Opioid-related deaths, particularly those associated with synthetic opioids, increased in the eastern United States between 1999 and 2016, leading to lower life expectancies, according to a study published in JAMA Network Open.

In this cross-sectional study, researchers used joinpoint modeling and life table analysis of individual-level data from the National Center for Health Sciences. The data from 351,564 residents who died of opioid-related causes between 1999 and 2016 were included in the analysis.

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The average age at death in this cohort was 39.8 for men and 43.5 for women. In 2016, there were 42,249 opioid-related deaths in the United States, corresponding to an age-standardized mortality rate of 13.2, and a 18.5% increase per year since 2014 (P <.001). The synthetic-opioid-related mortality rate in 8 states (Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire, and Ohio) was found to have at least doubled every 3 years (annual percent change ≥26%), and the states of Florida, Pennsylvania, and the District of Columbia had rates that at least doubled every 2 years (annual percent change ≥41%).

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In addition, 12 states had high mortality rates from synthetic opioids (>10 per 100,000 people). Of note, the District of Columbia recorded the fastest rate of increase in mortality from opioids, more than tripling every year since 2013 (annual percent change, 228.3%; P <.001). The region also had the nation’s highest all-opioid mortality rate in 2016 (29.3 per 100,000; P =.02) and the fifth-highest mortality rate from synthetic opioids (18.8 per 100,000; P <.001). The states with the most deaths related to synthetic opioids were New Hampshire (30.2 per 100,000; P <.001) and West Virginia (26.6 per 100,000; P =.005).

Across all states, overall opioid-related mortality was associated with 0.36 year of life expectancy lost in 2016, and synthetic opioids were associated with 0.17 year of life expectancy lost compared with 0.30 and 0.34 year of life expectancy lost due to motor vehicle crashes and deaths involving firearms, respectively.

Study limitations include potential misclassification of deaths and underreporting of deaths related to opioids.

“These findings indicate that policies focused on reducing opioid-related deaths may need to prioritize synthetic opioids and rapidly expanding epidemics in northeastern states and consider the potential for synthetic opioid epidemics outside of the heroin supply,” noted the study authors.


Kiang MV, Basu S, Chen J, Alexander MJ. Assessment of changes in the geographical distribution of opioid-related mortality across the United States by opioid type, 1999-2016 [published online February 22, 2019]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.0040

This article originally appeared on Clinical Pain Advisor