MedicalResearch.com Interview with:
Mathew Vinhhoa Kiang, PhD
Postdoctoral Research Fellow
Primary Care and Outcomes Research
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation’s capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate.
MedicalResearch.com: What should readers take away from your report?
Response: First, synthetic opioids are now the primary driver of the epidemic in these states and policies that are focused on prescription opioids are not adequate to address this new stage of the epidemic.
Second, in some states it appears the synthetic opioid mortality rate was higher than the heroin mortality rate. This suggests synthetic opioids are causes fatal overdoses through other drugs and not just from contaminated heroin. In other words, just because a state has not experienced high heroin mortality in the past does not mean it won’t experience high synthetic opioid mortality in the future.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Most policies so far have focused on the supply of prescription opioids. While this is important, we must address the epidemic in other ways and adapt to the changing nature of the epidemic. Specifically, treatment of opioid use disorder should be at least as prevalent and easy to access as heroin or synthetic opioids. In addition, we have life-saving drugs that reverse the effects of opioid overdoses — these need to be easily accessible and widely available. In terms of policies relevant to this study specifically (1) better surveillance of the illicit drug supply should be implemented in order to understand how quickly and where fentanyl and other synthetic opioids are being introduced into the market and (2) testing of synthetic opioids in coroner reports should become standard.
MedicalResearch.com: Is there anything else you would like to add?
Response: No disclosures. We started this paper as a way of educating the public and decision-makers — there are a lot of results and we encourage others to closely examine them through our online results viewer: https://sanjaybasu.shinyapps.io/opioid_geographic/
Kiang MV, Basu S, Chen J, Alexander MJ. Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016. JAMA Netw Open.2019;2(2):e190040. doi:10.1001/jamanetworkopen.2019.0040
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