Overview The U S Opioid Epidemic Peter Lurie

Overview: The U. S. Opioid Epidemic Peter Lurie, MD, MPH Associate Commissioner Office of Public Health Strategy and Analysis

Prescription Drugs Most Commonly Abused in the U. S. , 2014 Source: SAMHSA National Survey on Drug Use and Health, 2014

Trends in Prescription Opioid Use, 2002 -14 Source: SAMHSA National Survey on Drug Use and Health, 2002 -2014

Trends in Heroin Use, 2002 -2014 Source: SAMHSA National Survey on Drug Use and Health, 2002 -2014

The Prescription Opioid-Heroin Connection • Nonmedical use of opioid pain relievers is a risk factor future heroin use • Very small percentage of nonmedical users of pain relievers initiate heroin use • Increased accessibility, affordability, and high potency of heroin are likely driving increased use and transitions from prescription opioids • Evidence linking recently enacted prevention policies regarding prescription opioids to a shift to heroin is limited and non-definitive Source: Compton, et al. , NEJM 2016

Past Year Opioid Use Disorders, 2003 -14 Source: SAMHSA, NSDUH 2003 -2014 PUF

Overdose Deaths Involving Opioids, 2000 -2014 Source: CDC, NVSS 2000 -2014

Risk Factors for Rx Opioid Overdose Death • Demographics − − Men 35 -54 year olds Whites American Indians/Alaska Natives Source: HHS, FDASIA 1122 report , 2013 • Socioeconomics and Geography − Medicaid − Rural • Clinical Characteristics − − − − Chronic pain Substance abuse Mental health Nonmedical use Multiple prescriptions Multiple prescribers High daily dosage

Relationship Between Opioid Prescribing and Drug Overdose Death Rates Source: Death rate, 2008, CDC/NVSS. Opioid pain reliever sales rate, 2010, DEA’s ARCOS