This year drug overdose deaths may exceed 70,000 Americans. We do not really know, however. We have no estimate of the number of non-fatal overdoses and no estimate of how fast addiction is spreading.
Over 64,000 Americans died of drug overdoses in 2016 and that number has been growing at 20 percent a year. So it is likely that more than 170 Americans are dying each day from illegal drug use. Why, then, is the response to these deaths so much less urgent than the reaction to a health crisis such as the E. Coli outbreak in lettuce that has, so far, killed one person?
The most deadly part of the overdose carnage, the opioid epidemic, has yet to be treated as a true epidemic by the institution intended to combat such dangers — the Centers for Disease Control and Prevention (CDC). Most critically, though the death rate has reached historic levels, CDC has not committed resources to track the threat in a timely manner. It offers no real-time information on the spread of opioid use and addiction across America and CDC’s reports of overdose deaths lag by almost a year.
Contrast this response to the reporting on the Ebola virus in 2014, which caused one death in the U.S. in four reported cases. CDC received over $500 million for domestic preparedness and response and a total of $1.77 billion for domestic and global Ebola efforts for 2015–2019. Or compare the tracking and CDC funding for the Zika virus. Zika-related birth defects, certainly a serious risk, in reality involved fewer than 7,000 women between 2015 and 2018. Yet in 2016 alone, CDC received$1.1 billion in Zika response funding.
Certainly, Ebola and Zika are serious disease threats and the CDC responses can be associated with the containment of the risks to Americans. So why is the much more deadly disease of addiction tracked only in terms of deaths reported, over a year in the past? It is difficult not to suspect that drug addiction carries a stigma that did not apply to Ebola and Zika — that stigma and the deadly neglect it fosters is indefensible.
In the terrible days of rapidly increasing HIV infections and AIDS deaths in the 1980’s, CDC used its Morbidity and Mortality Weekly Report (MMWR) to create an almost real-time tracking of the disease. This created a common understanding of the epidemic, a sustained awareness of the need for action, and guidance for a national response. The MMWR still exists and CDC has used it to publish some reports on the opioid crisis. But the more than 326,000 deaths from illegal drugs between 2010 and 2016 has triggered nothing remotely approaching the epidemiological reporting for Ebola, Zika, or HIV/AIDS. This despite the fact that overdose deaths have now passed the peak annual numbers of deaths during the HIV/AIDS epidemic.
Tracking the opioid epidemic — as an epidemic — would foster greater awareness of the sheer size of the problem. Moreover, without real-time data, it is impossible to scale and target resources for an effective response. This requires more than the retrospective reporting of deaths; that can only tell us where the disease was, not where it is now. How many non-fatal overdoses are occurring each month and where and among what demographic? Or how many each week? How many Americans are using illegal drugs and how and where is use spreading? Can we trace the deadly networks supplying the poisons? What can we learn about the patterns of use and transmission of the epidemic? Are there places and measures that are saving lives with knowledge that should be shared immediately?
One cause for hope is that the new director of CDC, Dr. Robert Redfield, Jr., has saidhe will work to bring the opioid epidemic “to its knees.” Let us hope he means it, and even more, that he uses all of the epidemiological tools necessary to achieve this outcome. He should start with launching a system of real-time reports on use, abuse, and deaths — when and where they are occurring now. Dr. Redfield should move now by mobilizing the information at hand to build a comprehensive understanding of the threat. Promises to design a plan for next year are not enough.
CDC has shown itself capable of effective, immediate responses to critical disease threats. Dr. Redfield should start treating opioid deaths, addiction, and abuse as an epidemic — this week.