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May 2017

The Surge of Opioid Use, Addiction, and Overdoses: Responsibility and Response of the US Health Care System

Author Affiliations
  • 1Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
JAMA Psychiatry. 2017;74(5):441-442. doi:10.1001/jamapsychiatry.2017.0163

The crisis in opioid overdose deaths has reached epidemic proportions in the United States and currently (33 091 in 2015) exceeds all other drug-related deaths. The risk for overdose resides primarily among those harboring a medical diagnosis of an opioid use disorder. Prescription opioids remain a primary driver of opioid-related fatalities. It is incumbent on the medical community to prevent, diagnose, and facilitate treatment of this disease and its substantial health consequences.

From 1999 onwards, overdose deaths due to prescription opioids rose incrementally and consistently outpaced annual heroin death rates. Heroin overdose deaths remained relatively low from 1999 onwards and then escalated 3-fold from 2010 to 2015. These lamentable, premature, and preventable deaths persisted during 2014-2015, but surveys revealed a disproportionate rise in deaths attributable to fentanyl/analogs (72.2%) and heroin (20.6%) compared with prescription opioids (2.6%).1 In this issue of JAMA Psychiatry, Martins et al2 portray a detailed view of heroin use trends over time by excavating data from the 2001-2002 and 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions and National Epidemiologic Survey on Alcohol and Related Conditions–III. Although absolute values may be inexact because of different survey procedures in the 2 National Epidemiologic Survey on Alcohol and Related Conditions waves, or because homeless and incarcerated populations were not surveyed, the trends can assist in guiding targeted prevention and treatment services. The prevalence of heroin use increased 5-fold and use disorder tripled in the United States during the period of the 2 surveys. The rise was greater among white individuals, unmarried respondents, males, young users, those with lower educational achievement, and those living in poverty. Prior exposure to nonmedical prescription opioids increased among white heroin users, reinforcing concerns and other reports that prescription opioid misusers were transitioning to heroin use.