New research: Over 500,000 people could die of opioid overdoses by 2032
A round-up of recent figures and trends about America's overdose crisis paints a grim picture.
There were an estimated 107,375 overdose deaths in the 12-month period ending in January 2022, according to the CDC’s latest death data. That’s slightly less than CDC’s estimate for the 12-month period ending in December 2021, which provisionally showed 107,622 overdose deaths. While these figures remain exceedingly and unacceptably high, the rate of increase appears to be slowing down somewhat.
I read the latest mortality numbers in the context of a recent paper published in The Proceedings of the National Academy of Sciences (PNAS) in which researchers created a “mega-model” that made a series of predictions about the future of America’s overdose crisis. Brace yourself, even the “optimistic” projections were incredibly grim.
Under the “optimistic” scenario, 543,000 people would die between 2020 and 2032, whereas a “pessimistic” scenario would see 842,000 deaths over this period. Averaging out these deaths over a 12-year span, the “optimistic” model amounts to 45,250 deaths per year and the pessimistic model clocks out at 70,166 deaths per year.
Again, the “optimistic” projection still means that overdose deaths could claim more than half a million more lives over the next ten years. Under those conditions, annual overdose deaths (at least from opioids like illicitly manufactured fentanyl) would have to start a steep drop before the year 2025. That doesn’t seem likely given the current trends.
One thing to note: The paper shows that restricting opioid prescriptions would have very little impact on future overdose projections due to the fact that the vast majority of deaths today involve illicit substances. Depending who you ask, further restricting prescription opioids could actually be driving mortality up even higher by pushing people to the contaminated street market. The paper also showed that distributing naloxone was one of the key variables that would have a big impact on reducing deaths and pushing the crisis into more optimistic territory. (I previously wrote about how states are not distributing nearly enough naloxone).
The “mega-model” does have several limitations and caveats. It does not account for deaths involving stimulants, and if stimulants and other drugs are increasingly contaminated with illicit fentanyl, it’s possible that we could be in for substantially larger and longer-lasting overdose mortality before the crisis peaks. The whole model basically hinges on the extent to which illicit fentanyl penetrates the drug supply.
And just for kicks, check out this Rube Goldberg looking statistical model:
Looking back at CDC mortality data over the last 28 years, 2018 was the single time total overdose deaths fell, and that was by a meager 4.1 percent. If you’ve been following my work over the years you’ll rightly guess that I’m not really an optimist on this subject. But I’m not really a pessimist either. It just seems like we’re trapped in a sort of stasis and there isn’t much action to speak of that would make a dent in this thing. There is wide agreement about what must be done to prevent a flood of overdose deaths and it’s just not being done.
Drastically expanding syringe service programs, creating nationwide access to low-barrier treatment, flooding the streets with naloxone (make it OTC!), building overdose prevention centers, prescribing pharma-grade heroin (and other full-agonist opioids) are just some of the proposals that could make an impact. Countries with universal health care systems and a robust harm reduction infrastructure are not seeing the same levels of overdose mortality as America.
Then, there’s the things that need to stop happening. Namely, criminalizing addiction and arresting people for their substance use, which astronomically increases the risk of fatal overdose deaths. There is something to be said about the fact that America has the highest prison population in the world and the highest overdose mortality among other wealthy, developed nations. Overdose death rates in the US are, on average, three and a half times higher than other high-income counties, mostly those in Western Europe, Australia, and Japan (see the link above for more international comparisons).
All of this really throws a whole wrench in the idea that more incarceration, more policing, and more arrests keeps people safe and healthy. Overdose mortality has exploded while police officers make over one million drug arrests each year.
Let’s not fall into goldfish brain trap. Just a few years ago, the press ran with the idea that cops are going soft on addiction now that young and white suburbanites are dying from overdoses. Chiefs of police came out with catchy phrases like “we cannot arrest our way out of this crisis” and the New York Times ran headlines like: “In Heroin Crisis, White Families Seek Gentler War on Drugs.”
That all sounds nice but nothing has majorly changed and that’s why overdose deaths keep rising and rising. And there is little reason to suspect these trends will change. That’s neither optimism nor pessimism. That’s just the way things are. At least for now.
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"Depending who you ask, further restricting prescription opioids could actually be driving mortality up even higher by pushing people to the contaminated street market."
The other side of the argument is that restricting prescription opioid prescribing decreases the overdose rate, which is not at all how the history of this has played out. Overdose rates climbed as more prescriptions were written up to 2012 (is that surprising?). Since then, we've reduced prescribing to 1992 levels while the overdose rate skyrocketed.
I really think anyone taking that side of the argument has such strong moral investments in prohibition that they can't be taken seriously. Can anyone give me a counterexample?