Public Health · Literature

Research papers on The opioid epidemic

Recent and highly-cited academic work on the opioid epidemic, gathered from Semantic Scholar, CrossRef and OpenAlex.

1. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

   Deborah Dowell, Tamara M. Haegerich, Roger Chou · 2016 · MMWR Recommendations and Reports · 2,720 citations

   This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation

2. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015

   Rose A. Rudd, Puja Seth, Felicita David, et al. · 2016 · MMWR Morbidity and Mortality Weekly Report · 2,231 citations

   The U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999-2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid (1). Illicit opioids are contributing to the increase in opioid overdose deaths (2,3). In an effort to target prevention strategies to address the rapidly changing epidemic, CDC examined overall drug overdose death rates during 2010-2015 and opioid overdose death rates during 2014-2015 by subcategories (natural/semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone).* Rates were stratified by demographics, region, and by 28 states with high quality reporti

3. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014

   Rose A. Rudd, Noah Aleshire, Jon E. Zibbell, et al. · 2015 · MMWR Morbidity and Mortality Weekly Report · 1,894 citations

   The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin). CDC analyzed recent multiple cause-of-death mortality data to examine current trends and characteristics of drug overdose deaths, including the types of opioids associated with drug overdose deaths. During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014. The rate of drug overdose deaths incre

4. CDC Clinical Practice Guideline for Prescribing Opioids for Pain<b>—</b>United States, 2022

   Deborah Dowell, Kathleen Ragan, Christopher M. Jones, et al. · 2022 · MMWR Recommendations and Reports · 1,767 citations

   This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and

5. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017

   Lawrence Scholl, Puja Seth, Mbabazi Kariisa, et al. · 2018 · MMWR Morbidity and Mortality Weekly Report · 1,766 citations

   however, analysis of final data from 2018 is necessary for confirmation. More timely and comprehensive surveillance data are essential to inform efforts to prevent and respond to opioid overdoses; intensified prevention and response measures are urgently needed to curb deaths involving prescription and illicit opioids, specifically IMF.

6. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

   Andrew Kolodny, David T. Courtwright, Catherine S. Hwang, et al. · 2015 · Annual Review of Public Health · 1,406 citations

   Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is

7. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019

   Christine L. Mattson, Lauren J. Tanz, Kelly Quinn, et al. · 2021 · MMWR Morbidity and Mortality Weekly Report · 1,087 citations

   Deaths involving synthetic opioids other than methadone (synthetic opioids), which largely consist of illicitly manufactured fentanyl; psychostimulants with abuse potential (e.g., methamphetamine); and cocaine have increased in recent years, particularly since 2013 (1,2). In 2019, a total of 70,630 drug overdose deaths occurred, corresponding to an age-adjusted rate of 21.6 per 100,000 population and a 4.3% increase from the 2018 rate (20.7) (3). CDC analyzed trends in age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, heroin, and prescription opioids during 2013-2019, as well as geographic patterns in synthetic opioid- and psychostimulant-involved deat

8. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis

   Alexander Y. Walley, Ziming Xuan, Holly Hackman, et al. · 2013 · BMJ · 1,017 citations

   OBJECTIVE: To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. DESIGN: Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. SETTING: 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. PARTICIPANTS: OEND was implemented among opioid users at risk for overdose, social service ag

9. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants — United States, 2015–2016

   Puja Seth, Lawrence Scholl, Rose A. Rudd, et al. · 2018 · MMWR Morbidity and Mortality Weekly Report · 838 citations

   From 2015 to 2016, deaths increased across all drug categories examined. The largest overall rate increases occurred among deaths involving cocaine (52.4%) and synthetic opioids (100%), likely driven by illicitly manufactured fentanyl (IMF) (2,3). Increases were observed across demographics, urbanization levels, and states and DC. The opioid overdose epidemic in the United States continues to worsen. A multifaceted approach, with faster and more comprehensive surveillance, is needed to track emerging threats to prevent and respond to the overdose epidemic through naloxone availability, safe prescribing practices, harm-reduction services, linkage into treatment, and more collaboration between

10. The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis

    Daniel Ciccarone · 2019 · International Journal of Drug Policy · 698 citations

    The US mortality rate has gone up three years in a row from 2014 to 2017 (Murphy, Xu, Kochanek, & Arias, 2016, 2018; National Center for Health Statistics, 2017). Correspondingly, life expectancy at birth has declined; the first triple year decline since World War One and the devastating influenza pandemic one hundred years ago (Tejada Vera B, 2017). Most of the top ten causes of death are declining year over year; however, the third leading cause of death, unintentional injuries, has climbed in rate and rank since 2014 (Murphy et al., 2016). Driving this are deaths due to drug poisoning which exceeded 70,000 in 2017 (Hedegaard H, 2018). Annual deaths due to drug overdoses now exceed those f

11. Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993–2009

    George J. Unick, Daniel Rosenblum, Sarah G. Mars, et al. · 2013 · PLoS ONE · 263 citations

    The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpat

12. Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies.

