But the success of those efforts prompted prescription drug addicts to switch to heroin, which is cheaper and more available on the street, Salsitz and Vuolo said. To make matters worse, drug dealers started cutting heroin with even cheaper and more potent synthetic opioids like fentanyl, further increasing the risk of overdose and death.
“Because heroin and synthetic opioids are cheaper than prescription opioids and more widely available in certain areas hit hard by the epidemic, a singular focus on reducing accessibility to prescription opioids misses the mark,” Vuolo said.
Heroin accounted for one-quarter of overdose deaths in 2015 — triple the rate in 2010, said report author Dr. Holly Hedegaard, a medical epidemiologist with the CDC’s National Center for Health Statistics.
Four states — West Virginia, New Hampshire, Kentucky and Ohio — lead the nation with the highest overdose death rates, the CDC said.
Those states also have been identified as having high rates of death from fentanyl and other synthetic opioids, Vuolo added.
“This suggests that there is greater supply of synthetic opioids in certain areas and because they are more lethal than heroin or prescription opioids, they are contributing to the increases in overdose death rates,” Vuolo said.
To try to stop overdose deaths, access has been increased to naloxone (Narcan), a drug used to reverse an opioid overdose, Vuolo said.
But doctors are releasing people saved by naloxone directly from the hospital rather than steering them into drug treatment, leaving them vulnerable to another overdose, she said.
“There is a very high risk of overdose recurrence when an overdose is reversed but the individual is then released from medical care,” Vuolo said. By comparison, she noted, someone who has a heart attack receives extensive medical care to prevent it from happening again.
Vuolo and Salsitz said policy makers also need to take steps to make addiction-fighting medications like buprenorphine more easily available, so health professionals can treat the underlying drug habit.
Recently approved federal legislation will allow nurse practitioners and physician assistants to prescribe buprenorphine. “That’s going to really open up drug treatment, particularly in underserved areas,” Salsitz said.