This commentary was originally featured in Forbes on August 8, 2017. 

States With the Highest Rate of Opioid Overdose Deaths in 2014

Earlier this year the U.S. Centers for Disease Control and Prevention (CDC) issued a report that suggested a significant number of opioid related deaths were incorrectly attributed to pneumonia and other infectious diseases made worse by drug abuse.

The study, by CDC field officer Victoria Hall and colleagues, looked at deaths in Minnesota from 2006 to 2015. Hall noted that opioids can, “Make your immune system less effective at fighting off illness.” While opioids’ central nervous system depressive effect can slow breathing, suppress coughs, and make it easier for an addict to catch pneumonia, which is then listed as the cause of death.

Now a new study by University of Virginia public policy & economics professor Christopher Ruhm suggests that America’s opioid deaths are some 24 percent higher than reported —about 8,000 additional overdose deaths per year.

Using a different methodology than the CDC researchers, Ruhm found that hospitals often do not specify drugs present in the body of the deceased with between a fifth to a quarter of drug overdose deaths not listing any drug on the death certificate. Further, Ruhm discovered that this underreporting varies greatly by state. For example, he estimated that Pennsylvania had the greatest amount of opioid overdose death undercounting with drug poisoning fatalities as much as 108 percent higher than reported in 2014.

Ruhm noted that opioid overdose deaths rose 137 percent from 2000 to 2014 and that obtaining accurate information is an integral step in addressing the overdose crisis.

At a recent criminal justice and drug policy reform conference in Washington, D.C., Newt Gingrich, former Speaker of the U.S. House of Representatives, discussed one major difference between opioid abuse and alcohol abuse: “When someone gets addicted to alcohol, then goes sober, falling off the wagon results in that person simply getting drunk. But, as people abuse opioids, they build up a resistance to the drug. When they go clean, their body’s resistance to the drug fades. But, if they return to the drug, they often use the same dose they last used when they were addicted and they overdose and die.”

Ruhm said this deadly problem is compounded by the fact that, “Heroin sold on the streets is cheaper than prescription opioids while its purity and strength varies widely. Further, it is often mixed with fentanyl and other powerful drugs.”

President Donald Trump and Health and Human Services Secretary Tom Price are holding an opioid briefing today in Bedminster, New Jersey as part of the administration’s ongoing effort to stem the opioid epidemic.

Professor Ruhm’s study shows that opioid overdose deaths are far more widespread than reported with four states seeing an annual death rate in excess of 20 people per 100,000 population in 2014: West Virginia (30.3), New Hampshire (22.6), Kentucky (20.8), and Ohio (20.5). Ruhm estimates that 11.2 Americans in 100,000 died from opioid poisoning in 2014 or about 47,055 people.

Revised Opioid and Heroin Overdose Deaths per 100,000 Population in 2014 (C. Ruhm)
West Virginia 30.3
New Hampshire 22.6
Kentucky 20.8
Ohio 20.5
New Mexico 19.7
Rhode Island 19.5
Pennsylvania 17.8
Massachusetts 17.1
Delaware 16.8
Maryland 15.8
Utah 15.8
Tennessee 15.1
Connecticut 14.7
Michigan 14.7
Indiana 14.3
Missouri 14.0
Nevada 14.0
Oklahoma 13.8
Wyoming 13.3
Maine 13.0
Louisiana 12.6
Arizona 12.1
Wisconsin 12.1
Colorado 12.0
New Jersey 11.7
Alabama 11.6
Alaska 11.5
South Carolina 11.3
U.S. Average 11.2
North Carolina 10.6
Illinois 10.4
Vermont 10.4
Washington 10.0
Washington DC 9.9
Florida 9.7
Virginia 9.3
New York 9.2
Oregon 9.2
Georgia 8.6
Montana 8.5
Arkansas 8.3
Idaho 8.2
Kansas 8.1
Mississippi 8.0
California 6.9
Minnesota 6.7
Texas 5.9
Iowa 5.6
Hawaii 5.5
North Dakota 4.5
Nebraska 4.3
South Dakota 4.1