Opioid Drug Use and Abuse

The United States is facing a substance abuse crisis more deadly than in any other period in US history.  According to the CDC, over 52,000 people died of drug overdoses in 2015, and almost 2/3 of those deaths were linked to opioids.  In 2015, Missouri ranked 23rd out of the 50 states for drug abuse mortality at 15.7 deaths per 100,000 population, but the rate lies above the US average of 14.8.

In 2015, life expectancy in the US actually fell for the first time since 1993.  Studies have attributed the dip in life expectancy to the increase in what has been termed “deaths of despair” – deaths due to drugs, alcohol and suicide.  These studies have specifically emphasized rising mortality rates among middle aged white men, and nationally, drug poisoning mortality rates are highest among this demographic.  In Missouri, however, the highest drug poisoning mortality rates are among middle-aged black men.  The chart below compares US and Missouri drug overdose mortality rates by race and ethnicity.

Drug Poisoning Deaths, Age-Adjusted Mortality Rates Among Adults Age 25-54 by Race/Ethnicity and Gender, 2012-2015. Source: NCHS/CDC/HHS. Multiple Cause of Death 1999-2015 on CDC WONDER
Drug overdose mortality rate by county, 2011-15 (base map),total number of prescription opioid drug claims by ZIP Code, 2013 (inset), and locations of mental health/substance abuse treatment facilities. Sources: CDC/NCHS Mortality and CMS.

Two separate reports commissioned by the Missouri Hospital Association further examine trends in US and Missouri drug and opioid mortality and hospitalization. These reports show that between 1999 and 2015, substance abuse mortality rates increased by nearly 250% in Missouri, surpassing the national average in 2007. Reports also show that only about one fourth of drug abuse deaths occur in hospital settings.

Drug-Induced Deaths in Missouri by Setting and Percent Change From 1999. Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database.
Age-Adjusted Drug-Induced Death Rates in Missouri and the US, 1999-2015. Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database

The opioid epidemic has a large economic footprint.  The rate of hospitalization for opioid misuse is growing fastest in the Midwest, and often hospitals and law enforcement agencies are not staffed to deal with the increasing demand.  Between 2006 and 2015, the rate of hospitalization has increased by 138% in Missouri, and most of the increase has been among persons on Medicaid and the uninsured population.  This means there is increased financial burden on emergency departments and hospitals as well – providers do not necessarily receive full compensation for treating these individuals6

Another product of the opioid epidemic is the increase in infants born with neonatal abstinence syndrome (NAS).  Key findings from the Missouri Hospital Association show that:

Infants Born with NAS: Percent Change by Senate District, 2012-2016. Source: Hospital Industry Data Institute.
    • National rates of NAS increased by 300% between 1999 and 2013
    • Rates of NAS in Missouri increased by 538% between 2006 and 2016
    • Moderate increase in NAS for non-Medicaid births
    •  Dramatic increase in NAS for Medicaid births – 424 additional cases accounting for 86% of the total statewide increase between 2006 and 2016
    • Rates highest in rural, south-central Missouri and St. Louis city.
    • Iron county Missouri had the highest rate of NAS births between 2012-2016 at 26.37 births per 1,000 (4x higher than state average)

1. NCHS/CDC/HHS. Multiple Cause of Death 1999-2015 on CDC WONDER.
2. Bernstein, L. (2016). U.S. life expectancy declines for the first time since 1993. The Washington Post.
3. Greene, D. (Host). (2017, March 23). The Forces Driving Middle-Aged White People’s ‘Deaths Of Despair’. Morning Edition.  [NPR radio broadcast episode].
4. Reidhead, M. (May 2017). Drug deaths increase among middle-aged, white Missourians. HIDI/MHA.
5. Missouri Hospital Association. (2016). Trends in Hospital Utilization for Opioid Overuse and Drug – Dependent Newborns in Missouri.
6. Zaino, J. (2015). As epidemic grows, the cost of drug addiction weighs on hospital finances.  Healthcare Finance.