By David Heitz
By now, we all know that hundreds of people in America are dying of drug overdose every single day.
We also know that most of it is from opioids, which come in a range of formulations from painkillers like hydrocodone to heroin.
But which opioids and other drugs, specifically, are people overdosing on?
The U.S. Centers for Disease Control and Prevention (CDC) published the most recent overdose surveillance data available in December 2016. That report looked at death data from 2010 to 2014. (1)
Death by painkillers and heroin both are up, but heroin has seen the biggest spike by far.
Why? Most likely, it’s the result of painkillers becoming less available to those addicted to opioids. State monitoring programs, intense law enforcement and doctors whose feet are being held to the fire has led to fewer prescriptions being written.
So, opioid addicts are just turning to heroin they can buy on the street instead.
And that’s why it has landed in the top position of the Top 5 Most Overdosed Drugs.
- Heroin. In 2014, the CDC tallied 10,863 deaths, up 23.1 percent from 2010. We know the problem is far worse than that now, even though specific U.S. numbers are not yet available.
Availability, above all else, likely describes why heroin leads the pack of killer opioids.
Heroin comes from the poppy plant. You may recall that poppies are what puts Dorothy and her friends to sleep in the “Wizard of Oz,” one of the most legendary movies of all time.
Dorothy, the Tin Man, Scarecrow and Dorothy’s dog, Toto, are en route to Oz via the Yellow Brick Road. But the wicked witch stops them by putting poppies in their path. They fall into a deep sleep.
Glenda the good witch saves the day by causing snow to fall upon the poppies and die. Dorothy and her friends awaken, and they make it to Oz on time.
The analogy to “The Wizard of Oz” poppy scene is actually kind of profound and prophetic. “The Wizard of Oz” was made way back in 1939. Today, it is one of the most classic films of all time.
“The Wizard of Oz” was considered a breakthrough film in terms of special effects and technology at the time of its release. Indeed, it changed the face of the motion pictures in America.
Meanwhile, we now know that those pretty poppies can be deadly. Just as Glenda the Good Witch saved Dorothy and her friends, Naloxone is bringing back those who overdose on heroin and other opioids from the brink of death.
Naloxone reverses an opioid’s effects to bring the OD’d back from the brink.
Those who are saved by Naloxone also can find long-term relief and support at residential drug treatment centers. Treatment is more affordable than most people think.
Two types of heroin: Pure, and black tar
“Pure heroin is a white powder with a bitter taste that predominantly originates in South America and, to a lesser extent, from Southeast Asia, and dominates U.S. markets east of the Mississippi River,” according to the National Institute on Drug Abuse.
Many first-time users will try pure heroin because they can snort it. It takes a great deal of apathy to get to the point of injecting since it is so highly stigmatized. Far too many opioid addicts reach that point, however, and snorting pure heroin is a sure way to get there quick.
Once an opioid user no longer can afford pure heroin (and everyone knows the financial havoc addiction wreaks), they turn to black tar heroin. Black tar heroin, which is injected, is usually the cheapest way for an opioid addict to get high.
“Black tar” heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River,” NIDA explains. “The dark color associated with black tar heroin results from crude processing methods that leave behind impurities.
- Fentanyl. Although the 2014 CDC trend report puts this drug at No. 5 on the overdose list, 2016 numbers provided by CDC Wonder already have it at more than 20,000 deaths for that year alone. (2) For that reason, we are placing it in the No. 2 position. Reliable recent statistics for heroin are not yet available, and for that reason heroin is remaining in the No. 1 spot on this list, for now.
Fentanyl, a powerful painkiller given to dying cancer patients and others in severe pain, is unbelievably dangerous. Overdose deaths are up over 500 percent in the past three years alone.
What’s worse, some people are injecting heroin laced with fentanyl.
There are so many ways to die with fentanyl that those who survive it have lots of reasons to celebrate – and for getting sober.
Now, people are even overdosing on carfentanil, an elephant tranquilizer. It is 10,000 times more potent than morphine.
Law enforcement officers and even police dogs are OD’ing just by touching or smelling it.
- Cocaine. According to the CDC, 5,856 deaths occurred in 2014, up 12.4 percent from 2010.
For those who have been addicted to cocaine, this isn’t surprising. Cocaine can make a user’s heart pound very fast. Also, people who use cocaine tend to use a variety of other drugs, and alcohol, too.
Mixing drugs is a sure way to end up in the grave. In particular, opioids mixed with benzodiazepines, such as Ativan and Xanax, is particularly dangerous.
And yet, the fact remains that cocaine still came in at No. 2 in overdose deaths in 2014.
And the fact remains that many people who recreationally use cocaine think it’s relatively harmless. It’s not surprising given the focus of news media coverage has radically shifted away from cocaine in recent years to opioids.
Even the topic of marijuana, which never has had a recorded overdose, is stealing media attention away from deadly drugs like cocaine and Xanax (which comes in at No. 5 on the list).
- Oxycodone (OxyContin). In 2014, 5,417 people OD’d on this opioid per CDC data. That’s up 11.5 percent from 2010. More recent numbers from the CDC have 2015 overdoses from all opioids having tripled since 2010, to a staggering 64,000. (3)
OxyContin often catches people by surprise. They may take too much and become sleepy. The next thing they know they are unconscious. Their heart and breathing slow down. They can die if nobody is around.
Of course, OxyContin until recently was a fairly commonly prescribed painkiller. A person with a prescription who finds themselves repeatedly refilling it – and having the sorts of experiences I just described above – would be wise to have their use evaluated by a professional.
It’s nobody’s fault if they have begun to take too much in an effort to stay well. The problem is, it doesn’t work long term. Nobody deserves to die for something that isn’t their fault.
- Alprazolam (Xanax). In 2014, 4,217 people overdosed on Xanax.
Xanax is in a class of drugs known as benzodiazepines. It is commonly prescribed for anxiety.
Benzodiazepines affect the brain the same way as alcohol, and should be avoided by alcoholics in recovery.
These numbers are grossly underestimated
The truth is, the problem of drug overdose is even worse than what is described here. Surveillance methods (monitoring of deaths by the CDC) are clunky. Even classifying how someone died is much harder than you might think.
And the most recent and reliable U.S. numbers we have already are three years old. Consider just how bad the opioid epidemic has worsened since 2014, both in terms of anecdotal reports and also with recent overdose statistics available in some states or in partial form.
Finally, a big part of not having a true handle on overdose numbers is this: Often it’s impossible to trace the overdose to a single drug. So, sometimes it is not even classified as an overdose.
Nobody needs lectured about the dangers of overdose. However, if you or someone you care about is hooked on a drug on this list, consider reaching out for help.
Addiction is nobody’s fault.
- Warner, M. et al. (2016, Dec. 20). Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. Retrieved Sept. 21, 2017, from
- Katz, J. et al. (2017, Sept. 2). The first count of Fentanyl deaths in 2016. The New York Times. Retrieved Sept. 21, 2017, from https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html
- Overdose death rates. (2017, September). National institute on Drug Abuse. Retrieved Sept. 21, 2017, from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates