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The opioid epidemic has morphed over the years from prescription overdoses in the 1990s to a rise of heroin overdoses around 2010 to, since 2013-14, a fast rise in opioid deaths from synthetic opioids such as fentanyl and manufacturers encouraging MDs to over-prescribe to patients.
As the epidemic is addressed state by state and at the U.S. government level, experts continue to attempt to wrap their arms around the numbers to find out the extent of reporting of opioid deaths and in what direction the numbers are trending.
“Sadly, opioids have now claimed more American lives than the battlefields of both World Wars combined,” said Richard Weisler, MD, in 2020 speaking to the Psychiatry & Behavioral Health Learning Network. “The United States suffered 53,402 deaths in World War I and another 291,557 in World War II, for a total of 344,959 lives lost in battle in both wars. That is more than 5,000 fewer deaths than the opioid epidemic’s projected death toll in the United States at the end of 2017.”
Florida is a case in point where the numbers are not synching with the national averages.
Researchers at the University of South Florida studied overdose deaths from opioids between 2008-17 and determined that approximately one-third of all overdose deaths were not included in government reporting. Another 3,000 deaths caused by cocaine usage were also not included, nor were the potential deaths from heroin use.
Medical examiners in Florida can take weeks or even months to determine the cause of death and the drugs involved. what drugs might have been involved. Contrast this with the U.S. Centers for Disease Control and Prevention’s Multiple Cause of Death (MCOD), which collects data at the time of death, when the cause may be unclear, resulting in some deaths caused by drug overdose to be underreported.
“The CDC data are widely reported in the news and referenced by politicians, which is problematic since those estimates significantly undercount the true scope of the epidemic for specific drugs,” says Troy Quast, a Ph.D. professor at the USF College of Public Health, who found that the MCOD database underreported deaths caused by benzodiazepines by 45% and amphetamines by 17%. “The rate of underreporting for all overdose deaths in Florida is near the national average, so the problem is not the state.”
Federal statistics seem to be impacted also by underreporting.
“This is something that needs to be addressed and soon,” says Mike Carberry, DC. “Without knowing the true numbers, working to find an actual solution to the problem and scale it up to help people nationwide would be unlikely, if not impossible.
Allowing for faster toxicology reporting and holding off on the data for opioid deaths so they’re only recorded after the toxicology reports have come back are two steps that would have an immediate impact. This way, the state can know for sure how many people have died as a result of opioids and other drugs, and in what proportion.”
States and reporting
“As has widely been discussed, overdoses involving opioids are undercounted,” writes Alex Cohen, PhD and director of learning and evaluation for the Richard M. Fairbanks Foundation. “Drug overdoses involving opioids were responsible for almost 400,000 deaths from 1999-2017 in the United States…These figures have prompted the federal government to appropriate nearly $11 billion in fiscal years 2017 and 2018 to address the opioid epidemic.”
Cohen found that states with the lowest federal opioid funding, relative to their share of reported opioid-involved overdose deaths, missed out on anywhere from $137-413 million each due to underreporting of deaths.
“There is a substantial mismatch between states’ shares of federal opioid funding and their shares of opioid-related overdose deaths,” Cohen concluded in the 2019 study Comparison of State Share of Federal Opioid Funding to State Share of Opioid-Involved Overdose Deaths.
The issue’s true scope
More than 130 people die on a daily basis from opioids. With more than 2 million prescriptions for highly-addictive opioids, the epidemic remains at a critical juncture.
Pharmaceutical companies over the past year have been sued or lost cases for hundreds of millions and even over a billion dollars. Documented are the less-than-ethical marketing and distribution practices used to create the epidemic and the billions reaped in profits. Data revealed that Walgreens alone provided more than 1.5 billion opioid pills purchased by customers.
Pharmaceutical companies promised the drugs were not addictive, but are now spending much of their time in court defending the crisis they created. The long-running opioid crisis is far from over, but progress has been made in decreasing the number of opioid prescriptions by MDs and first looking for non-drug pain treatment alternatives.
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About the author
Mike Carberry, DC founded Advanced Medical Integration along with his wife, Coleen Carberry, PT. Dr. Carberry is a nationally renown speaker on the topics of business, ethics, chiropractic philosophy, and functional rehabilitation.