The number of opioid-related deaths quadrupled between 1999 and 2015, from around 8,000 to more than 33,000.
The Columbia University study – the largest ever on opioid deaths – analyzed the prescriptions of 13,000 victims through Medicaid to find almost two-thirds of them had been diagnosed with chronic pain, and a significant proportion of them also suffered depression and anxiety.
Around a third of victims had been diagnosed with their pain condition within 12 months of their death.
And yet, fewer than one in 20 of the victims had been diagnosed with substance abuse disorder.
This graph from the study shows the rate of opioids and benzodiazepines prescribed in the last 30 days of a victim’s life, depending on whether they had chronic pain or not
Mark Olfson, MD, professor of psychiatry at the university’s medical center and lead investigator of the study, said the data provide a clear picture of the American healthcare system: big on pills, vague on alternative methods.
‘The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems,’ he said.
‘Such a strategy might increase early clinical intervention in patients who are at high risk for fatal opioid overdose.’
He added: ‘Because clinical diagnoses generally indicate treatment, this service pattern suggests that dropout from drug treatment is common before fatal opioid overdose.
‘Improving treatment retention with contingency management or other effective behavioral interventions might help lower the risk of fatal overdose in these patients.’
In the year before death, more than half had filled prescriptions for opioids or benzodiazepines, and many had filled prescriptions for both types of medications.
‘This medication combination is known to increase the risk of respiratory depression, which is the unusually slow and shallow breathing that is the primary cause of death in most fatal opioid overdoses,’ Dr Olfson said.
He cautions that this study could be an underestimation: these data were compiled between 2001 and 2007 – before the epidemic was declared in 2013. The scale of opioid abuse deaths reached its peak in 2016, when more than 62,000 people died of an overdose from painkillers.
‘In the years since, there has been an increase in the proportion of US overdose deaths involving benzodiazepines and opioids,’ Dr Olfson added.