John M. Talmadge, M.D.

A Blog Covering Many Topics

Drug Overdose Deaths, Injuries

Texas Had the 39th Highest Rate of Injury Deaths in U.S.

The good news? We are better off than 38 other states when it comes to events like drug overdose, car wrecks, killings, drownings, and the million other ways to die in The West. I just reviewed the report sponsored by the Robert Wood Johnson Foundation, a leading source of funding for medical research and education.

In The Facts Hurt: A State-By-State Injury Prevention Policy Report, Texas ranked 39th highest for the number of injury-related deaths in the state, with a rate of 55.3 per 100,000 people. Overall, the national rate is 58.4 per 100,000.

Rates in Texas decreased over the past four years for injury deaths, which includes drug overdoses, motor vehicle crashes, homicides and others. Overall, 17 states increased, 24 remained stable and 9 decreased. Injuries are the leading cause of death for Americans ages 1 to 44 – and are responsible for nearly 193,000 deaths per year.

Drug overdoses have become the leading cause of injury in 36 states, not including Texas, surpassing motor vehicle-related deaths.

Some key findings include:

Drug abuse: More than 2 million Americans misuse prescription drugs. The prescription drug epidemic is also contributing to an increase in heroin use; the number of new heroin users has doubled in the past seven years.

Key report indicators include the finding that 34 states and Washington, D.C. have “rescue drug” laws in place to expand access to, and use of naloxone - a prescription drug that can be effective in counteracting an overdose - by lay administrators. This is double the number of states with these laws in 2013 (17 and Washington, DC). While every state except Missouri has some form of Prescription Drug Monitoring Program (PDMP) in place to help reduce doctor shopping and bad prescribing, only half (25) require mandatory use by healthcare providers in at least some circumstances.

Motor vehicle deaths: Rates have declined 25 percent in the past decade (to 33,000 per year).

Key report indicators include observation that 21 states have drunk driving laws that require ignition interlocks for all offenders;
and while most states have Graduated Drivers Licenses that restrict times when teens can drive, 10 states restrict nighttime driving for teens starting at 10 pm; and 35 states and Washington, D.C. require car safety or booster seats for children up to age 8.

Homicides: Rates have dropped 42 percent in the past 20 years (to 16,000 per year).

The rate of Black male youth (ages 10 to 24) homicide victims is 10 times higher than for the overall population. One in three female homicide victims is killed by an intimate partner. Research shows that 31 states have homicide rates at or below the national goal of 5.5 per every 100,000 people.

Suicides: Rates have remained stable for the past 20 years (41,000 per year). More than one million adults attempt suicide and 17 percent of teens seriously consider suicide each year. Seventy percent of suicides deaths are among White males.

Falls: One in three Americans over the age of 64 experiences a serious fall each year, falls are the most common nonfatal injuries, and the number of fall injuries and deaths are expected to increase as the Baby Boomer cohort ages.

A key report indicator includes: 13 states have unintentional fall-related death rates under the national goal (of 7.2 per 100,000 people – unintentional falls).

Traumatic brain injuries: (TBIs) from sports/recreation among children have increased by 60 percent in the past decade.

Nationally, drug overdose deaths have more than doubled in the past 14 years – resulting in 44,000 deaths per year, and half of those deaths (22,000) are related to prescription drugs. Texas ranked sixth lowest for drug overdose deaths—at a rate of 9.6 per 100,000 people.

Texas scored three out of 10 on key indicators of steps states can take to prevent injuries – nationally, 29 states and Washington, D.C. scored a five or lower. New York received the highest score of nine out of a possible 10 points, while four states scored the lowest, Florida, Iowa, Missouri and Montana, with two out of 10 points.
Drug overdoses are the leading cause of injury deaths in the United States, at nearly 44,000 per year. Prescription drugs are the leading cause. 

These deaths have more than doubled in the past 14 years, and half of them are related to prescription drugs (22,000 per year).  Overdose deaths now exceed motor vehicle-related deaths in 36 states and Washington, D.C. And, in the past four years, drug overdose death rates have significantly increased in 26 states and Washington, D.C. and decreased in six.

The Facts Hurt report uses10 key indicators of leading evidence-based strategies that help reduce injuries and violence.  The indicators were developed in consultation with top injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Research (SAVIR). 

The 10 indicators include:

Does the state have a primary seat belt law? (34 states and Washington, D.C. meet the indicator and 16 states do not.)

Does the state require mandatory ignition interlocks for all convicted drunk drivers, even first-time offenders? (21 states meet the indicator and 29 states and Washington, D.C. do not.)

