By Pat Anson,
Researchers with the Centers for Disease Control and Prevention have acknowledged that the agency’s methods for tracking overdose deaths are inaccurate and have significantly overestimated the number of Americans that have died due to prescription opioids.
In an editorial appearing in the American Journal of Public Health, four researchers in the CDC’s Division of Unintentional Injury Prevention say many overdoses involving illicit fentanyl and other synthetic black market opioids have been erroneously counted as prescription drug deaths.
“Availability of illicitly manufactured synthetic opioids (e.g., fentanyl) that traditionally were prescription medications has increased. This has blurred the lines between prescription and illicit opioid-involved deaths,” they wrote. “Traditionally, the Centers for Disease Control and Prevention (CDC) and others have included synthetic opioid deaths in estimates of ‘prescription’ opioid deaths. However, with IMF (illicitly manufactured fentanyl) likely being involved more recently, estimating prescription opioid–involved deaths with the inclusion of synthetic opioid–involved deaths could significantly inflate estimates.”
How inflated were the overdose numbers? Using the agency’s “traditional definition” for prescription opioids, the CDC estimated that 32,445 Americans died from overdoses of pain medication in 2016.
Under a new “conservative definition” – one that excludes the “high proportion of deaths” involving synthetic opioids like fentanyl – the death toll from prescription opioids is cut nearly in half to 17,087 overdoses.
The researchers note that even that estimate is likely wrong for a variety of reasons:
- The number of deaths involving diverted prescriptions or counterfeit drugs is unknown
- Toxicology tests cannot distinguish between pharmaceutical fentanyl and illicit fentanyl
- Drugs are not identified on death certificates in 20% of overdose deaths
- Multiple drugs are involved in almost half of drug overdose deaths
The editorial by CDC researchers Puja Seth, Rose Rudd, Rita Noonan and Tamara Haegerich carries a disclaimer that their views “do not necessarily represent the official position” of the CDC. But given the agency’s past reluctance to let employees speak to the media without prior approval, it’s highly unlikely the editorial was not cleared beforehand.
How the new “conservative definition” will be used by the CDC is unclear. One suggestion by the authors is to amend the agency’s 2016 opioid prescribing guideline — what they artfully call an “academic detailing” of the guideline.
The CDC did not respond to a request for comment on the editorial.
President Trump’s opioid commission warned last year that a better system was needed to keep track of overdose deaths. “We do not have sufficiently accurate and systematic data from medical examiners around the country to determine overdose deaths, both in their cause and the actual number of deaths,” the commission said in its final report.
The CDC has recently implemented a new overdose surveillance system in 32 states that supplements data from death certificates with toxicology tests and death scene investigations to more accurately reflect which drugs are involved in overdose deaths.
Lies and Damned Lies
We’ve written before about how confusing, flimsy and exaggerated the numbers can be for overdoses (see “Lies, Damned Lies, and Overdose Statistics”). Last October, PNN reported that the Drug Enforcement Administration changed its definition of prescription drug deaths for three consecutive years in an annual report, apparently in an effort to inflate the number of Americans dying of overdoses.
In 2016, we reported that within one week the CDC and the White House Office of National Drug Control Policy released three different estimates of the number of Americans that died from prescription opioids the year before. The numbers were wildly different, ranging from a low of 12,700 to a high of 17,536 deaths.
To be clear, one overdose is too many. But if we are ever going to find real solutions to the overdose crisis, we need to find accurate numbers to reflect what is causing so many drug deaths. Pinning the blame on prescription opioids, pain patients and prescribers has only led to a growing catastrophe in pain care – where doctors are too fearful to prescribe opioids and patients can’t get treatment.
As the CDC researchers say in their editorial, “inaccurate conclusions” not only mask what’s driving the overdose crisis — they mask the solutions too.
“Obtaining an accurate count of the true burden and differentiating between prescription and illicit opioid-involved deaths are essential to implement and evaluate public health and public safety efforts,” they wrote. “If deaths involving synthetic opioids—likely IMF—are categorized as prescription opioid overdose deaths, then the ability to evaluate the effect of interventions targeting high-risk prescribing practices on prescription opioid–involved deaths is hindered. Decreases in prescription opioid–involved deaths could be masked by increases in IMF deaths, resulting in inaccurate conclusions. ”