Which Drug Causes the Most Deaths Each Year?
Drugs containing oxycodone, hydrocodone and methadone are the most common drugs involved in prescription opioid overdose deaths.
Consider these facts:
- In 2015, about 91 Americans died per day from an opioid overdose, with an annual mortality count of more than 33,000 deaths.
- Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
- Prescription drugs deaths actually outnumbered heroin deaths.
- Since 1999, the number of prescription opioids sold in the U.S. nearly quadrupled. During the same timeframe, overdose deaths involving prescription opioids, as well as heroin, also quadrupled.
- As a point of comparison, 12,982 people lost their lives to heroin overdoses in 2015.1,2
- In 2015, an estimated 276,000 adolescents aged 12 to 17, 829,000 young adults aged 18 to 25, and 2.7 million adults 26 and older misused prescription pain relievers of any kind in the past month.
- Oxycodone caused 5,417 deaths versus 3,274 deaths from hydrocodone in 2014. An analysis broken down by specific prescription opioids has not yet been published for 2015 drug overdoses.3,4,5
What Is Oxycodone?
Looking for a non-addictive alternative to treating pain, Purdue Pharma hailed OxyContin as the latest and greatest “miracle pill.”
Heroin addicts and other drug users quickly discovered that crushing the tablets gave them a much larger dose of the opioid with a more powerful high than traditional fast-acting narcotic medications. In 2010, in an attempt to decrease epidemic levels of abuse, Purdue reformulated OxyContin into an abuse-deterrent pill which contains a polymer, supposedly making it harder to crush, snort or inject. About 25% of users claimed they figured out how to defeat the deterrent. Addiction experts correlate the rise of addictive prescription drugs such as OxyContin to the recent heroin epidemic and increase in heroin-related overdoses.
- A retrospective analysis of people discharged from emergency departments for pain-related issues showed oxycodone was the most widely prescribed pain reliever with 52.3% of total dispensed drugs. Of those, 97.9% were for the 5-mg pill.6,7,8
What Is Hydrocodone?
Hydrocodone is in the same drug family as morphine and oxycodone. The drug is a semi-synthetic opioid synthesized from codeine.
- Several variants available in the U.S. also contain acetaminophen.
- Hydrocodone has a high potential for physical dependency and addiction if it is abused.
- The number of prescriptions for opioids (like hydrocodone and oxycodone products) escalated from around 76 million in 1991 to nearly 207 million in 2013, with the U.S. responsible for nearly 100% of the world’s consumption of hydrocodone.
- The recent introduction of extended-release formulations of hydrocodone has fueled controversy about the general safety and need for opioid medications in light of their potential for misuse, abuse, diversion and addiction.
- From 2007 to 2009, data from RADARS poison control centers showed hydrocodone was involved in more intentional exposures by adolescents than any other prescription opioid.9
What Is Methadone?
Methadone is used for moderate to severe pain and for opioid addiction treatment.
- Researchers believe a variety of potentially fatal cardiovascular side effects associated with this drug are responsible for methadone deaths.
- Studies have shown cardiovascular disease is a significant factor in morbidity and mortality for recovering addicts undergoing methadone maintenance treatment.10
- In 2006, the U.S. Food and Drug Administration issued warnings about respiratory depression and cardiac arrhythmias with the possibility of unintentional overdoses, drug interactions and cardiac toxicity.
- Methadone prescriptions account for 0.85% in the commercially insured population and 1.1% in the Medicaid population.
- Despite the relatively low number of prescriptions written, methadone-related deaths accounted for 22.9% of all opioid-related deaths with 3,400 people losing their lives to the drug in 2014.11
An Emerging Killer: Fentanyl
Initially used as a general anesthetic during surgery, fentanyl is a powerful synthetic opioid analgesic 50 to 100 times stronger than morphine and 50 times more potent than heroin. An amount the size of three grains of sugar is lethal to an adult.
While the majority of fentanyl overdoses in the U.S. are attributed to illegal stockpiles produced by Mexican cartels, some are linked to legal prescriptions. It is hard to obtain accurate numbers on how many fentanyl deaths are caused by prescription fentanyl. Most medical examiners and coroners are unable to tell the difference between pharmaceutical and black-market versions of the drug.12,13
- Of 351 people who suffered fatal opioid overdoses in New Hampshire, fentanyl was a factor in 253 of those deaths.11
- Most experts blame fentanyl for the 72.2% increase in synthetic opioid deaths from 2014 to 2015. Furthermore, they point the finger at illegally manufactured versions for causing triple the number of synthetic opioid overdoses in just two years — from 3,105 in 2013 to 9,580 in 2015.
- It is common for people using and overdosing on fentanyl to have demographic similarities with heroin users.
- The drivers of fentanyl use are more complex because the drug is often sold in counterfeit pills that are designed to look like common prescription opioids (e.g. hydrocodone) or benzodiazepines (e.g. Xanax).
- Fentanyl is also added as an adulterant to heroin or other drugs, which is a contributing factor in many deaths.
- A variety of fentanyl analogues and synthetic opioids are included in the overdose statistics, such as carfentanil (about 10,000 times more potent than morphine), acetyl-fentanyl (about 15 times more potent than morphine), butyrfentanyl (at least 30 times more potent than morphine), U-47700 (about 12 times more potent than morphine), and MT-45 (the same potency as morphine).14
Contributing Factors in Prescription Opioid Overdoses
A huge push has been made to warn the public of the dangers of prescription opioids. What gets lost in the message: the issue of polysubstance abuse.
For example, if the coroner found oxycodone, heroin and benzodiazepine in a person’s system, each drug would be listed separately under their respective overdose categories.
Nearly 30% of fatal opioid overdoses also involve benzodiazepines, which are often used concurrently with opioids. It is possible the increase in opioid-related deaths is in part related to the surge in concurrent benzodiazepine/opioid use. The number of people using both classes of drugs increased from 9% in 2001 to 17% in 2013.15
A recent study by the Veterans Health Administration (VHA) found nearly 30% of VHA-treated individuals who were prescribed opioids also received a concurrent prescription for benzodiazepines. Furthermore, this study found co-prescribing was associated with a significantly higher risk of death than opioids used alone. The combination of the two drugs is dangerous because benzodiazepines increase the respiratory depressant effect of opioids. Compared with opioid users who do not use benzodiazepines, concurrent use of both drugs is associated with an increased risk of emergency room visits and inpatient admissions for opioid overdose. Assuming this association is causal, elimination of concurrent benzodiazepine/opioid use could reduce the risk of emergency room visits related to opioid use and inpatient admissions for opioid overdose by an estimated 15%.15