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37 SPOTLIGHT ON OPIOID EPIDEMIC The Opioid Epidemic's Geographic Footprint: 4 Things to Know By Brian Zimmerman M ore than 33,000 people died from opioid overdoses in 2015, continu- ing a consistent upward trend in the rate of opioid-related deaths in the United States. In 1999, the number of opioid over- dose deaths was 8,280. While these numbers demonstrate the human cost of the epidemic, they do not adequately convey the region- al burden of the problem or its multifaceted nature. In a December article from e Washington Post, Christopher Ingraham analyzed the geographical burden of the opioid epidemic based on data from the CDC. While the CDC suppresses data on specific communities for privacy reasons, the agency does offer up state specific data on opioid overdose death rates and categorizes deaths by the specific type of opioid responsible. e Post article suggests the nation is not simply facing a singular opi- oid epidemic, but rather several at once. Here are four things to know about the geo- graphic footprint of the opioid epidemic. 1. Overall opioid deaths: e national rate for opioid overdose deaths per 100,000 people in 2015 was 10.4. But, when assessing this rate at the state level, it becomes clear certain regions are experienced much higher rates of death. Kentucky, Massachusetts, New Hampshire, Ohio, Rhode Island and West Virginia had the highest rate of overall opioid overdose deaths. In each of these states, at least 36 people per 100,000 died of an opioid over- dose. 2. Heroin deaths: For the first time in re- cent history, heroin overdoses surpassed gun homicides as the more prolific killer in 2015. e states with the highest rates of heroin related deaths were Connecticut, Ohio and West Virginia. ose states experienced at least 13.3 heroin-related overdose deaths per 100,000 people. To protect community privacy, the CDC sup- presses data for several states, mostly due to low population and low rates of overall opioid deaths, according to the Post. e CDC does not make state-level data on heroin overdoses available for Arkansas, Montana, Nebraska, North Dakota, South Dakota and Wyoming. 3. Synthetic opioid deaths: Synthetic opioids are created with chemicals not found in poppy seeds, morphine, codeine or opi- um. e substance primarily responsible for synthetic opioid deaths in the U.S. is fentanyl, a product 50 times more potent than mor- phine. While synthetic opioid deaths have signifi- cantly impacted states like Ohio and West Virginia, the drugs have taken the largest toll on New England. In 2015, Rhode Is- land's synthetic opioid overdose death rate was 13.2 per 100,000 people, Massachu- setts' was 14.4 and in New Hampshire — which had the highest rate in the nation — it was 24.1. 4. Classic opioid deaths: Opioids that have chemical similarities with the natural opium found in poppy plants are categorized as classic opioids. ese substances include drugs like hydrocodone and oxycodone. e top states for these types of deaths in 2015 were Utah and West Virginia. is was the only category in which Massachusetts and Ohio weren't at least near the top rankings. "e important takeaway here is that there's not just one opiate epidemic but several," Christopher Ingraham wrote in the Post. "For policymakers, this may mean that solving the problem will similarly require a more nu- anced basket of solutions than a blanket 'war on drugs.' A strategy to reduce pill overdoses in Utah may not have any effect on fentanyl deaths in Massachusetts." n 1 in 3 Long-Term Opioid Users Say They're Addicted: 3 Survey Takeaways By Brian Zimmerman O ne-third of long-term prescription opioid us- ers said they were physically dependent on the drugs, according to a collaborative sur- vey from The Washington Post and the Kaiser Family Foundation. For the survey, researchers polled 809 adults who had ei- ther taken opioid prescription pain medication for a peri- od of at least two months, or were living with a household member taking the prescription drugs for that period of time. Here are three key takeaways from the survey. 1. While nearly all long-term users said they were first intro- duced to the narcotic painkillers by a physician, more than 60 percent said their provider offered no advice on how or when to stop taking the drugs. Also, approximately 25 per- cent reported receiving insufficient information regarding the side effects of opioid use. 2. Two-thirds of those surveyed said the relief provided by the medication was worth the risk of addiction. 3. While one-third of opioid users believed they were addicted, their housemates reported a different outlook. More than half of respondents living with long-term opi- oid users suspected their family member or roommate was addicted. Additionally, family members of long- term users were more likely to report opioids as having a damaging influence on their loved ones' physical and mental health, finances and personal relationships. n