Despite Limited Prescriptions, Little Change In Deaths, Emergency Room Visits For Non-Fentanyl Opioid Overdoses

As the opioid epidemic grew through the 2000s, prescription opioids like Oxycodone and Hydrocodone were leading to thousands of overdoses, emergency room visits, and deaths.

In 2011, the Centers for Disease Control (CDC) declared the situation to be an “epidemic,” and the agency would release new voluntary prescribing guidelines in 2016 to limit the number of prescription opioids in circulation.

As a result, retail distribution of opioids would decline by almost half between 2012 and 2018 according to Drug Enforcement Agency (DEA) Automated Reports and Consolidated Ordering System (ARCOS) data.

While the prescription of opioids would decline substantially since 2012, the appearance of fentanyl—a synthetic opioid that can be 50-80 times more potent than heroin—would be associated with an even larger upswing in overdoses.

Most fentanyl is assumed to be illegally imported from other countries as it is rarely prescribed in the U.S. Data from Customs and Bureau Patrol (CBP) show a large growth in seizures across all drugs except marijuana beginning in 2015.

Yet despite the large drop in prescriptions, deaths associated with prescription opioids like Oxycodone have barely declined since 2016 based on CDC multiple cause of death data.

While the number of deaths didn’t decline substantially, it at least plateaued. Between 2016 and 2019, deaths related to other opioids went from 15,114 a year to 14,019 in 2020. Strangely enough, there would be a larger drop in deaths related to heroin over the same time.

Emergency room visits in 2021 for opioid overdoses not including heroin or fentanyl would be just slightly higher than where they were in 2011—going from 444,972 in 2011 to 484,735 in 2021.

While limiting prescriptions might not limit the abuse of street drugs, ostensibly overdoses related to prescribed medication should be affected.

Return of DAWN Data

New emergency room treatment data has not been available for over a decade as the program, the Drug Abuse Warning Network (DAWN) run by the Substance Abuse and Mental Health Services Administration (SAMHSA), stopped collecting data in 2011—the same year the CDC declared the epidemic.

This last year, 2021, is the first time a new dataset has been available. In the new DAWN report, all opioids besides heroin and fentanyl are grouped together as “other opioids.” DAWN data is based on a survey of a randomly sampled selection of hospitals.

More Emergency Room Visits Than Deaths

While the 2004-2011 DAWN data appears to generally follow the trends in CDC death data for opioids, the 2021 data diverges drastically.

While overdose deaths have gone up a lot in the last five years, particularly for fentanyl, they haven’t gone up in any kind of proportion to the number of reported emergency room visits. The ratio of deaths to emergency room visits for an overdose is now about 1/6th what it was in 2011 when DAWN data was last available. Now, the ratio is about the same for all opioid types—about .3 to .4 percent.

Ostensibly, the rate of emergency room visits for an overdose should be similar across opioid types.

Since 2021 CDC mortality data is not available, the following chart uses 2020 CDC data with 2021 DAWN data. Methodology of the DAWN survey may have changed substantially between 2011 and 2021.

AMA’s Push Against Prescription Limits

While the American Medical Association (AMA)—the largest industry group that represents physicians and other medical professionals—has worked to limit opioid prescriptions after the CDC’s announcements, they didn’t support the CDC’s recommendations as they would harm patients under pain management who need more access to opioid treatment.

In a 2021 report, the AMA highlighted the growing number of overdose deaths as an indicator that limiting opioid prescriptions wasn’t working, especially with the growing number of deaths during the COVID-19 pandemic.

The group has steadily lobbied against prescribing restrictions, such as changing hydrocodone from schedule III to schedule II, for the last few decades.

Instead, they regularly support alternatives such as training physicians to help treat opioid use disorder (OUD) and prescribing anti-overdose medications like naloxone.