there’s not a great path. We none of us get out of here alive. So let’s be kind out there.
