By Dave Williams Published: January 8, 2015, 10:21 am Updated: January 8, 2015, 11:15 am
Will the number of overdose deaths attributed to prescription drugs peak in a few years?
A new analysis suggests this may be possible when viewing the problem as an epidemic. After applying a theory known as Farr’s Law, a group of Columbia University professors calculate that the number of prescription drug overdoses each year in the U.S. will peak in 2017 at 16.1 deaths per 100,000 people, and by 2034 will fall back to much lower rates last seen in the early 1980’s. What is Farr’s Law? Named after an epidemiologist known as William Farr, the premise is that an epidemic generally follows a symmetrical curve – a pattern indicates a natural uptake before subsiding. The motion has previously been applied to mapping outbreaks of smallpox, cattle disease and the AIDS epidemic, although with mixed results, as the authors acknowledge.
Nonetheless, as the Columbia University researchers write in Injury Epidemiology, a medical journal, they applied the theory to existing data and plan to test whether their projections will hold in coming years. They do not, however, see this as an academic exercise. Rather, they believe the patterns may hold clues into the extent to which public policy is making a dent in a serious problem. “Our projections, if partially accurate, may help assess intermediate outcomes to gauge whether interventions are working and guide long-term planning and management of public health resources and prevention efforts,” they write. Two of the four authors, by the way, are also editors of the journal.
Indeed, the burgeoning abuse and misuse of prescription painkillers has been a troubling issue for a number of years. The authors noted, for instance, that a 2011 report from the U.S. Centers for Disease Prevention and Control found that opioid painkillers accounted for approximately two-thirds of the total number of deaths attributed to prescription drug overdose. As we have written previously, the FDA has been struggling to find ways to ensure that drug makers develop abuse-resistant painkillers. However, efforts to restrict access have also caused a backlash among some physicians and patients, who say that well-intentioned moves to reduce addiction and overdoses have, in some cases, also overlooked legitimate need for pain relief.
We should note that there are some limitations to their theory. As the authors concede, the method they applied “originated from studies of infectious diseases” and “it is unknown whether Farr’s Law applies to epidemics of a non-infectious origin.” Nonetheless, the authors maintain “it is plausible that a non-communicable disease, such as drug overdose, can follow infectious patterns.” As they explain it, a “theory of social contagion” has been used to explain various behavioral disorders and a “social mechanism of transmission may underlie” the reasons some people start using these drugs. From there, the usage may mimic infectious disease patterns, they write, “proliferating through the population until some natural threshold or intervention prevents further spread.” Of course, such thinking has been applied to obesity, which the authors also acknowledge has been controversial. Whether public policy interventions, such as prescription drug monitoring programs, prove to be effective remains to be seen. But the authors argue that if the rate at which deaths occur does drop, as their projections indicate, this would imply such efforts are “working and should be continued.
