Opioid Overdose Deaths: Prescription vs. Illicit Opioids
Of the nearly 47,000 opioid overdose deaths in 2017, approximately 17.4% (roughly 8,200 deaths) involved prescription opioids only, while the vast majority—58.7% (approximately 27,600 deaths)—involved illicit opioids only, and 18.5% (approximately 8,700 deaths) involved both prescription and illicit opioids. 1
Understanding the Breakdown
The 2017 mortality data reveals a critical shift in the opioid epidemic:
- Total opioid deaths in 2017: 47,600 out of 70,237 total drug overdose deaths (67.8%) 2
- Prescription opioids only: 17.4% of opioid deaths 1
- Illicit opioids only: 58.7% of opioid deaths 1
- Both prescription and illicit opioids: 18.5% of opioid deaths 1
- Unclassified: 5.5% could not be categorized 1
The Evolving Epidemic
The prescription opioid component represents a minority of current opioid deaths, with illicitly manufactured fentanyl (IMF) and heroin driving the majority of fatalities. 1, 3
Key Temporal Trends:
- From 2017 to 2018, deaths involving prescription opioids decreased by 13.5%, while deaths involving synthetic opioids (primarily IMF) increased by 10% 3
- By January-June 2018, IMF was involved in approximately two-thirds of all opioid deaths 4
- The sharp increase in synthetic opioid deaths in 2014 coincided with increased availability of illicitly manufactured fentanyl, which increased by 80% between 2013 and 2014 5
Critical Clinical Context
Polysubstance involvement substantially increases mortality risk. 2, 4
- Benzodiazepines were present in 62.6% of all opioid deaths in 2018, increasing death rates 3- to 10-fold compared to opioids alone 2
- During January-June 2018,62.6% of all opioid deaths co-occurred with at least one common nonopioid drug (benzodiazepines, cocaine, or methamphetamine) 4
- In North Carolina data, benzodiazepines were prescribed in the past year for 80% of decedents and were involved in 61% of deaths involving opioid pain medications 6
Geographic Distribution
The hardest-hit states in 2017 were concentrated in Appalachia and the Northeast 2:
- West Virginia: 51.5 per 100,000
- Delaware: 43.8 per 100,000
- Maryland: 37.2 per 100,000
- Pennsylvania: 36.1 per 100,000
- Ohio: 35.9 per 100,000
- New Hampshire: 35.8 per 100,000
Common Pitfalls in Interpretation
Do not assume "prescription opioid deaths" means legally prescribed medications. 5 Death certificates cannot distinguish between legitimately prescribed opioids, diverted prescription opioids, or illicitly manufactured fentanyl pressed into counterfeit prescription pills. 4 The CDC historically characterized all opioid pain reliever deaths as "prescription" opioid overdoses, but this classification has become increasingly problematic as IMF is pressed into counterfeit pills resembling prescription medications. 5
Bystanders were present in approximately 40% of deaths, yet naloxone was rarely administered by laypersons. 1 This represents a critical missed opportunity for intervention and underscores the need for expanded naloxone distribution and training. 1