Boomers, Millennials Affected the Most by Opioid Epidemic

Guohua Li, MD, DrPH, professor of epidemiology, Columbia University Mailman School of Public Health

Guohua Li, MD, DrPH

A new study published in American Journal of Public Health has found that baby boomers and millennials are stricken with an excess risk of prescription opioid overdose death and heroin overdose death.

Using data from the National Center for Health Statistics’ multiple-cause-of-death 1999—2014 file, researchers from Columbia University’s Mailman School of Public Health assessed cohort patterns in drug overdose mortality in the US using the multiphase technique for age-period-cohort analysis.

“The CDC has recommended that physicians evaluate risk factors for opioid-related harms when prescribing opioids for chronic pain,” senior Guohua Li, MD, DrPH, professor of epidemiology, Columbia University’s Mailman School of Public Health, told MD Magazine. “The new risk factor identified in our study — birth cohorts known as baby-boomers and millennials — should be incorporated into pain management plans, including risk assessment and risk reduction.”

During the period between 1999—2014, drug overdose deaths per 100,000 people increased from 4.71 to 13.56. Since 1999, the opioid overdose death rate has nearly quadrupled and is primarily driven by the opioid epidemic and a spike in overdose deaths from prescription opioids and illicit drugs like heroin and fentanyl.

“Our study provides new insights on the epidemiologic patterns in drug overdose mortality and helps identify 2 demographic groups that are disproportionately afflicted by the opioid epidemic,” said Li.

Study findings, consistent for both men and women, found that since 2010, boomers have heightened rates of death from prescription opioids and heroin, while millennials have also been hit hard by heroin overdoses.

“Previous studies have shown that about 25% of US overdose deaths had no drug information on the death certificate, so it is likely that national statistics underestimate the number of opioid-related deaths,” lead study author, Xiwen Huang, MPH said.

The findings on boomers were not surprising to researchers, as the generation is known to have a relatively high rate of drug abuse compared with other generations. The boomer generation was middle-aged when opioid prescriptions took off in the 1990s, indicating they were a primary target for the medications.

According to researchers, baby boomers may be at increased risk because of their high rate of illicit drug use which may make them more vulnerable to drug abuse. Regarding millennials’ higher risk of heroin overdose death, researchers suggested it could be linked to the availability of the drug and the desire for new experiences.

Prior to 2010, the age-specific death rates increased steadily for both prescription opioid and heroin overdose death rates, however since 2010, the prescription opioid overdose death rate for those in their late 40s—60s increased faster than any other age group. In comparison, heroin overdose death rates for those in their 20s–30s increased faster than other age group since 2010.

Study authors noted there is likely not enough data for individuals born after 1993, due to their young age, to determine their risk of overdose death and how it compares to other generations.

Overall, baby boomers experienced 25% excess deaths from prescription opioid overdose and heroin overdose, while millennials experienced about 20% excess deaths from heroin overdose, compared to those born in 1997 and 1978.

Researchers concluded individuals born between 1947—1964 and between 1979–1992 are particularly afflicted by the epidemic and intervention programs are needed to reduce the excess overdose mortality in these specific demographic groups.

Various medical groups are taking preventative measures and changed guidelines to rein in opioid prescriptions. US states have launched drug monitoring programs, which electronically track prescriptions for controlled substances and allow doctors to ensure that before prescribing opioids, patients don’t doctor shop and bounce from one provider to the next seeking a new prescription.

Medication-assisted treatment is considered the most effective therapy for opioid dependence, where drugs like methadone, buprenorphine or naltrexone act on the same brain targets as opioids do and help to suppress withdrawal symptoms and cravings.

While the abuse level has leveled off, overdose deaths continue to climb.

Between 2002—2016, deaths soared by 533% nationwide, from under 2,100 deaths to more than 13,200.

The study, “Increasing Prescription Opioid and Heroin Overdose Mortality in the US, 1999—2014: An Age-Period-Cohort Analysis” was published in The American Journal of Public Health.

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