Visits to U.S. hospital emergency rooms for suspected opioid overdoses have shot up 30% across the nation, health officials reported.
"We are currently seeing the highest drug overdose death rates ever recorded in the United States, driven by prescription opioids and illicit opioids, such as heroin and illicitly manufactured fentanyl," said Anne Schuchat, acting director of the Centers for Disease Control and Prevention.
All five regions of the U.S. saw significant increases, Schuchat told reporters during a March 6 briefing.
"The bottom line is, no area of the United States is exempt from this epidemic," Schuchat said, adding that the new data should be a "wake-up call" for the entire nation.
Of the more than 63,000 drug overdose deaths in the U.S. in 2016, more than 42,000 involved opioids. On average, 115 Americans died each day from an opioid overdose involving prescription or illicit opioids in 2016, Schuchat noted.
"We have been challenged to keep up with this fast-moving epidemic," she said.
According to data the CDC examined, out of the 91 million ER visits from July 2016-September 2017, there were 142,557 suspected opioid overdoses, Schuchat said.
The highest rate increases were in large central metropolitan areas with populations of 1 million or more.
While some areas of the U.S. were worse than others in experiencing opioid overdoses, the Midwest was hit the hardest — jumping 70%. That high rate was largely attributed to the 109% increase in ER opioid overdose visits in Wisconsin, Schuchat noted.
Opioid overdose visits at ERs rose by 66% in Illinois, 35% in Indiana, 28% in Ohio and 21% in Missouri, the CDC data revealed.
In the West, those ER visits climbed 40%, although the rate in Southwestern states grew by only half of that, at 20%.
Northeastern states saw an increase of 21% for ER visits related to opioid overdoses. But when CDC officials took a closer look at some of those states, they found that the visits jumped by 105% in Delaware, 81% in Pennsylvania and 34% in Maine.
Schuchat said the large increase in Delaware and Pennsylvania — which reflected about a doubling of opioid overdose ER visits — was particularly concerning. She said the CDC does not have enough data to know if there were changes in the local drug supply that drove the increase or if the agents being used in that area were more toxic than others.
In the Southeast, North Carolina reported an increase of 31%.
Some good news
However, in a report that was "quite, quite concerning," Schuchat said the CDC found some "good news," with the data showing declines in ER opioid overdose visits in Massachusetts, New Hampshire, Rhode Island and Kentucky — states where the epidemic has been ongoing for many years and has hit populations particularly hard.
Kentucky had the largest decrease, with a decline of 15% that Schuchat said was statistically significant.
The other three states where the rates of ER opioid overdose visits dropped, however, did not have decreases above 10%, so those reductions were not considered significant.
Schuchat said the CDC was cautiously optimistic about those declines, although she emphasized that there was insufficient data to evaluate whether the declines in ER opioid overdose visits were due to certain interventions or because those states have been addressing the crisis longer than others.
ERs provide opportunity for intervention
Schuchat said that up until now, the CDC has been mostly reporting on deaths from drug overdoses.
"But for every fatal case, there are many more nonfatal cases, each one with its own emotional and economic toll," she said.
People who have had at least one overdose are more likely to have another, according to Schuchat.
But the ER provides an opportunity to take steps to prevent a repeat overdose by providing patients with the opioid-reversal agent naloxone and training family members on how to use it, the CDC chief said.
ERs can also link people to follow-up care and can either start those patients on medication-assisted treatment, or MATs, or direct them to where in the community they may find help for substance use disorders and therapy for mental health issues, Schuchat added.
Last week, U.S. Department of Health and Human Services Secretary Alex Azar urged more states to seek government waivers that would allow Medicaid programs to cover MATs and other care at substance use disorder treatment facilities with more than 16 beds.
Azar said his agency has approved five waivers since November 2017, when it created a more streamlined approach, but he added, "I want more."
U.S. lawmakers and prosecutors last week unveiled new actions aimed at holding drug manufacturers and distributors accountable for their role in fueling the opioid epidemic.
As part of other government efforts to address the opioid crisis, U.S. Food and Drug Administration Commissioner Scott Gottlieb, who has made tackling the epidemic a top priority for 2018, plans to convene a public meeting April 17 on patient-focused drug development for opioid use disorder.
