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America’s drug abuse crisis has reached epic proportions, a recent report from the Centers for Disease Control and Prevention confirms. Drug-related deaths in 2016 alone spiked by 22 percent.

Beyond quantifying the problem, this report also breaks down the data by drug and by state. It’s one of the first attempts to do so.  And it reveals a complex relationship between the abuse of prescription opioids and the abuse of illicit opioids such as heroin.  Better understanding that relationship may aid policymakers in addressing the growing epidemic.

What the CDC Data Reveals

The CDC has shown that deaths from prescription opioids alone are leveling off. Meanwhile, deaths involving heroin or the synthetic opioid fentanyl have skyrocketed.  Heroin-related deaths have increased by 533% since 2002, and deaths from the illicit use of fentanyl have increased by a jaw-dropping 540% in just the last three years.

Both drugs now have eclipsed prescription opioids as a cause of overdose death in America.

The report also shows, however, that deaths from a combination of prescription opioids and illicit opioids are rising.

How Policymakers Address Opioid Abuse

In recent years, policymakers have attempted to address the opioid epidemic at the state level by focusing on abuse and diversion of prescription opioids.  That includes regulating pain clinics and implementing prescription drug monitoring programs – sometimes mandating their use.  Several states have introduced prescribing restrictions; Arizona, Connecticut, Delaware, Massachusetts, New Jersey and Ohio now limit an initial opioid prescription to five-to-seven days’ worth of medication.  Earlier this year, U.S. Senators John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.) introduced similar legislation on the federal level.

Patients, health care providers and policymakers are still gauging the success of these efforts.  Some may point to the leveling off of deaths related to prescription opioids as a sign of success.  Others may interpret the spike in heroin and fentanyl deaths as evidence that policies impeding opioid prescribing have inadvertently made illegal alternatives the more accessible option.  Meanwhile, patients report that these policies have made access more difficult for those in legitimate need of pain treatment.

Why Clear Data Matters

Distinguishing between prescription and illicit opioids’ role in the epidemic is important for effective policy. That fact became evident in July, when speculation began on Capitol Hill that Obamacare’s Medicaid expansion had fueled the opioid epidemic.  The theory stemmed from a Department of Health and Human Services analysis, which found that states that expanded Medicaid through the Affordable Care Act saw a greater increase in opioid-related deaths than other states did.  As reported by the Washington Examiner, Senator Ron Johnson (R-Wis.) interpreted this data to mean that dishonest people were obtaining prescription opioid pain pills through Medicaid, then selling them on the black market.

Critics of Senator Johnson’s theory point out that overdose deaths were higher in those states even before Medicaid expansion.  Worth noting, the analysis grouped heroin and fentanyl together with prescription opioids, making it difficult to discern the driver behind the rising death toll.

The debate serves as a reminder that how data on opioid abuse is grouped and analyzed can bring researchers and policymakers to starkly different conclusions.  As policymakers continue their work, distinguishing one type of abuse from another could be critical – for patients, for policy and for the communities that drastically need solutions.

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