Cited by 1,859Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPoisoning and overdose treatments

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Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014

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Rudd, Rose A., Aleshire, Noah, Zibbell, Jon E., Gladden, R. Matthew·2016·MMWR Morbidity and Mortality Weekly Report

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Abstract

The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin). CDC analyzed recent multiple cause-of-death mortality data to examine current trends and characteristics of drug overdose deaths, including the types of opioids associated with drug overdose deaths. During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014. The rate of drug overdose deaths increased significantly for both sexes, persons aged 25-44 years and ≥55 years, non-Hispanic whites and non-Hispanic blacks, and in the Northeastern, Midwestern, and Southern regions of the United States. Rates of opioid overdose deaths also increased significantly, from 7.9 per 100,000 in 2013 to 9.0 per 100,000 in 2014, a 14% increase. Historically, CDC has programmatically characterized all opioid pain reliever deaths (natural and semisynthetic opioids, methadone, and other synthetic opioids) as "prescription" opioid overdoses (1). Between 2013 and 2014, the age-adjusted rate of death involving methadone remained unchanged; however, the age-adjusted rate of death involving natural and semisynthetic opioid pain relievers, heroin, and synthetic opioids, other than methadone (e.g., fentanyl) increased 9%, 26%, and 80%, respectively. The sharp increase in deaths involving synthetic opioids, other than methadone, in 2014 coincided with law enforcement reports of increased availability of illicitly manufactured fentanyl, a synthetic opioid; however, illicitly manufactured fentanyl cannot be distinguished from prescription fentanyl in death certificate data. These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl.

