Opioid-related mortality in the United States has increased over 400% since 2000.
In 2016, opioids were involved in over 42,000 deaths --- more than the number of
deaths due to firearms or motor vehicles accidents.
At the national level, the epidemic has evolved as a series of three intertwined, overlapping epidemics.
The first epidemic occurred in the 1990s with an increase in deaths due to natural (i.e., prescription) opioids.
The second epidemic began in 2010 with a surge in heroin-related deaths.
The third and current epidemic is being driven by potent synthetic opioids such as fentanyl.
However, it is unclear if this progression has occurred similarly across different race/ethnic groups or across geography.
We systematically describe the trends of the opioid epidemic by using joinpoint regressions, stratified by state, race/ethnicity, and opioid type. Further, we describe the current state of the epidemic in terms of the mortality level as well as the rate of increase.
We find substantial variation in both the opioid mortality rate and the rate of increase across race/ethnicity, state, and opioid type.
Our findings indicate that the current epidemic is driven primarily by heroin and synthetic opioids with epidemic hotspots (i.e., areas of high mortality and rapid increase) clustered in the eastern US.
We anticipate a better understanding of the opioid epidemic, across geography, race/ethnicity, and opioid type, will provide important information for tailored health policies and focused interventions.
The substantial geographic variation emphasizes the need for improving surveillance of the illicit drug supply in terms of potency, type, and availability.