What works

A simple line graph shows that more people are dying from methadone than heroin and the difference is growing over time. It also shows that cocaine is more dangerous than anything other drugs on the graph, at least when it comes to fatalities. Note that these data represent deaths due to acute overdoses as well as fatalities due to complications from long term use.

What needs work

I have no idea what the bars behind the line graphs represent. They seem to be there just to be graphic – I am not in favor of the use of meaningless graphic dross. The article that accompanied this graph mentions that 39,000 people die every year due to drugs and 45,000 die in traffic accidents (though auto-deaths are dropping and were at ~37,000 in 2008 according to Fatality Analysis Reporting System). This means that in some states – mostly in New England and the Mid-Atlantic – more people are dying from drugs than cars. This is big in America where traffic fatalities have long been an unfortunate fact of life. Safety standards have been improving so traffic deaths have fallen. I would have liked to see the traffic deaths applied to this graphic. It would have been more meaningful in the context of the article than the random bars behind the lines.

Where are alcohol related deaths?

The labels go from the very specific “Methodone” to the incredibly vague “other synthetic narcotics” and “other opioids”. The article says that the growth in drug-related fatalities is coming from prescription drugs like Oxycontin, Vicodin, and Methadone. OxyContin and Vicodin contain hydrocodone which places them in the “other opioids” category but it seems like it would also place them in the “other synthetic narcotics” category.

There are plenty of people who will not read the whole article. The graphic needs to speak for itself with clarity, complexity, and completeness otherwise it risks oversimplification and obfuscation.

Bonus graph

The Proceedings of the Community Epidemiology Work Group, January 2009 included a presentation by James Cunningham that featured this data about the increase of oxycodone across the US population. I think this graph helps contextualize the oddly stylized line graph that is the central focus of this post. Here you can see that there is simply much more hydrocodone around than there used to be. The original article by the AP attributes this to the recognition of the treatment of chronic pain as a new and challenging medical field. In that case, then, it should be no surprise that Arizona is a hotbed for hydrocodone prescriptions because the state’s demographic is over-represented by the elderly who are more likely to need pain management strategies.

Final question

I don’t usually get political, and I’ll probably regret posing this question, but here goes.

Do drug companies bear any responsibility for the fatalities involving prescription drugs? Clearly it is in their financial interest to sell an addictive product – and nobody denies that opioids are addictive. Big tobacco ended up having to pay out millions, but that’s because in the beginning, they denied that their products were so unhealthy that using them was potentially fatal. Opioid producers are not making claims one way or the other on the question of fatality beyond admission that the substances are addictive and should be monitored by doctors. This shifts the blame to doctors, but it is often the case that addicted patients will seek these drugs from all sorts of different doctors making it difficult for any given doctor to know just what the patient was prescribed by some other health care professional. It is important to note that opioids offer meaningful treatment for chronic pain where tobacco products did not play a legitimate roll in mainstream medicine and thus should not be banned or taxed, etc.

This brings us back to the original question: should big pharma take some responsibility for deaths due to use/abuse of the prescription drugs from which they derive profit?

References

Associated Press. (2009, September 30) In 16 states, drug deaths overtake traffic fatalities at cleveland.com

A bigger version of the graphic is here: Drug-related deaths increase

Hydrocodone fast facts from drug-addiction.com

Community Epidemiology Working Group. (2009, January) Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Working Group | Highlights and Executive Summary [PDF] US Department of Health and Human Services, National Institutes of Health.