How big a problem is prescription drug overdose?
We see the country’s surging number of deaths involving prescription drugs as an epidemic. In 2008, the most recent year for which we have national figures, more than 36,000 people died of drug overdoses in the U.S., and more than 20,000 of these overdose deaths were from prescription drugs. We have seen this number steadily increase over the last decade.
A specific class of prescription drugs known as prescription painkillers—also called opioid pain relievers and including drugs such as OxyContin (oxycodone), Vicodin (hydrocodone), and methadone—is driving this increase. In 2008, nearly 15,000 people died from overdoses involving these drugs. This is more than three times the number of people who died from these drugs in 1999.
Why has the rate of prescription drug overdose risen so sharply?
In the last decade, sales of these drugs have increased 300%. This increase has been paralleled by increases in abuse and overdose of these drugs. These trends are all connected. Last year, nearly one in 20 people in the U.S. age 12 or over reported using prescription painkillers nonmedically—without a prescription, or for the “high” they cause. In 2009, there were nearly half a million emergency department visits due to the misuse or abuse of these drugs. It is this pattern—increased sales and increased abuse—that has lead to the current epidemic.
Are there any groups that are most at-risk for prescription painkiller overdose?
While we have seen prescription painkiller overdoses impacting families and communities across the country, certain groups are especially vulnerable. As is the case with the abuse of other drugs, men are more likely to overdose on prescription painkillers than women. Middle-aged adults, particularly those ages 34-55, have the highest rates of overdose. We also know that whites and American Indians and Alaska Natives, as well as people who have substance abuse or other mental health problems, have higher rates of overdose compared to other groups.
Are all states equally impacted by the drug overdose epidemic?
No. Rates of drug overdose vary significantly between states. For instance, the state with the highest rate of overdose, New Mexico, has a rate nearly five-times higher than the state with the lowest rate, Nebraska. We generally see the highest rates of overdose deaths in the Southwest and in the Appalachian states like Kentucky and West Virginia. We can’t say exactly why there is such variation among states, but we do know people in rural counties are about two times more likely to overdose on prescription painkillers than people in big cities. And our analysis shows that some of the states that saw the largest increases in overdose deaths between 1999 and 2008 were states that had some of the highest poverty levels among non-Hispanic whites. In addition, differences in prescribing habits among states may also be contributing to state variation.
What policies can help reduce deaths from prescription drug overdose?
Efforts to reduce prescription drug overdose must strike a balance between preventing deaths and safeguarding legitimate access to pain medications. Everyone has a role to play in reducing the number of overdoses in the United States including the federal government, state and local governments, health care providers, health insurers, communities, and individuals. CDC believes that if we can improve how these powerful drugs are prescribed, we can reduce the number of people who are abusing and overdosing on prescription painkillers, while ensuring people who have legitimate pain are treated safely and effectively.
Two promising policies are prescription drug monitoring programs and patient review and restriction programs. Prescription drug monitoring programs—which track controlled substance medications in a state—are a tool used by healthcare providers to identify patients who may be at risk for an overdose. Patient review and restriction programs require patients who are inappropriately using controlled substances to receive them only from one physician and one pharmacy. Both of these programs can improve patient care while also helping to reduce abuse and overdose.
What is CDC doing about prescription drug overdose?
CDC is working with many federal and state partners, as well as stakeholder organizations, to address this epidemic. CDC is specifically focusing on three key areas: enhancing public health surveillance so that we can better understand the epidemic; strengthening policy by identifying, evaluating, and disseminating promising policies designed to reduce overdose; and improving the clinical practice of health care providers.
What steps can people take to prevent prescription drug overdose?
The most important thing is to take prescription painkillers only as directed by a health care provider. Individuals should not share or sell them to others. More than half of the people in the U.S. who use a prescription pain reliever nonmedically obtained it for free from a friend or relative. People should also make sure to store their prescriptions securely and to dispose of unused medications properly. Finally, people who are struggling with substance abuse problems should get help, for instance by contacting 1-800-662-HELP.
How and where can people learn more?
For more information, people can visit CDC’s unintentional poisoning web site.
Dr. Jones is one of two lead subject matter experts on prescription drug overdose in the Injury Center’s Division of Unintentional Injury Prevention. He is a pharmacist and public health practitioner by training and primarily focuses his prescription drug overdose work on strategic policy development and implementation, engaging national and state partners, and conducting research to improve policy and clinical practice.