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Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008.
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ResultInfluential
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Background
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Background
Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana
Broz, D., Zibbell, J. E., Foote, C. E., Roseberry, J. C., Patel, M. R., Conrad, C., Chapman, E., Peters, P. J., Needle, R. H., McAlister, C., et al. (2017) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2017.12.003 · Cited by 67
Naloxone laws facilitate the establishment of overdose education and naloxone distribution programs in the United States
Lambdin, B. H., Davis, C. S., Wheeler, E., Tueller, S., & Kral, A. H. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.04.004 · Cited by 68
The value of harm reduction for injection drug use: A clinical and public health ethics analysis
Vearrier, L. E. (2018) · Disease-a-Month · doi:10.1016/j.disamonth.2018.12.002 · Cited by 76
Overdose and adverse drug event experiences among adult patients in the emergency department
Bohnert, A. S. B., Walton, M. A., Cunningham, R. M., Ilgen, M. A., Barry, K. L., Chermack, S. T., & Blow, F. C. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.11.030 · Cited by 68
“The rate of drug overdose death increased 137% between 2000 and 2014 (Rudd et al., 2016).”
How States Are Tackling the Opioid Crisis
Wickramatilake, S., Zur, J. B., Mulvaney‐Day, N., Campopiano, M., Selmi, E., & Harwood, H. J. (2017) · Public Health Reports · doi:10.1177/0033354916688206 · Cited by 69
“These agencies have undertaken numerous initiatives to address this issue as the toll of opioid overdoses has continued to rise in most states.(10) However, to our knowledge, the range and scope of interventions implemented at the state level have not been quantified or summarized.”
Background
State prescription drug monitoring programs and fatal drug overdoses.
Nam, Y. H., Shea, D. G., Shi, Y., & Moran, J. R. (2017) · PubMed · Cited by 66
Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!
Manchikanti, L., Hirsch, J. A., Pampati, V., & Boswell, M. V. (2016) · Current Pain and Headache Reports · doi:10.1007/s11916-016-0588-2 · Cited by 67
In-hospital illicit drug use, substance use disorders, and acceptance of residential treatment in a prospective pilot needs assessment of hospitalized adults with severe infections from injecting drugs.
Fanucchi, L. C., Lofwall, M., Nuzzo, P. A., & Walsh, S. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.06.011 · Cited by 64
A systematic review of opioid overdose interventions delivered within emergency departments
Chen, Y., Wang, Y., Nielsen, S., Kühn, L., & Lam, T. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108009 · Cited by 68
The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations
Mdege, N. D., Meader, N., Lloyd, C., Parrott, S., & McCambridge, J. (2017) · Public Health Research · doi:10.3310/phr05040 · Cited by 64
A Tool to Assess Risk of De Novo Opioid Abuse or Dependence
Ciesielski, T., Iyengar, R. N., Bothra, A., Tomala, D., Cislo, G., & Gage, B. F. (2016) · The American Journal of Medicine · doi:10.1016/j.amjmed.2016.02.014 · Cited by 65
Medications for Treatment of Opioid Use Disorder among Persons Living with HIV
Fanucchi, L. C., Springer, S. A., & Korthuis, P. T. (2019) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00436-7 · Cited by 65
Facing Addiction in the United States
Murthy, V. H. (2016) · JAMA · doi:10.1001/jama.2016.18215 · Cited by 64
Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers
Deyo, R. A., Hallvik, S. E., Hildebran, C., Marino, M., Springer, R. J., Irvine, J. M., O’Kane, N., Otterloo, J. V., Wright, D. A., Leichtling, G. J., et al. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.10.001 · Cited by 64
Pharmacokinetic Properties of Intranasal and Injectable Formulations of Naloxone for Community use: a Systematic Review
Ryan, S. A., & Dunne, R. (2018) · Pain Management · doi:10.2217/pmt-2017-0060 · Cited by 67
Potential of Cannabinoid Receptor Ligands as Treatment for Substance Use Disorders
Galaj, E., & Xi, Z. (2019) · CNS Drugs · doi:10.1007/s40263-019-00664-w · Cited by 69
“Substance use disorder (SUD) remains a serious problem worldwide and has an enormous economic burden in the USA and many other countries because of costs related to crimes, loss of productivity, and healthcare.”
Influential
Early life adversity promotes resilience to opioid addiction-related phenotypes in male rats and sex-specific transcriptional changes
Sanchez, E. O., Bavley, C. C., Deutschmann, A. U., Carpenter, R., Peterson, D. R., Karbalaei, R., Flowers, J., Rogers, C. M., Langrehr, M. G., Ardekani, C. S., et al. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2020173118 · Cited by 63
Emergency department visits by pediatric patients for poisoning by prescription opioids
Tadros, A., Layman, S. M., Davis, S. M., Bozeman, R., & Davidov, D. M. (2016) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2016.1194851 · Cited by 63
Clinical Management of Opioid Use Disorder
Dunlap, B., & Cifu, A. S. (2016) · JAMA · doi:10.1001/jama.2016.9795 · Cited by 63
Brief Opioid Overdose Knowledge (BOOK): A Questionnaire to Assess Overdose Knowledge in Individuals Who Use Illicit or Prescribed Opioids
Dunn, K. E., Barrett, F. S., Yepez-Laubach, C., Meyer, A. C., Hruska, B. J., Sigmon, S. C., Fingerhood, M., & Bigelow, G. E. (2016) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000235 · Cited by 63
Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks
Mauermann, E., Ruppen, W., & Bandschapp, O. (2017) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2017.11.003 · Cited by 67
Recidivism Is the Leading Cause of Death Among Intravenous Drug Users Who Underwent Cardiac Surgery for Infective Endocarditis
Tiako, M. J. N., Mori, M., Mahmood, S. U. B., Shioda, K., Mangi, A. A., Yun, J. J., & Geirsson, A. (2018) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2018.07.016 · Cited by 63
Street fentanyl use: Experiences, preferences, and concordance between self-reports and urine toxicology
Daniulaityte, R., Carlson, R. R., Juhascik, M. P., Strayer, K. E., & Sizemore, I. E. P. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.05.020 · Cited by 65
A substance use cost calculator for US employers with an emphasis on prescription pain medication misuse.
Goplerud, E., Hodge, S., & Benham, T. (2017) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0000000000001157 · Cited by 60
Use of a prescription opioid registry to examine opioid misuse and overdose in an integrated health system
Campbell, C. I., Bahorik, A. L., VanVeldhuisen, P., Weisner, C., Rubinstein, A. L., & Ray, G. T. (2018) · Preventive Medicine · doi:10.1016/j.ypmed.2018.01.019 · Cited by 63
“In 2016, nearly half of all U.S. opioid overdose deaths involve a prescription opioid (Rudd et al., 2016a).”
Background
Novel Synthetic Opioids: An Opioid Epidemic Within an Opioid Epidemic
Lucyk, S. N., & Nelson, L. S. (2016) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2016.08.445 · Cited by 62
Metabolism of novel opioid agonists U‐47700 and U‐49900 using human liver microsomes with confirmation in authentic urine specimens from drug users
Krotulski, A. J., Mohr, A. L. A., Papsun, D. M., & Logan, B. K. (2017) · Drug Testing and Analysis · doi:10.1002/dta.2228 · Cited by 63
Knowledge of the 911 Good Samaritan Law and 911-Calling Behavior of Overdose Witnesses
Jakubowski, A. U., Kunins, H. V., Huxley‐Reicher, Z., & Siegler, A. (2017) · Substance Abuse · doi:10.1080/08897077.2017.1387213 · Cited by 62
Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population‐Based Cohort Study
Li, Y., Delcher, C., Wei, Y. J., Reisfield, G. M., Brown, J. D., Tighe, P. J., & Winterstein, A. G. (2020) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.1807 · Cited by 62
“The opioid overdose epidemic has risen to unprecedented levels in the United States.1,2 Although the most recent overdose wave is marked by increasing involvement of synthetic opioids, prescription opioids continue to contribute to the risk of opioid-related morbidity and mortality.3,4 In light of increasing pressures…”
Influential
Epidemiologic Trends in Loperamide Abuse and Misuse
Vakkalanka, J. P., Charlton, N. P., & Holstege, C. P. (2016) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2016.08.444 · Cited by 62
Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia
de Vera, M. E., Volk, M. L., Ncube, Z., Blais, S., Robinson, M. K., Allen, N., Evans, R., Weissman, J., Baron, P. W., Kore, A., et al. (2018) · American Journal of Transplantation · doi:10.1111/ajt.15031 · Cited by 61