    Kathryn Hawk, Federico E. Vaca, Gail D’Onofrio · 2015 · PubMed · 206 citations

    The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread imp

13. Rationale for cannabis-based interventions in the opioid overdose crisis

    Philippe Lucas · 2017 · Harm Reduction Journal · 77 citations

14. Opioid overdose crises during the COVID-19 pandemic: implication of health disparities

    Ishika Patel, Lauren A. Walter, Li Li · 2021 · Harm Reduction Journal · 45 citations

    Abstract Background Recent data suggest a disproportionate impact of opioid overdoses on Black Americans. The study aims to describe emergency department (ED) visits at a Southern, urban ED pertaining to opioid overdose and associated health disparities. Methods Patients presenting to the ED at the University of Alabama at Birmingham Hospital with opioid overdoses from January 1 to October 31, 2019, and from January 1 to October 31, 2020, were identified from electronic medical records. Results

15. Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services

    Katrina Milaney, Jenna Passi, Lisa Zaretsky, et al. · 2021 · Harm Reduction Journal · 45 citations

    Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hosp

16. Opioid Harm Reduction: A Scoping Review of Physician and System-Level Gaps in Knowledge, Education, and Practice

    E. Gugala, Owanate Briggs, L. Moczygemba, et al. · 2022 · Substance Abuse · 27 citations

    Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians’ knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians’

17. The Public Health Approach to the Worsening Opioid Crisis in the United States Calls for Harm Reduction Strategies to Mitigate the Harm From Opioid Addiction and Overdose Deaths.

    Yvon Yeo, Rosemary Johnson, C. Heng · 2021 · Military medicine · 25 citations

    The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid c

18. The Need to Rethink Harm Reduction for People Using Drugs Alone to Reduce Overdose Fatalities

    Vaishali S Deo, Manreet K. Bhullar, Thomas P. Gilson, et al. · 2023 · Substance Use & Misuse · 16 citations

    Abstract Background: During the ongoing opioid epidemic, Cuyahoga County (second largest in Ohio) reported overdose mortality rates (54/per 100,000) higher than the national average. Prior research demonstrates that people who use drugs often use alone but there is minimal research on people who died of overdose while using alone. The objective of this study is to examine sociodemographic, toxicologic, and injury characteristics, and emergency medical response to overdose decedents who died using drugs alone. Method: Data from the Cuyahoga County Medical Examiner’s Office (2016–2020, N = 2944) on unintentional overdose deaths in adults was tabulated including socio-demographic, toxicologic,

19. “They make it too hard and too many hoops to jump”: system and organizational barriers to drug treatment during epidemic rates of opioid overdose

    Julia Dickson-Gomez, Sarah Krechel, Jessica Ohlrich, et al. · 2024 · Harm Reduction Journal · 11 citations

    The United States is currently facing an opioid overdose crisis. Research suggests that multiple interventions are needed to reduce overdose deaths including increasing access and retention to medications to treat opioid use disorders (MOUD, i.e., methadone, buprenorphine, and naltrexone) and increasing the distribution and use of naloxone, a medication that can reverse the respiratory depression that occurs during opioid overdoses. However, barriers to MOUD initiation and retention persist and discontinuations of MOUD carry a heightened risk of overdose. Many times, MOUD is not sought as a first line of treatment by people with opioid use disorder (OUD), many of whom seek treatment from med

20. Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community

    Moonseong Heo, Taylor Beachler, L. Sivaraj, et al. · 2023 · Substance Abuse Treatment, Prevention, and Policy · 10 citations

    Background Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. Methods The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic

21. One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

    Birgitte Thylstrup, Morten Hesse, Marian Jørgensen, et al. · 2019 · Harm Reduction Journal · 10 citations

    Abstract Background Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program. Methods Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (

22. Comparing Harm Reduction Vending Machines and In-Person Overdose Prevention Services in Practice: A Case Study From Rhode Island

    Leah C. Shaw, Erin Brown, Emma Creegan, et al. · 2025 · Journal of public health management and practice : JPHMP · 9 citations

    Objective: Improved harm reduction approaches are needed to address the ongoing opioid epidemic in the United States. The study aimed to evaluate the statewide implementation of harm reduction vending machines (HRVMs) and existing in-person harm reduction services. Design: We analyzed 2 years of data from in-person harm reduction encounters and an HRVM pilot program between January 1, 2022, and December 31, 2023. Setting: Rhode Island. Participants: This analysis compared unique persons served, total encounters, types of products dispensed, and time and day of transaction (weekday vs weekend) for in-person services provided by state-funded community organizations and the HRVMs in operation d

23. A systematic review of macro-, meso, and micro-level harm reduction interventions addressing the U.S. opioid overdose epidemic

    Katie A. McCormick, Jake Samora, Kasey R. Claborn, et al. · 2024 · Drugs (Abingdon, England) · 7 citations

    Abstract Background This systematic review aimed to 1) identify the range of opioid harm reduction interventions implemented at macro-, meso-, and micro-levels in the United States, and 2) summarize the outcomes of these interventions. Methods We conducted a systematic review of academic literature published between 2011–2023 following PRISMA guidelines. Articles were excluded if they reported on research that was not specific to opioids, did not report the effects of an intervention, or focused on a medical treatment for opioid use disorder. Two coders independently extracted data and reconciled discrepancies prior to narrative synthesis. Results Of 6,198 articles initially identified, 36 m

24. Community Support for Harm Reduction and Treatment of Opioid Use Disorder

    Bridget L. Hanson, Kari Finley, Jay Otto, et al. · 2024 · Journal of Community Health · 7 citations