The epidemiology of the opioid overdose epidemic in the United States

Introduction

The opioid overdose epidemic is the latest phase of a multidecade exponential increase in drug-related mortality in the United States [ ]. The severity of the current crisis has driven up the overall US mortality rate 3 years in a row from 2014 to 2017 [ ]. Correspondingly, life expectancy at birth has declined; the first triple-year decline since World War I and the devastating influenza pandemic 100 years ago [ ]. Most of the top 10 causes of death are declining year over year; however, the third leading cause of death, unintentional injuries, has climbed in rate and rank since 2014 [ ]. Driving this increase are deaths due to drug poisoning, which exceeded 70,000 in 2017 [ ]. Annual deaths due to drug overdoses now exceed those caused by motor vehicle accidents, gun violence, and even HIV infection at the height of the 1990s HIV epidemic [ ].

The focus of this chapter is on the epidemiology of the US opioid overdose epidemic. National trends and demographics will be presented first. Then, using the framework of the “triple wave,” each phase of the opioid crisis will be discussed separately in terms of regional distribution, demographics, and supply and demand drivers. It is critical to discuss the drivers of each wave to best inform policy and intervention responses.