Opiate Trends 2004-2014

Executive Summary

Opiates are an ancient and powerful class of drugs derived from the opium poppy, Papaver somniferum. Modern chemists have created countless synthetic versions known as opioids that include illegal heroin, as well as prescription medications such as OxyContin, Vicodin, and Percocet. In this report, we use the term “opiate’’ to refer to both. While prescription opiates are essential for treating severe pain, they are problematic when used widely for chronic conditions outside of cancer and terminal illness. Although these potent drugs are unrivaled for treatment of severe pain, they also cause euphoria and can lead to physical dependence, addiction and death from overdose.

Opiate overdose and death can occur from the misuse of either heroin or prescription opiates. In addition, these drugs are even more dangerous when used at the same time as other respiratory depressants,such as benzodiazepines or alcohol. Since the vast majority of fatal opiate overdoses are accidents or suicides, the Multnomah County Health Department considers all these deaths to be preventable. This report is intended to help our local community monitor the magnitude of opiate misuse and measure our progress in responding to the threat.

This assessment draws from a variety of sources including the Multnomah County Medical Examiner database, the syringe exchange programs operated by Multnomah County and Outside In, ambulance response reports and addictions treatment data. From these, we learn that:

  • Deaths from opiate overdose occurred more than twice a week in 2014 (109 deaths). While unacceptably high, this figure is a substantial improvement from three deaths per week in 2011 (156 deaths).

  • The decrease in opiate deaths reflects a decrease in heroin-related deaths, which have dropped by more than 30% since 2011.

  • Prescription opiate deaths have not decreased. In 2014, half of all fatal overdoses were associated with prescription opiates.

  • Deaths represent only a fraction of the overdoses occurring. Ambulances responded to opiate overdoses in Multnomah County more than a dozen times per week (632 times in 2014).

  • The expanded availability of naloxone, a drug that reverses opiate overdose, has had a significant effect on overdose outcomes. More than 1,000 lay people in Multnomah County were trained to reverse overdoses using naloxone in 2014 and they reported more than 450 overdose reversals.

  • Opiates are the most rapidly growing reason for substance misuse treatment in Multnomah County and in Oregon.

  • This analysis indicates that the combined efforts of Outside In and Multnomah County to distribute life-saving naloxone rescue kits to syringe exchange clients has likely resulted in fewer people dying from heroin overdoses. Yet, more action is needed to reduce the devastating personal toll and community-wide cost of opiate misuse. Heroin deaths still occur more than once a week, and the number of prescription opiate deaths shows no consistent sign of declining.

  • To win the battle against opiate misuse, our efforts must be broad-based and address inappropriate prescribing, access to alternative treatment for pain, and compassionate, effective, evidence-based treatment for those suffering from substance use disorders.