Opioid crisis is just getting worse

The number of Americans turning up in emergency rooms suffering from opioid overdoses has risen sharply in recent years, according to new federal data, as the size and scope of a devastating public health crisis evolves in ways officials say is difficult to combat.

Data released this week by the Centers for Disease Control and Prevention show emergency room visits for suspected opioid overdoses increased by 30 percent between July 2016 and September 2017.

Rust Belt states have been hardest hit, with emergency room visits rising 108 percent in Wisconsin, 80 percent in Pennsylvania and 65 percent in Illinois. Indiana and Ohio also experienced substantial growth in overdose treatments.

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While the crisis began in rural America among low-income whites, it has now moved into larger urban areas, where minority communities now account for the fastest growth among overdoses and deaths. Emergency room visits in large cities rose by 54 percent over the last year, the CDC data show.

“We often talk about the opioid epidemic as a singular epidemic. But if you look at it it’s actually two distinct epidemics going on simultaneously,” said Jon Zibbell, a senior public health scientist at RTI International, a public health nonprofit. “In some states, prescription opioids were driving the epidemic. In other states, illicit opioids are driving the epidemic. And in some states it’s both.”

Those watching the epidemic unfold say deaths caused by opioid overdoses will rise before they fall — perhaps dramatically.

Opioid overdoses killed an estimated 33,000 Americans in 2015, more than half the total number of deaths caused by drug overdoses, according to the latest data made available by the National Institute on Drug Abuse. As recently as 2001, fewer than 10,000 Americans died of opioid overdoses. 

The number of total drug overdose deaths has more than tripled since the turn of the century; preliminary figures peg the number of drug overdose deaths in 2016 at more than 64,000.

Experts say the crisis is metastasizing, opening new fronts for state and local governments. Controls on prescription opioids have succeeded in flattening the once-exponential growth of legal opioids, but an influx of illicit opioids has moved into the market to meet demand.

The rise in emergency room visits is evidence of an evolving crisis, those experts said. When prescription opioids are less available, illicit opioids like heroin and fentanyl fill demand. The potency of those drugs vary widely, leading to more overdoses by drug users.

“The ER visits are to be expected, because as doctors write for fewer narcotics, the drug dealers are there to pick up the slack,” said Rick Blondell, vice chairman for addiction medicine at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.

The number of prescriptions that doctors are writing for opioids has flattened out after more than a decade of explosive growth, according to federal and state-level data. But those drugs have been replaced by illicit fentanyl, a synthetic opioid manufactured overseas that can be shipped into the United States in a package as small as a regular business envelope.

“The introduction of the fentanlys have completely changed the situation. We now have deadlier drugs and thus deadlier drug combinations,” said Kevin Sabet, a former top official in the Office of National Drug Control Policy under the Obama administration.

Fentanyl has exacerbated the crisis in rural America, and created one in urban areas too.

“The prescription opioids really started in those rural areas, Appalachia, the Rust Belt, the Deep South and the West,” Zibbell said. “A majority of [fentanyl] markets are in urban areas, so I think we’re seeing the transition into urban areas more because we’re seeing the expansion of the illicit side of the epidemic.”

The Trump administration has held several high-level meetings on the opioid epidemic, which the Department of Health and Human Services has called a public health emergency. But skeptics have said few solutions have actually come out of the White House or Congress.

Blondell, of the University of Buffalo, likened the response to the campaign against tobacco companies in the 1990s and early 2000s, when state governments sued to win concessions from an industry that created a public health threat. He said a part of the solution would include getting pharmaceutical manufacturers to spend money to address a crisis they in part created.

“We gotta go after the pharmaceutical industry. They made and continue to make drugs way in excess of what we need. Whether that’s production quotas or taxes or limits on their marketing campaigns, whatever,” Blondell said. “They knew what they were doing, so I think they have to pony up the money to help address the problem.”

States, counties and cities have filed more than 100 lawsuits against opioid manufacturers. Attorney General Jeff Sessions said last month the Justice Department would file a statement of interest in an Ohio case, essentially backing plaintiffs who have sued manufacturers over false and deceptive marketing practices.

But those suits address only one front in the crisis. The second, the growing illicit market, is made more difficult as the sources and types of illegal drugs proliferate.

“We have a lot of sourcing of fentanyl. We have a lot of it coming across the southern border, but we also have a lot of it coming through the post via the internet,” Zibbell said. “There’s so much fentanyl and there’s so many different players that people are having a hard time adapting to the market.”