Over the past two decades, deaths from opioids have increased five-fold, and the number of people seeking treatment for opioid addiction now outweighs alcohol abuse at reporting facilities.

Few communities remain untouched by the epidemic, which kills an average of 130 people each day and costs the US economy an estimated $78 billion a year. In 2018, Western states like Oregon and Colorado had some of the highest rates of painkiller misuse, indicating a shift West from states like West Virginia that were ground zero for the crisis.

USAFacts combed through buried PDF reports spread across law enforcement, public health, and substance abuse agencies to bring to light new data for a fuller picture of the opioids crisis. Learn more below in our outline of the government’s numbers on the crisis.

Why has opioid use become so deadly?

Deaths from opioids, including heroin, painkillers, and synthetics like Fentanyl, all increased since 2013. However, Fentanyl — a pain medication that is nearly 100 times stronger than morphine — stands out for an 800% increase in overdose deaths in just four years. Even tiny doses of Fentanyl can be deadly. Users often don’t know if their dose includes Fentanyl, and if so, how much.

Opioids were responsible for 46,802 overdose deaths in 2018, nearly double the number of deaths attributable to non-opioid drugs. This is the first time in decades deaths from opioids has decreased though, a small victory compared to stemming the public health campaigns and new laws targeted towards avoiding addiction.

However, opioids remain responsible for more deaths than cars or guns, and are about equal to suicides in the US.

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What is driving the supply of opioids?

The increase in supply is driven by both legal prescriptions for opioid painkillers and illegal heroin trafficking.

The availability of prescriptions painkillers peaked in 2012 at 81 prescriptions per 100 people. Recent efforts to curtail overprescription have brought that down to 51 prescriptions per 100 people as of 2018. In addition, 15% of Americans had at least one opioid prescription filled in 2018, down from 17% in 2017. However, as the CDC notes, prescription rates vary greatly by region, and some counties had prescription rates six times higher than the national average.

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It has been widely reported that prescription painkillers are a legal gateway to heroin abuse. Analysis from the Substance Abuse and Mental Health Services Administration states that as addicts need stronger painkillers to achieve the same effect, they may be unable to access pills through their healthcare provider or unable to afford illegally-sold pills. Some end up switching to heroin, a cheaper illegal opioid.

The Controlled Substances Act requires companies and the Drug Enforcement Agency to track distribution of opioids. A 2018 report from the House Energy and Commerce Committe detailed the role of pharmaceutical companies in increasing access to legal painkillers despite data that indicated the pills were being abused. It also documented the failure of the DEA to monitor the flow of prescription painkillers and intervene.

How have drug use and addiction rates changed?

A new insight from government data is that the number of people seeking treatment for opioid abuse has surpassed alcohol abuse in the US at reporting treatment facilities.

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Heroin abuse has been steadily increasing, even as people report they are less likely to abuse or be dependent on other illicit drugs, such as cocaine and marijuana. The government has only tracked painkiller misuse since 2015, but data shows that nearly three times as many people abuse painkillers as heroin. In addition, nearly 80% of heroin users have previously abused prescription painkillers.

As users move from painkillers to heroin, the rate of addiction spikes. Of people who have misused painkillers in the past year, 1 in 5 have a dependence. Among heroin users, 4 in 5 are dependent on continued use of the drug.

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Are people seeking treatment?

In 2017, 2.1 million people reported using heroin or abusing painkillers and 680,000 sought treatment at reporting treatment facilities, resulting in roughly 32% of people seeking treatment. Almost 90% of approved treatment facilities in the US reported their data to the government.

Among those who self-identified as needing treatment but did not receive it, cost was the biggest barrier. In 2017, 41% of people in the National Survey on Drug Use and Health reported that they either lacked health insurance, their health insurance did not cover addiction treatment, or if it did, the cost for their share was still too expensive to afford.

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Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States
National Survey on Drug Use and Health, Tables 9 and 12
National Survey of Substance Abuse Treatment Services, Table 6.2a