Article: Increases in Heroin Overdose Deaths – 28 States

Centers for Disease Control and Prevention, MMWR, Vol. 63, No. 39. October 3, 2014.  Increases in Heroin Overdose Deaths – 28 States, 2010 to 2012.

The CDC collected from 28 state health departments (representing 56% of the U.S. population) the mortality data for the period 2008-12.  From 2010 to 2012, the death rate from heroin overdose for 28 states increased from 1.0 to 2.1 per 100,000, whereas the death rate from opioid pain relievers (OPR) overdose declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012.  While OPR overdose mortality decreased  significantly among males, persons aged <45 years, persons in the South, and non-Hispanic Whites, heroin overdose rates increased significantly for both men and women, all age groups, all geographic regions, and all racial/ethnic groups other than American Indians/Alaska Natives.  These data highlight the importance of efforts to prevent expansion of OPR users, who might use heroin when it is available and less expensive than OPR.  Even though death rates declined overall, they remained twice as high as heroin overdose deaths.  In addition, mortality from any type of drug rose slightly.

Limitations of the present report include: death certificates may fail to specify the drug involved; death certificate data might misclassify heroin deaths as OPR if the heroin metabolite morphine is listed instead of heroin itself; several states reported only provisional data; certain racial/ethnic populations may be misclassified, unclassified, or underreported.

Taken together, these epidemiologic findings represent a growing problem with heroin overdoses superimposed on a continuing problem with OPR overdoses.   Clinical interventions that might address the abuse of both OPR and heroin include: screening for substance abuse, urine testing for drug use, and referral to substance abuse treatment.  Other policies that can lower the risk of fatal opioid overdoses include the use of prescription drug monitoring programs, state policies that increase access to naloxone (a drug that can reverse potentially fatal respiratory depression following an opioid overdose), or “Good Samaritan” laws that eliminate or reduce penalties when someone reports and overdose.  These are all potentially useful strategies, together with timely surveillance of drug-specific fatal and non-fatal overdose data in order to target prevention efforts.


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