Over the past 21 years, geography has played a role in opioid overdose deaths, reports a new Northwestern Medicine study.
for the first time there is a convergence and escalation of acceleration rates for each type of rural and urban province.”
Director of the Buehler Center for Health Policy and Economics, Northwestern University Feinberg School of Medicine
But the coming wave will not differentiate between rural and urban areas, the study results suggest. Every type of province — from the most rural to the most urban — is expected to see a dramatic increase in deaths from opioid overdoses. The reason opioid overdoses have reached historic highs is because of combining synthetic opioids with stimulants such as cocaine and methamphetamines, a deadly cocktail that is difficult to reverse during an overdose, the study authors said.
“I’m sounding the alarm because, for the first time there is a convergence and escalation of acceleration rates for each type of rural and urban province,” said corresponding author Lori Post, director of the Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine. “Not only is an opioid’s death rate at an all-time high, but the acceleration in that death rate signals explosive exponential growth that is even greater than an already historic high.
The research was published July 28 in JAMA Network Open.
The study examined geographic trends in opioid overdose deaths between 1999 and 2020 to determine whether geography played a role in the three waves and the theoretical fourth wave of America’s opioid crisis. The authors used data captured in the Centers for Disease Control and Prevention’s WONDER database for 3,147 counties and county equivalents, categorized on a six-point urbanity scale (most urban to most rural).
First Study to Accelerate Opioid-Related Deaths
To the best of the study’s authors’ knowledge, this is the first time anyone has examined the acceleration rates of opioid-related death rates. Post used methods she developed to assess where COVID-19 outbreaks are brewing and applied them to opioid abuse.
By the end of the available data from 2020, the number of overdose deaths in rural areas escalated faster than in urban areas, according to the study. A visualization of the data illustrates that between 2019 and 2020, the number of opioid overdose deaths converged as it escalated for the first time in six types of rural and urban counties, Post said.
“We have the highest escalation rate in America for the first time, and this fourth wave will be worse than ever before,” Post said. mean mass death.”
A deadly combination
The study authors examined toxicology reports and found that people use fentanyl (a synthetic opioid 50 to 100 times more potent than morphine) and carfentanil (a synthetic opioid approximately 100 times more potent than fentanyl) in combination with methamphetamines and cocaine. The result is a potent and deadly cocktail that can evade even the help of overdose-reversing drugs like naloxone.
“The stronger the drugs, the harder it is to revive someone,” said study co-author Alexander Lundberg, assistant professor of emergency medicine at Feinberg. “The use of polydrugs complicates an already dire situation.”
“It appears that those who died of opioid overdose played pharmacist and tried to manage their own dosage,” Post said. “This is a bigger problem because you have people abusing cocaine and methamphetamines along with an opioid, so you have to treat two things at once and the fentanyl is terribly volatile.”
What can be done?
“Nobody wants to be a drug addict,” Post said. “It doesn’t matter if you’re on Percocet because you broke your back while mining or if you’re a high school student who died because they got into grandma’s medicine cabinet. We need to immediately look at opioid addiction and overdose prevention.”
That could be in the form of methadone centers, which offer drug-assisted anti-addiction treatments, Post said, though they usually only open in urban areas. Rural areas don’t have drug-assisted treatment options, she said, adding that what works in big cities probably isn’t as helpful for rural areas.
“The only way forward is to raise awareness to prevent opioid use disorders and to provide drug treatment that is culturally appropriate and non-stigmatizing in rural communities,” Post said.
The study is titled, “Geographical Trends in Opioid Overdose in the U.S. from 1999 to 2020.” Other Northwestern co-authors include Maryann Mason and Irene Quan.
The study was funded by the United States Department of Agriculture (grant 2019-67023-29347), the National Center for Advancing Translational Sciences, part of the National Institutes of Health (grant UL1TR001422), and Northwestern University Clinical and Translational Sciences Institute (NUCATS).