Opiates are chemical compounds that are extracted or refined from natural plant matter poppy sap and fibers. Examples of opiates:. Opioids are chemical compounds that generally are not derived from natural plant matter. Most opioids are "made in the lab" or "synthesized. Though a few opioid molecules — hydrocodone e. The phrase "synthetic opioid" is considered redundant; nearly all opioids are synthesized. The pharmaceutical industry has created more than different opioid molecules.
Some are widely used medically, some are not. Examples of well-known opioids used medically in the U. Both groups of drugs are "narcotics. Purdue Pharma and other companies promoted their opioid products heavily. They lobbied lawmakers, sponsored continuing medical-education courses, funded professional and patient organizations and sent representatives to visit individual doctors.
During all of these activities, they emphasized the safety, efficacy and low potential for addiction of prescription opioids. In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. But doctors and patients were unaware of that at the time. The structure of the health-care system in the United States also contributed to the overprescription of opioids.
Because many doctors are in private practice, they can benefit financially by increasing the volume of patients that they see, as well as by ensuring patient satisfaction, which can incentivize the overprescription of pain medication. Prescription opioids are also cheap in the short term. Canada shares some of these vulnerabilities. For example, like their counterparts in the United States, Canadian doctors are entrepreneurs who are paid by the unit. This might help to explain why Canada is also experiencing an opioid crisis, with 10, opioid-related deaths between January and September Most European countries, however, have so far been insulated from the epidemic.
Doctors in Europe are not motivated financially to make prescriptions. And whereas the US medical community eagerly embraced the small studies that suggested that people had a low risk of developing an addiction to opioids, European pain specialists viewed that work more sceptically, says Jan Van Zundert, an anaesthesiologist at East Limburg Hospital in Genk, Belgium. Large-scale surveys show that there is a similar prevalence of pain in France and Italy as there is in the United States 3.
But according to data from the United Nations, US doctors write five and a half times more prescriptions for opioids than do their counterparts in France, and eight times more than do physicians in Italy. Humphreys says that this might be because people in the United States expect to receive a prescription when they go to the doctor with a health concern. Meanwhile, direct advertising of pharmaceuticals to consumers permitted only in the United States and New Zealand encourages them to ask doctors for specific drugs.
Racial attitudes and socio-economic trends also helped the opioid epidemic to gain a foothold in the United States. Purdue Pharma focused the initial marketing of OxyContin on suburban and rural white communities. That strategy took advantage of the prevailing image of a drug addict as an African-American or Hispanic person who lived in the inner city to head off potential concerns about addiction, says Helena Hansen, an anthropologist and psychiatrist at NYU Langone Health in New York City.
With the introduction of drugs such as OxyContin came a surge in opioid prescriptions for pain relief. But Hansen points out that, in this respect, the natural history of the opioid crisis might not be as unique as commonly thought. The opioid epidemic has had three phases: the first was dominated by prescription opioids, the second by heroin, and the third by cheaper — but more potent — synthetic opioids such as fentanyl.
All of these forms of opioid remain relevant to the current crisis. And there are plenty of people who start on one and die on another. During the first phase, from the mids to about , there was a steady increase in deaths from prescription-opioid overdoses.
Patient-privacy laws and a lack of coordination between US states meant that users could amass numerous opioid prescriptions and then sell their excess pills. This was a departure from the supply chain of previous epidemics, says Jonathan Caulkins, a drug-policy researcher at Carnegie Mellon University in Pittsburgh, Pennsylvania. Rather than the supply being dominated by organized drug traffickers, users were responsible for the drugs entering the black market.
This enabled the epidemic to spread quickly, he says. This did discourage abuse. But at the same time, for unclear reasons, the supply of heroin increased, and its price dropped sharply.
Some opioid users switched to heroin because it was easier to obtain than prescription opioids. Switching also enabled those who still had access to OxyContin to sell more of the higher-value prescription opioids on the black market. And data from the US National Center for Health Statistics show that between and , deaths from heroin overdoses increased almost fivefold in the United States.
Around , the contours of the epidemic shifted for a third time. Heroin dealers who wanted to increase profits began to mix their products with fillers and fentanyl. Because fentanyl is more potent than heroin, it is also more deadly.
Given the surge in availability of IMF starting in , the CDC Injury Center began analyzing synthetic opioids other than methadone separately from other prescription opioids for mortality data. This analysis provides a more detailed understanding of the increase in different categories of opioid deaths. Using this approach, we learned that more than 14, deaths involving this more specific category of prescription opioids occurred in , which is equivalent to about 38 deaths per day.
Drug overdose deaths can be hard to categorize. Regardless of the method used to calculate the total numbers, prescription opioids continue to be involved in a significant proportion of drug overdose deaths, and the numbers are likely an underestimate of the true burden, given the large proportion of overdose deaths where the type of drug is not listed on the death certificate.
CDC uses a variety of data tools and resources to understand the scope of the drug overdose epidemic, both for overdose deaths and nonfatal overdoses treated in emergency departments or by emergency medical services. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate.
Opioid Data Analysis and Resources. Minus Related Pages. On This Page. Overdose Waves. Trends in Death Rates. Data Analysis. Data Sources. The platform was developed through collaboration among CDC and other federal agencies, state and local health departments, and other public health partners.
It provides access to a wide array of public health information, including births, deaths, diagnoses, vaccinations, environmental exposures, and population estimates. These data collections are available as online databases, which provide public access to ad hoc queries, summary statistics, maps, charts, and data extracts.
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