Authors: Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M.
Affiliations: National Center for Injury Prevention and Control (US)
ORCID: Rudd, Rose A.
Zibbell, Jon E.
Venue: MMWR Morbidity and Mortality Weekly Report
Publisher: Centers for Disease Control MMWR Office
Published: 2016-01-01
Volume: 64
Issue: 50-51
Pages: 1378-1382
ISSN: 0149-2195 (ISSN-L)
1545-861X
DOI: 10.15585/mmwr.mm6450a3
OpenAlex: W2292748019
Cited by: 1,859
References: 10
Citations by year: 2026: 16 · 2025: 35 · 2024: 42 · 2023: 79 · 2022: 118 · 2021: 144 · 2020: 242 · 2019: 271 · 2018: 332 · 2017: 406 · 2016: 169
FWCI: 321.02
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: public-domain
Locations: MMWR Morbidity and Mortality Weekly Report (publishedVersion, public-domain)
PubMed (publishedVersion)
Funders: Centers for Disease Control and Prevention
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
Keywords: drug overdose deaths, opioid overdose deaths, opioid epidemic, heroin, illicitly manufactured fentanyl, synthetic opioids, methadone, mortality trends, age-adjusted death rates, opioid use disorder, opioid supply
MeSH terms: Adolescent, Adult, Aged, Analgesics, Opioid, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, United States, Young Adult, Drug Overdose

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Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014

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