Coming wave of opioid overdoses

Over the past 21 years of opioid overdose deaths-from prescription drugs to heroin to synthetic and semisynthetic opioids such as fentanyl-geography has played a role in where opioid-involved overdose deaths have occurred, reports a new Northwestern Medicine study.

But the coming wave will not discriminate between rural and urban areas, the study findings suggest. Every type of county-from the most rural to the most urban-is predicted to see dramatic increases in deaths from opioid-involved overdoses, the study's author said.

The study examined geographic trends in opioid-involved overdose deaths between 1999 and 2020 to determine if geography played a role in the three waves and the theorized fourth wave of America's opioid crisis. The authors used data recorded in the Centers for Disease Control and Prevention's WONDER database for 3,147 counties and county equivalents categorized on a six-point urbanicity scale (most urban to most rural).

While some researchers have looked at an acceleration rate from one year to the next, the study authors said, to their knowledge, no one has examined acceleration rates of opioid-involved overdose death rates systematically by geography for every year.

The study authors examined toxicology reports and found people are using fentanyl (a synthetic opioid that is 50 to 100 times more potent than morphine) and carfentanil (a synthetic opioid approximately 100 times more potent than fentanyl) combined with methamphetamines and cocaine. The result is a powerful and lethal cocktail that can even evade help from overdose-reversing drugs like naloxone.

"The only path forward is to increase awareness to prevent opioid use disorders and to provide medication-assisted treatment that is culturally appropriate and non-stigmatizing in rural communities," the authors noted.

Ref:

Lori Post et. al,Geographic Trends in Opioid Overdoses in the U.S. From 1999 to 2020, JAMA Network Open, 28-Jul-2022, 10.1001/jamanetworkopen.2022.23631