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Opiate 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 opiate.

While death rates have grown state-wide, this increase is less than that of the other indicators presented here (all admissions, first admissions, and crime lab cases). The slower increase in deaths compared to other indicators may be because overdose deaths often lag treatment and morbidity indicators.

Deaths attributed to any opiate: 18% increase

As a whole, opiate deaths regardless of subtype occur throughout the state. Modest growth in larger counties and a 42% decline in the opiate death rate in Spokane County between 2002-2004 and 2013-2015 have balanced apparently large increases in relatively small counties such as Lewis, Douglas, and Kittitas. The later period reflects a decline in deaths from intervening years--opiate deaths peaked in 2009 at 699 statewide.

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

Deaths involving heroin versus deaths involving other opiates

In the graph below, you can track a county's rate of opiate deaths attributed to heroin versus prescription-type and other opiates over time. (Other opiates includes those available pharmaceutically and illegal opiates other than heroin.) Movement along the horizontal axis represents changes in the non-heroin opiate death rate (per 100,000 county residents) with no heroin deaths reported. Note that deaths are not necessarily unique--some deaths involve both heroin and other opiates. You can also see the effect of small counties on rate stability: Watch the bubbles for small counties such as Wahkiakum and Skamania bounce around. The size of the bubble reflects the death rate for all opiates--the state opiate death rate peaked in 2009 at 10.5 per 100,000.

Opiate death rates by major subtypes over time, by Washington county

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

Deaths attributed to any opiate: The cumulative toll

In the map below, each dot represents a single death during the period 1999 through 2015 (the dots are randomly placed in the county). For more on opiate deaths in King County, go here.

Download PDF. Data sources: Center for Health Statistics, Washington State Department of Health.

Heroin deaths: Modest growth east of the mountains, more growth west

Between the two time periods compared here, heroin deaths have increased while the rate prescription-type and other opiate deaths decreased. Heroin deaths continue at a higher rate west of the Cascades, where Clallam County???s rate nearly tripled and the Skagit and Snohomish County rates more than doubled. While counties east of the mountains, such as Chelan, Kittitas, and Douglas, appear to have rapid increases in the rate of heroin deaths, the rates are unstable due to the small population size and small underlying number of deaths involved. Yakima County went from 2 to 19 deaths over the respective three-year periods.

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

Deaths attributed to other opiates: Recent declines

Over the time periods compared here, deaths attributed to prescription-type and other opiates decreased 11%, but some counties saw increases. The rate of 6.4 per 100,000 in 2013-2015 represents a larger decline from 2007-2009, when the rate was over 9. This decline in the rate of other-opiate-involved deaths as heroin death rates increased may be due in part 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).

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

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

We compare deaths attributed to methadone, hydrocodone, and oxycodone, with data on the same drugs legitimately distributed up to the retail level obtained from the US Drug Enforcement Administration. We also show the overall death rate attributed to other opiates (which, again, includes a small but unknown number of deaths involving illegal opiates other than heroin, and a larger number of deaths also involving heroin) and the overall opiate death rate compared to the distribution of all legal opiates. Deaths (solid lines) are expressed as rates per 100,000 residents, supply (dashed lines) as defined daily doses per person for the whole year.

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). Split in methadone series reflects ARCOS apparently including opiate treatment programs (OTPs) in distribution data beginning in 2006. All Rx opiates begins in 2005 due to prior inconsistent reporting of component drugs in ARCOS data.
More Washington state substance use data and resources from ADAI