Epidemiology

Opioid use disorder and overdose is a growing concern worldwide.[1]

In the UK, a total of 2,263 drug poisoning deaths registered in 2020 involved opiates; this was 4.8% higher than in 2019 (2160 deaths) and 48.2% higher than in 2010 (1527 deaths). Opiates were involved in just under half (49.6%) of drug poisonings registered in 2020, increasing to 64.5% once deaths that had no drug type recorded are excluded.[2]

In 2011, there were more than 5 million drug-related emergency department visits in the US; about one half of these (2.5 million visits) were attributed to drug misuse.[3] In the US, between 1991 and 2019, almost half a million people died from an overdose involving an opioid.[4] Data from the Centers for Disease Control and Prevention's National Center for Health Statistics indicate that reported overdose deaths in the US increased from 96,118 in the 12-month period ending February 2021 to 105,258 in the 12 months ending February 2023. Of these deaths, 79,644 involved opioids in the 12 months ending February 2023, rising from 72,081 in the 12-month period ending February 2021.[5]​ The sharp increase in prescription opioid overdoses since the late 1990s may be due in part to more aggressive pain management strategies.[6]

During 2016, the rate of synthetic opioid overdose deaths (other than methadone) exceeded those of heroin overdose deaths for the first time in the US (6.2 per 100,000 population vs. 4.9 per 100,000 population, respectively).[7] Enhanced surveillance of opioid overdose deaths in 10 US states (State Unintentional Drug Overdose Reporting System) found that in 7 of those states, more than half of all opioid overdose deaths tested positive for fentanyl or fentanyl analogues (e.g., 3-methylfentanyl, carfentanil) for the period July 2016 to June 2017.[8] Data from public health and law enforcement agencies indicate widespread adulteration of cocaine with fentanyl and its analogues.[8] Illicitly produced opioids containing the veterinary drug xylazine have also been associated with a number of overdose fatalities in the US.[9]

Recent abstinence, resulting in loss of tolerance (e.g., during incarceration), increases the risk of overdose. Because of this, drug overdose is the most common cause of death of former inmates after prison release; the risk of death in the 2 weeks after release is 12 times that of the general population.[10]

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