Does the state require car seats or booster seats for children up to at least the age of 8? (35 states and Washington, D.C. meet the indicator and 15 do not.)

Does the state have Graduated Driver Licensing laws - restricting driving for teens starting at 10 pm? (11 states meet the indicator and 39 states and Washington, D.C. do not. Note a number of other states have restrictions starting at 11 pm or 12 pm.)

Does the state require bicycle helmets for all children? (21 states and Washington, D.C. meet the indicator and 29 states do not.)

Does the state have fewer homicides than the national goal of 5.5 per 100,000 people established by the U.S. Department of Health and Human Services (HHS) (2011-2013 data)? (31 states meet the indicator and 19 states and Washington, D.C. do not.)

Does the state have a child abuse and neglect victimization rate at or below the national rate of 9.1 per 1,000 children (2013 data)? (25 states meet the indicator and 25 states and Washington, D.C. do not.)

Does the state have fewer deaths from unintentional falls than the national goal of 7.2 per 100,000 people established by HHS (2011-2013 data)? (13 states meet the indicator and 37 states and Washington, D.C. do not.)

Does the state require mandatory use of data from the prescription drug monitoring program by at least some healthcare providers? (25 states meet the indicator and 25 states and Washington, D.C. do not.)

Does the state have laws in place to expand access to, and use of, naloxone, an overdose rescue drug by laypersons? (34 states and D.C. meet the indicator and 16 states do not.)

Score Summary: Texas Scores 3 out of 10

For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest.

9 out of 10: New York
8 out of 10: Delaware
7 out of 10: California, New Jersey, North Carolina, Tennessee, Washington and West Virginia
6 out of 10: Alaska, Colorado, Hawaii, Indiana, Kentucky, Louisiana, Maine, Minnesota, Nevada, New Mexico, Oregon, Rhode Island and Virginia
5 out of 10: Alabama, Arkansas, Connecticut, Georgia, Illinois, Kansas, Massachusetts, Oklahoma, Utah, Vermont and Wisconsin
4 out of 10: Arizona, District of Columbia, Idaho, Maryland, Michigan, Mississippi, New Hampshire, North Dakota and Pennsylvania
3 out of 10: Nebraska, Ohio, South Carolina, South Dakota, Texas and Wyoming
2 out of 10: Florida, Iowa, Missouri and Montana

Painkiller Overdoses On the Rise

In 2012, physicians wrote 259 million prescriptions for pain killers, enough to give a bottle of pills to every adult in the USA, Frieden said. More than 2 million Americans abuse prescription opiates, according to the National Institute on Drug Abuse. About 669,000 use heroin, to which many opiate users turn when they can no longer afford pain killers.

This news isn’t shocking to those of us who encounter addiction daily, but it’s in the headline today at USA Today. Other items of note from today’s paper:

With nearly 44,000 deaths a year, more Americans today die from drug overdoses than from car accidents or any other type of injury. Many of these deaths could be prevented if patients had better access to substance abuse therapy, experts say. Yet people battling addiction say that treatment often is unavailable or unaffordable.

Only 11% of the 22.7 million Americans who needed drug or alcohol treatment in 2013 actually got it, according to the Substance Abuse and Mental Health Services Administration. While some of those who went without care did so by choice, at least 316,000 tried and failed to get treatment.

"We know addiction treatment saves lives, reduces drug use, reduces criminal activity and improves employment," says Paul Samuels, president and director of the Legal Action Center, which advocates on behalf of people with HIV or addiction. "The data is there, the evidence is in, but our public policy has not caught up with the science."

Meanwhile, the crisis is getting worse, says Thomas Frieden, director of the Centers for Disease Control and Prevention. The death rate from drug overdoses more than doubled from 1999 to 2013, according to the CDC. The bulk of these deaths involve opiates, a class of pain killers that includes morphine and Oxycontin.

Injection drug use has fueled an outbreak of HIV in rural Indiana, a nationwide surge in hepatitis C infections, and an increase in the number of babies born addicted to drugs. States have responded to the surge in overdose deaths by expanding access to naloxone, a fast-acting rescue drug that can reverse the effects of an opiate overdose. Indiana lawmakers also voted to allow needle exchange programs in communities facing a public health crisis related to injection drug use. While those approaches are welcome, they don't treat the underlying addiction.

The wait for a spot in a detoxification program ranges from days to weeks, and it can be very expensive. As I say elsewhere here on my site, it's also true that not all treatment is really good treatment. Consumers are disadvantaged twice. Not only is treatment hard to find in the first place, but it's hard to know what constitutes a good treatment program. I have some comments about this on my FAQ page and on my Philosophy page.