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From 1999 to 2017, more than 700,000 people died in the United States from a drug overdose. About 400,000 of these deaths involved both prescription and illicit opioids (eg, heroin); 218,000 deaths involved prescription opioids. In 2017 alone, there were more than 70,000 overdose deaths, with nearly 70% involving opioids. This was a 10% increase from 2016, when there were 63,632 overdose deaths and two-thirds involved opioids.

The current rise in opioid overdose deaths can be described in three distinct phases. The first phase began in 1999 following an increase in the prescribing of opioids during the 1990s, due in part to a new, patient-centered focus on relieving pain as the 5th vital sign. The second phase began in 2010, with rapid increases in overdose deaths involving heroin. The third phase began in 2013, with significant increases in overdose deaths involving synthetic opioids (eg, tramadol, fentanyl), especially illicitly manufactured fentanyl. Although the opioid overdose epidemic has evolved and worsened in recent years, provisional data from 2018 indicates potential improvements in some overdose indicators. However, a final analysis will be necessary to confirm this change.

Since 2012, opioid prescribing rates have declined, suggesting that prescribers have become more cautious in their prescribing practices. However, prescriptions for opioids continue to contribute to the epidemic, with more than 35% of all opioid overdose deaths specifically involving prescription opioids. Prescription opioid use is a risk factor for illicit drug abuse, such as with heroin or fentanyl. Evidence suggests that most individuals became addicted to illicit opioids after using prescription opioids…

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