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    5 Comments for this article
    The stunning toll of opioid related death
    Stephan Fihn | University of Washington, Seattle
    There is a risk of becoming inured to the daily barrage of news about the opioid epidemic. This article provides a sobering perspective on the enormity of the toll on the U.S. population, especially younger adults, in terms of mortality and years of life lost. This is an epidemic as serious as any in this country during the past century.
    CONFLICT OF INTEREST: Deputy Editor, JAMA Network Open
    Contributing to an Opioid Crisis False Narrative
    Chad Kollas, MD | Orlando Health UFHealth Cancer Center
    A recent article by Seth et al. (AJPH, April 2018, Vol. 8, No. 4: 500-501) questioned the accuracy of the CDC’s method of calculating opioid overdose deaths, which resulted in a substantial overestimation of deaths from prescription opioids.
    The authors of this study do not mention the importance of distinguishing between deaths from prescription opioids and those from illegal drugs, such as heroin and illicit fentanyl, nor do they cite that as a study limitation. This detracts from the article’s credibility and calls into question the expertise of the editorial review staff.
    CONFLICT OF INTEREST: Member, AMA Opioid Task Force
    Roy Perlis, MD MSc | Massachusetts General Hospital
    It seems to me the entire limitations paragraph addresses the challenge in defining the outcome of interest, entirely consistent with the recent work of Seth et al. It is always possible to quibble with population estimates, but hard to argue with the authors' basic point. Moreover, while we the editors hold authors to a high standard in peer review, we do not require that they cite work not yet published.
    CONFLICT OF INTEREST: Associate Editor, JAMA Network Open
    Considering Roles of Prescribed and Illicit oOioids
    Tara Gomes, PhD | St. Michael's Hospital
    The article by Seth et al. (1) was unfortunately not published at time of this manuscript being submitted, which is why we did not specifically cite it in our discussion. However, despite this, we specifically describe the limitations of the CDC Wonder data in the discussion of the manuscript. Importantly, Seth et al. speak to the challenges of differentiating prescribed from illicit sources of opioids when using ICD-10 codes, and their overarching findings align with our approach to not attempt such a stratification in this analysis given these limitations. We agree with Dr. Kollas that undertaking such a stratification would have been interesting, had we had reliable data to do so.

    Finally, the intention of this manuscript was not to focus on the source of opioids, but to highlight the ongoing, and growing burden of opioid overdose on society. In our introduction, we speak to the limitations of previous work in this area which focused solely on prescription opioid overdose, and highlight that incorporating the growing role of illicit opioids into these estimates is a main impetus for this new research.


    Seth P, Rudd RA, Noonan RK, and Haegerich TM. Quantifying the Epidemic of Prescription Opioid Overdose Deaths. AJPH. 108(4); pp. 500–502.

    108(4)pp. 500–502
    108(4)pp. 500–502
    CONFLICT OF INTEREST: Lead Author, Grant Funding from Ontario Ministry of Health and Long-Term Care
    Lives Saved
    Sergio Stone |
    I have a rather cynical view of the "lives saved" claimed by many published research articles, like one and many others about diets, cholesterol levels, vitamins etc. What is the relative value for the individual and society of dying at 40 or at 80? Is it less painful, less of a burden to society, less expensive, less dementia and time in the ICU, less useful or productive? As I get to be 80, with associated infirmities, I wonder whether, if I would have died at 40 instead of 80 I would have been less happy, which is after all the pursuit of the Republic. I suspect that I will not care after my death, at whatever age.

    Original Investigation
    Substance Use and Addiction
    June 1, 2018

    The Burden of Opioid-Related Mortality in the United States

    Author Affiliations
    • 1Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
    • 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • 3Sunnybrook Research Institute, Toronto, Ontario, Canada
    JAMA Netw Open. 2018;1(2):e180217. doi:10.1001/jamanetworkopen.2018.0217
    Key Points español 中文 (chinese)

    Question  What has been the burden of opioid-related deaths in the United States over a recent 15-year period?

    Findings  In this serial cross-sectional study, we found that the percentage of all deaths attributable to opioids increased 292% (from 0.4% to 1.5%) between 2001 and 2016, resulting in approximately 1.68 million person-years of life lost in 2016 alone (5.2 per 1000 population). The burden was particularly high among adults aged 24 to 35 years; in 2016, 20% of deaths in this age group involved opioids.

    Meaning  Premature death from opioids imposes an enormous and growing public health burden across the United States.


    Importance  Opioid prescribing and overdose are leading public health problems in North America, yet the precise public health burden has not been quantified.

    Objective  To examine the burden of opioid-related mortality across the United States over time.

    Design, Setting, and Participants  This study used a serial cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes in the United States between January 1, 2001, and December 31, 2016.

    Main Outcomes and Measures  Opioid-related deaths, defined as those in which a prescription or illicit opioid contributed substantially to an individual’s cause of death as determined by death certificates. We compared the percentage of deaths attributable to opioids and the associated person-years of life lost by age group.

    Results  Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42 245 deaths (33.3 to 130.7 deaths per million population). By 2016, men accounted for 67.5% of all opioid-related deaths, and the median (interquartile range) age at death was 40 (30-52) years. The percentage of deaths attributable to opioids increased in a similar fashion. In 2001, 0.4% of deaths (1 in 255) were opioid related, rising to 1.5% of deaths (1 in 65) by 2016, an increase of 292%. This burden was highest among adults aged 24 to 35 years. In this age group, 20.0% of deaths were attributable to opioids in 2016. Among those aged 15 to 24 years, 12.4% of deaths were attributable to opioids in 2016. Overall, opioid-related deaths resulted in 1 681 359 years of life lost (5.2 per 1000 population) in the United States in 2016, most of which (1 125 711 years of life lost) were among men. Adults aged 25 to 34 years had 12.9 years of life lost per 1000 population, and those aged 35 to 44 years had 9.9 years of life lost per 1000 population.

    Conclusions and Relevance  Premature death from opioid-related causes imposes an enormous public health burden across the United States. The recent increase in deaths attributable to opioids among those aged 15 to 34 years highlights a need for targeted programs and policies that focus on improved addiction care and harm reduction measures in this high-risk population.