TMC PULSE

t m c » p u l s e | f e b r u a r y 2 0 1 9 36 How Are We Most Likely to Die? Opioid overdose is now one of the top five causes of death in the United States B y S h a n l e y P i e r c e F or the first time in United States history, people are more likely to die from accidental opioid over- doses than car crashes. According to a recent report from the National Safety Council, a Congressionally-chartered non- profit that promotes health and safety, a person born in 2017 has a greater chance of dying from an opioid overdose (one in 96) than a motor vehicle crash (one in 103). This makes opioid overdose, con- sidered accidental, one of the top five causes of death, behind heart disease, cancer, chronic lower respi- ratory disease and suicide. "For the longest time, injury had been one of the leading causes of lost life in young people. Now opioid overdoses and other drug overdoses are overtaking that. This happened very quickly," said John Harvin, M.D., a trauma surgeon at Memorial Hermann-Texas Medical Center and associate professor in the division of acute care surgery at The University of Texas Health Science Center at Houston's McGovern Medical School. "The way that it has exponentially increased has been quite shocking." Illicit fentanyl has largely driven the opioid epidemic in the U.S. In December 2018, the U.S. Centers for Disease Control and Prevention's (CDC) National Vital Statistics System report showed that fentanyl- involved overdose deaths surpassed the number of deaths from heroin and oxycodone. Fentanyl, a syn- thetic opioid painkiller, is 80 to 100 times stronger than morphine and 30 to 50 times more potent than heroin. More than 130 Americans die each day from opioid over- dose, according to the CDC. Approximately 29 percent of patients who had a prescription for opioids to treat chronic pain misused the drugs. In addition, 80 percent of heroin addicts first used prescription opioids. "When you look at the data, there's definitely a role that the medical community has played in this problem," Harvin said. The Joint Commission, an independent, U.S. nonprofit that administers voluntary accreditation programs for hospitals and other health care organizations, issued pain management standards in 2001 to help address the underas- sessment and inadequate diagno- sis of pain. The standards, some critics charge, encouraged more aggressive treatments that included opioids, leading to the misguided notion that pain was the fifth vital sign. Critics say health care providers over-prescribed opioids to elimi- nate pain and unwittingly ushered in an opioid epidemic. The Joint Commission, it should be noted, disputes this characterization and says its pain standards did not cause a rise in opioid prescriptions. The organization wrote in 2016 that it doesn't endorse pain as a vital sign and doesn't require the use of drugs to manage patients' pain. In an effort to curb the opioid overdose crisis, the U.S. Department of Health and Human Services launched initiatives around five main areas: improving access to treatment and rehabilitation; increasing access to lifesaving opi- oid overdose reversal drugs, such as naloxone; expanding public health surveillance of opioid use; support- ing pain and addiction research; and promoting pain management programs and practices among caregivers. "Over time, we've learned a number of things: First off, you don't always need opioids to treat patients," Harvin said. "A lot of ODDS OF DYING IN THE UNITED STATES * Heart disease Cancer Chronic lower respiratory disease Suicide Opioid overdose Motor vehicle crash Fall Gun assault Pedestrian incident Motorcyclist Drowning Fire or smoke Choking on food Bicyclist Accidental gun discharge Sunstroke Electrocution, radiation, extreme temperatures, pressure Sharp objects Cataclysmic storm Hot surfaces and substances Hornet, wasp and bee stings Dog attack Passenger on an airplane Lightning Railway passenger * The figures here are statistical averages over the whole U.S. population and do not refer to any individual's odds of dying. Figures are based on the number of deaths, relative to the total, U.S. population, extrapolated across the average life expectancy of 78.6 years. Source: National Safety Council "Injury Facts" (https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/) 1 in 6 1 in 7 1 in 27 1 in 88 1 in 96 1 in 103 1 in 114 1 in 285 1 in 556 1 in 858 1 in 1,117 1 in 1,474 1 in 2,696 1 in 4,047 1 in 8,527 1 in 8,912 1 in 15,638 1 in 28,000 1 in 31,394 1 in 46,045 1 in 46,562 1 in 115,111 1 in 188,364 1 in 218,106 1 in 243,765

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