Synthetic Opioid Overdose Deaths in Michigan Continue to Rise, Outpace Other Opioid Related Deaths

Michigan’s opioid epidemic is no secret, and it is not just prescription pills that are contributing to the rise in overdoses. Opioids include prescription pain relievers such as oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, fentanyl, methadone, and the illegal drug heroin. However, pain killers that are not prescribed or are used outside of the prescription are considered illegal. Furthermore, pain killers such as fentanyl are being illegally manufactured and distributed at an increasing rate. As the first chart below shows, the number of overdose deaths for all opioids has increased since 2000, but synthetic opioid overdose deaths have risen the most over the last several years, according to data from the Michigan Department of Health and Human Services.

In 2000 there were 17 synthetic opioid overdose deaths (not including methadone) in the State of Michigan. Comparably there were 60 prescription opioid overdose deaths in Michigan in 2000 and 89 heroin overdose deaths. In 2021 there were 2,287 synthetic opioid overdose deaths, 512 prescription opioid overdose deaths and 145 heroin overdose deaths. In Michigan, synthetic opioid overdose deaths increased the most between 2014 and 2015 and 2019 and 2020. Between 2014 and 2015 synthetic opioid overdose deaths increased by 465 deaths, from 175 overdose deaths to 465 overdose deaths. Between 2019 and 2020 opioid overdose deaths increased by 466, from 1,445 to 1,911. Although heroin and prescription overdose deaths have also increased since 2000, the number of overdose deaths for both categories have not grown by the amounts that synthetic opioid overdoses have, nor have they reached (individually) as high an overdose death number as synthetic opioid overdose deaths.

The yellow line in the chart represents the total number of opioid overdose deaths between 2000 and 2021, as reported by the Michigan Department of Health and Human Services. The yellow line often falls below the total number of opioid overdose deaths calculated when combining prescription and synthetic opioids and heroin. According to the Michigan Department of Health and Human Services, the summing of categories will not always result in more than the number of all opioid drug overdoses and the categories of death are not exclusive as deaths might involve more than one drug.

It is also important to note that prescription overdoses includes both prescription opioid pain relievers (e.g., hydrocodone, oxycodone, and morphine) and opioids used to treat addiction (e.g., methadone)

The first chart shows the sheer number of opioid overdose deaths by category, and the chart below shows the rate of opioid overdoses by category, again highlighting the increase in synthetic opioid overdoses. The rates below are calculated per 100,000 people. Prescription opioids regularly had the highest overdose mortality rate up until 2015. In 2015 the overdose mortality rate for prescription opioids was 4.5 overdoses per 100,000 people and for synthetic opioids the rate was 4.7. From there, the overdose rate for synthetic opioids grew to a rate of 23.9 overdose deaths per 100,000 in 2021. Prescription opioid overdose rates and heroin overdose rates also grew for a few years beyond 2015, both peaking after then. The prescription opioid overdose rate peaked in 2016 at 7.7 and the heroin overdose rate peaked at a rate of 8.2 overdoses per 100,000 in 2017. Overdose rates for prescription opioid overdoses and heroin overdoses have decreased since then.

The data clearly shows opioid overdoses continue to increase in Michigan, and synthetic opioid (such as fentanyl) overdoses are playing a large role in that. An obvious question may be, why fentanyl? Well, fentanyl is a highly potent opioid that only requires people to ingest a tiny amount to overdose.

According to Rutgers University, in many areas, fentanyl has nearly completely replaced heroin and can be found in many counterfeit prescription opioid and benzodiazepine pills bought on the street. Methamphetamine and cocaine may also contain undeclared fentanyl.

As shown, Michigan is not immune to its population gaining access to this highly dangerous drug. And while it is still found on the streets, law enforcement agents are working to stop production and distribution. According to the US Department of Justice, more than 65 kilograms of fentanyl powder and 88,000 fentanyl laced pills were seized by federal agents during May 23 and Sept. 8, 2022. The USDOJ said this was enough to provide 4.7 million deadly dosages.

According to the USDOJ,  fentanyl is 50 times more potent than heroin. Just two milligrams of fentanyl, or the amount that could fit on the tip of a pencil, is considered a potentially lethal dose.

