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CDC: Life expectancy improves, partly due to decrease in drug overdose deaths

In 2018, American life expectancy increased for the first time in 4 years, data show. Also in 2018, fewer Americans died of drug overdoses than the year before for the first time in more than 20 years.

Robert Anderson, PhD, chief of the Mortality Statistics Branch of the National Center for Health Statistics, explained during a press conference that the increase in life expectancy was partially due to fewer deaths from unintentional injuries, mostly drug overdoses.

In response to these findings, HHS Secretary Alex Azar said in a press release that “this news is a real victory, and it should be a source of encouragement for all Americans who have been committed to connecting people struggling with substance abuse to treatment and recovery.”

Changes in life expectancy

The 0.1-year life expectancy increase between 2017 and 2018 is largely due to decreases in mortality from cancer (30.2% of the positive contribution), unintentional injuries (25.4% of the positive contribution) and chronic lower respiratory diseases (9.3% of the positive contribution), according to a new report from the CDC's National Center for Health Statistics.

“Drug overdose death rates have been increasing over the last several years — it would be hard to miss that headline,” Anderson said. “In 2018, there were 67,367 drug overdose deaths in the United States, that’s 4.1% fewer than in 2017, when it was 70,237.”

The age-adjusted rate of drug overdose deaths in 2018 — 20.7 per 100,000 deaths — was 4.6% lower than in 2017, when the rate was 21.7 per 100,000 deaths, according to the report.

Anderson noted that preliminary data for 2019 show that “the decline doesn’t appear to be continuing into 2019. It appears rather flat and maybe actually increasing a little bit.”

The data further indicate:

• The rate of drug overdose deaths involving synthetic opioids other than methadone (such as fentanyl) in 2018 was 9.9% per 100,000 deaths, up from 9% per 100,000 deaths in 2017.
• The rate of drug overdose deaths involving cocaine more than tripled from 2012 to 2018, from 1.4 per 100,000 deaths to 4.5 per 100,000 deaths.
• The rate for deaths involving psychostimulants with abuse potential (such as methamphetamine) increased nearly fivefold from 2012 to 2018, from 0.8 per 100,000 deaths to 3.9 per 100,000 deaths.

“Our work is far from finished, and there are some disturbing trends, such as rising rates of methamphetamine overdoses,” Azar said in the release. “Using these data and the best science we have, the Trump administration will continue its deep commitment to improving the physical and mental health and well-being of every American.”

Opioid prescribing rates also drop

Other data published in Morbidity and Mortality Weekly Report show that opioid prescribing rates dropped in 11 states — California, Delaware, Florida, Idaho, Kentucky, Louisiana, Maine, Ohio, Texas, Virginia and West Virginia — during 2010 to 2016. These states represent about 38% of the U.S. population, according to researchers.

Gail K. Strickler, PhD, of the Institute for Behavioral Health, Brandeis University, and colleagues reviewed opioid prescribing rates, mean daily opioid dosages in morphine milligram equivalents, percentage of patients with a high daily dosage of opioids, percentage of opioid-treated days with overlapping Drug Enforcement Administration (DEA) schedules, percentage of opioid-treated days with overlapping benzodiazepine prescriptions and multiple provider episode rates.

The researchers found:

• daily dosage, based on average quarterly percent changes, declined the least (–0.4%) in Idaho and Maine and the most (–1.6%) in Florida;
• percentage of patients with high daily dosage had average quarterly percent changes ranging from –0.4% in Idaho to –2.3% in Louisiana; and
• rates at which a patient used multiple prescribers and pharmacies within specified periods to obtain controlled substances dropped by at least 62% in the seven states with available data.

“The findings in this report indicate encouraging trends in controlled substance prescribing behaviors,” Strickler and colleagues wrote.

They noted that the introduction of a reformulated OxyContin with abuse-deterrent properties as well as the DEA’s rescheduling of hydrocodone combination products from Schedule III to the “more restrictive” Schedule II — both of which occurred during the period studied — might account for the decline. However, it is possible that some individuals who were misusing prescription opioids may have switched to heroin or illicitly manufactured fentanyl, “a change that has made the drug overdose epidemic and associated overdose rates more complex,” they added.

“Because the opioid overdose epidemic began with increased deaths and treatment admissions related to opioid analgesics in the late 1990s, initiatives to address overprescribing might eventually result in fewer persons misusing either prescription or illicit drugs. Reduction in overprescribing opioids might lead ultimately to a decrease in overall overdose deaths,” Strickler and colleagues concluded. – by Janel Miller and Erin Michael

References:

Hedegaard H, et al. Drug overdose deaths in the United States, 1999-2018. NCHS Data Brief.

Kochanek KD, et al. Changes in life expectancy at birth, 2010-2018. NCHS Health E-Stat. 2020.

Strickler GK, et al. MMWR. Morb Mortal Wkly Rep. 2020;69(1):1-6.

Disclosures: Azar is HHS secretary. Strickler and colleagues report no relevant financial disclosures.

*Editor’s note: This story has been updated with new information from the CDC.