“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county,” Lori Ann Post, PhD, director of the Buehler Center for Health Policy and Economics at Northwestern University and study author, said in a press release accompanying the study.
“Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high,” she said.
Post and colleagues used data from CDC’s WONDER database for 3,147 United States counties and county equivalents and categorized them on a six-point urbanicity scale. Opioid overdose deaths were defined using ICD-10 codes for underlying and multiple causes of death.
According to Post and colleagues, opioid overdose deaths have increased in waves since 2000. Wave 1, which came in 2000, was prompted by over-prescribing painkillers. Wave 2, in 2007, involved heroin. Wave 3, which escalated after 2013, involved illicit synthetic opioids, such as fentanyl. Post and colleagues predict wave 4 is occurring due to stimulants and the COVID-19 pandemic.
“We have the highest escalation rate for the first time in America, and this fourth wave will be worse than it’s ever been before,” Post said. “It’s going to mean mass death.”
According to Post and colleagues, counties of urbanicity experienced statistically significant annual overdose death rate growth.
In waves 1 and 4, overdose death rates were higher in most urban communities, the authors wrote. However, acceleration rates were higher in most rural counties. During wave 2, overdose death rates had trends across urbanicity types. In wave 3, linear growth shifted to nonlinear, with 4 years of substantial acceleration across all urbanicity types.
“Nobody wants to be a drug addict,” Post said. “It doesn’t matter if you’re taking Percocet [oxycodone and acetaminophen, Endo Pharmaceuticals] because you broke your back while mining or if you’re a high schooler who died because they got into grandma’s medicine cabinet. We need to look at opioid addiction and overdose prevention immediately.”