The risk of overdose remains high with opioid use, as do other negative consequences from using opioids. So, while law enforcement officials work to eliminate illegal production, distribution and use of opioids there are also organizations working to help those with an opioid addiction. As we have noted throughout this series, to end the opioid epidemic we need a multi-faceted approach and treating addiction is part of that approach. In our next post we will discuss these programs and their impacts.

Young Females, Black Community Impacted by Opioid Use, Overdose

We know, according to the new Michigan Substance Use Vulnerability Index (MI-SUVI), that St. Clair and Wayne counties are the most vulnerable when it comes to substance use in Southeastern Michigan. Additional data shows that it isn’t just residents of those counties who are vulnerable to opioid use, and related harm, though. Rather the black community and the young female population appear to be amongst the most vulnerable populations when it comes to opioid use, death and related Emergency Department visits.

In general, we know that the number of opioid related deaths are increasing across the State of Michigan.  When examining just the number of opioid related deaths in Southeastern Michigan we also know that Wayne County has the highest number of such deaths, in part due to it having the highest population in the state. However, the chart below shows that in recent years only Wayne and Macomb counties have been experiencing noticeable increases in the number of opioid related deaths. In 2020, Wayne County recorded 706 opioid related deaths and Macomb County reported 269; these are increases from the 660 opioid related deaths Wayne County recorded in 2019 and the 215 Macomb County recorded.  Monroe County also experienced an increase in the number of opioid related deaths between 2019 and 2020.

It should be noted that while the state has some data for opioid related deaths in 2021 it was not accessible at the county level. Additionally, data for opioid related deaths in Oakland County was not available for the year 2018 and beyond; this data was suppressed according to the Michigan Department of Health and Human Services.

As the data below shows, males in Michigan have regularly had a higher number of opioid related deaths as compared to women. In 2021 there were 1,528 opioid related deaths amongst Michigan males and 672 amongst Michigan females. (See the chart below.) In 2000, when the data started to be tracked, there were 98 and 25 opioid deaths, respectively. While the number of opioid related overdose deaths for both males and females has been growing, officials are also zeroing on data related to a specific age group of females.

According to the State of Michigan, in 2021, most overdose Emergency Departments visits among young women and girls were intentional and related to self-harm. According to the State, there were 602 more intentional overdose Emergency Department visits among females between the ages of 11-24 years old than in 2020. This was a 30 percent increase. These data further indicate that only 2 percent of that overdose Emergency Departments visits were related to opioids (40% Non-opioid analgesics, antirheumatics, and antipyretics, 25% were related to anti-depressants and 3% were related to psycho-stimulants).

These data indicate how important mental health is in substance use and addiction. That are many factors that impact a person’s mental health, but this recent study by the State highlights how young women are just one group with an increased risk of substance use and its impacts.

The data below shows the number of opioid related deaths for Black males and females and White males and females to further show the details of opioid death trends. While the raw numbers highlight that White Males have always had the highest number of opioid related deaths (1,199 in 2021), followed by White females (542 in 2021), the number of opioid related deaths in the Black male community are rapidly increasing.

In 2000 there were 32 opioid related deaths in the Black male community and by 2021 that increased to 492. The Black female community had 19 reported opioid related deaths in 2000 and by 2021 that increased to 216. The data clearly shows an increase, but we must also be considered that much of this may be related to measurement or aggregation of the data.

According to the Michigan Overdose Data to Action Dashboard, between August 2021 to July 2022 759 Black Michiganders died from an opioid overdose. According to the National Institute on Drug Abuse, the trend we are seeing in Michigan of increased opioid related deaths is also a national trend. According to the institute, Black individuals in four U.S. states(New York, Massachusetts, Kentucky, Ohio) experienced a 38 percent increase in the rate of opioid overdose deaths between 2018 to 2019. Many of these overdoses were driven by heroin and fentanyl, according to the National Institute on Drug Abuse.
While these numbers continue to increase, the focus on the addressing the forces behind these overdose deaths, including the harm reduction from the drugs themselves and the breakdown of societal structures that contribute to them, are increasing. According to NIDA Director Nora D. Volkow, M.D.,  ”systemic racism fuels the opioid crisis, just as it contributes mightily to other areas of health disparities and inequity, especially for Black people.”
As we have briefly touched on, the way to tackle the opioid epidemic in our state, and our country, is to create multi-faceted policies and programs that directly address specific communities. There is no blanket approach to tackling the opioid epidemic, but as we will show in our next post, several programs in Michigan are making headway.