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Opioid trends across Washington state

Death data from the Washington State Department of Health Center for Health Statistics are combined with population data from the Office of Financial Management to create rates of death. Data include only deaths for which an underlying cause of death was determined to be any opioid. For more information on data, see details at the end of the page.

Deaths attributed to any opioid: 77% increase

As a whole, opioid deaths regardless of subtype occur throughout the state. Modest declines in the opioid death rate in Chelan County (and some smaller counties) between 2002-2004 and 2015-2017 have been outweighed by increases in most counties, particularly more populous counties. The rate in this recent period remains below the rate per 100,000 residents in the prior peak of opioid deaths, from 2006 through 2009, but the prevalence of these deaths is clearly increasing again. 2017 saw 798 drug deaths involving an opioid, above the previous high count of 720 in 2009.

Data sources: Center for Health Statistics, Washington State Department of Health (deaths), Washington State Office of Financial Management (population)

Heroin deaths by county

Heroin is not confined to the western part of the state, or to more populous areas. We should note that for small counties, such as Ferry, the rates are unstable due to the small population size and small underlying number of deaths involved. We do not show rates for the earlier period (2002-04) for heroin or other opioid (non-heroin) deaths because of the likely misclassification we discuss further below, which varied by county. To summarize, in the earlier period, some counties were much better than others at identifying true heroin deaths, and thus changes over time are likely to be amplified simply by better classification.

Data sources: Center for Health Statistics, Washington State Department of Health (deaths), Washington State Office of Financial Management (population)

Deaths attributed to other opioids

The rate of deaths attributed to prescription-type and other opioids of 8.2 per 100,000 in 2015-2017 represents a decline from 2007-2009, when the rate was over 9.

Data sources: Center for Health Statistics, Washington State Department of Health (deaths), Washington State Office of Financial Management (population)

Drug poisonings involving opioids versus cocaine and methamphetamine

Data sources: Washington State Department of Health (deaths), state Office of Financial Management (population)

In the figure above, we simply report rates per 100,000 residents of drug poisonings attributed to opioids, cocaine or methamphetamine. These rates are not mutually exclusive, and many deaths involve more than one of these 3 major types of drugs. In the figure below, we again show death rates, but break out deaths involving methamphetamine (M), cocaine (C), and opioids (O) alone or in combination. To focus on the relationship among these three drugs we ignore the (frequent) presence of any other drug, most prominently alcohol or benzodiazepines. Thus, opioid deaths are broken out as opioids only (no C or M), opioids and cocaine (no M), methamphetamine and opioids (no C), and all three (methamphetamine, opioids, and cocaine), each with or without other substances. For each type of drug poisoning, we present the results in a stacked chart to show how they contribute to the overall rate of drug poisonings.

Alcohol, barbiturates, or benzopiazepines, which all act as central nervous system depressants, are commonly involved with other drugs in drug poisonings, particularly with opioids. If you click on the 'Opioid deaths detail' button, the chart switches to subtypes of drug poisonings involving opioids. Those not involving cocaine or methamphetamine are further divided into those that did and those that did not also involve alcohol, barbiturates, and/or benzodiazepines (ABB).

Data sources: Washington State Department of Health (deaths), state Office of Financial Management (population)

Deaths attributed to prescription-type and other opioids versus prescription supply

We compare deaths attributed to any opioid and any opioid except heroin with data on pharmaceutical legitimately distributed up to the retail level obtained from the US Drug Enforcement Administration. Deaths attributed to other opioids include a small but unknown number of deaths involving illegal opioids other than heroin (e.g., illicitly manufactured fentanyl or fentanyl analogues), and a larger number of deaths also involving heroin. Deaths (solid lines) are expressed as rates per 100,000 residents, supply (dashed line) as defined daily doses per person for the whole year for all legal opioids consistently counted by the DEA. See our ARCOS analysis page for more information.

Data sources: Center for Health Statistics, Washington State Department of Health (deaths), US Department of Drug Enforcement Administration ARCOS database (legal wholesale distribution), Washington State Office of Financial Management (population), World Health Organization Collaborating Centre for Drug Statistics Methodology (defined daily dose equivalents). All Rx opioids begins in 2005 due to prior inconsistent reporting of component drugs in ARCOS data.

Statewide opioid deaths by subtypes

In order to compare to national trends from the CDC, we compare opioid-involved drug poisonings involving heroin, commonly prescribed opioids, and other synthetic opioids, some of which are illegal. Press the "Death rates" button to see rates per 100,000 residents, and the "Percent of opioid deaths" to see what percentage of all these deaths involved each of the three main subtypes. Specification of opioids into specific subtypes in death certificate data has improved over the years. Thus, part of the increase in the share of opioid deaths involving heroin is due to better documentation of heroin by medical examiners (see details at the end of the page). We do know that part of the decline in the rate of other-opioid-involved deaths as heroin death rates increased may be due to a switch to heroin among those with opioid use disorders (for example, a survey of heroin users in King County found that 39% reported being "hooked on" prescription-type opioids first). Recall that many opioid deaths involve multiple opioids, and so these rates and percentages are not mutually exclusive.

Data sources: Washington State Department of Health (deaths), state Office of Financial Management (population)

Data notes

Drug-caused deaths are based on individual-level death certificate data from the state Department of Health. We restrict analysis to drug poisonings (based on ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14 as the underlying cause of death) involving Washington residents who died in Washington. This common definition excludes cases where alcohol poisoning or alcoholism, carbon monoxide poisoning, etc., was coded as the underlying cause of death. Deaths involving any opioid are based on contributing cause of death coding (ICD codes T40.0-T40.4 or T40.6; T40.5 signifies cocaine). As of this writing, death data are available through 2017. (However, the state's review and confirmation of potential opioid cases, conducted from 1999 through 2015, has been eliminated from defining opioid deaths.) Many drug deaths involve multiple drugs, and identifying the single drug out of many that resulted in death is impossible. Thus, these deaths are best described as drug poisonings involving the drug or category of drugs specified.

Identification of heroin (T40.1) as a contributing cause of death is difficult and has improved over time, due in part to the state Department of Health working with local coroners and medical examiners to improve testing and reporting. This paper describes some of the difficulties (see sidebar).

Following the lead of the CDC, among other opioids (anything besides heroin) we specify deaths involving commonly prescribed opioids--combining methadone (T40.3) with other natural and semisynthetic opioids (T40.2)--and other synthetic opioids (T40.4), most prominent among them being fentanyl and fentanyl analogues.

Identification of methamphetamine deaths is based on searching written information saved in the electronic death certificates for relevant words containing "meth" and/or "thamphet", including innumerable misspellings of methamphetamine. This written information ("literals") is available back to 2003.