The epidemiology of the opioid overdose epidemic in the United States

Abstract

Abstract The opioid overdose epidemic in the United States is of historic proportion. This chapter describes the scope and epidemiology of the crisis; using the framework of the “Triple Wave” each phase of the overdose epidemic – due to pills, heroin and illicit synthetic opioids – will be discussed separately in terms of regional distribution, demographics and supply and demand drivers. All three waves have impressive supply-side drivers including excessive prescribing of medication, a new form of highly refined Mexican-sourced heroin and a new illicit source of synthetic opioids, i.e., fentanyls, adulterating heroin and counterfeit pills. Demand for opioid pills partially drove demand for heroin while demand for heroin unsuspectingly feeds demand for synthetics-as-substitute. What is driving increases in opioid mortality most recently are deaths due to fentanyl-adulterated or -substituted heroin. The second and third waves are largely regional, with the Northeast (including Mid-Atlantic) and Midwest (including Appalachia), the most affected regions. To address the epidemic, both supply and demand side interventions are discussed. Considering the inadequate and paradoxical effects of current opioid supply interventions, supply-side policies must be combined with sufficient investments in and expansion of effective prevention, substance use treatment and harm reduction services.