The opioid epidemic is fast becoming a big city problem.
There was a 54 percent increase in overdoses from July 2016 through September 2017 in the major metro areas of 16 states surveyed by the federal Centers for Disease Control and Prevention — a chunk of the country that includes Chicago, Philadelphia, Milwaukee, Cleveland and Columbus, Ohio.
Nationwide, the scourge that President Donald Trump has vowed to defeat shows no sign of abating, with a 30 percent increase in opioid overdoses reported during that same period, the data released Tuesday shows.
Anne Schuchat, the CDC's acting director, said the grim new arithmetic, which came from emergency room statistics, confirmed some suspicions.
"We're currently seeing the highest drug overdose death rates ever recorded in the United States," Schuchat said in a Q&A session with reporters.
Asked specifically about the rise in urban opioid overdoses, Schuchat said health officials suspect a "change in the toxicity" of drugs on the street.
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Urban heroin dealers have been boosting profits by cutting their drugs with fentanyl, which is 25 to 50 times more powerful. That combination was why Columbus was averaging one fatal overdose per day in the first half of last year.
"The issue of cutting heroin with fentanyl is a very major problem right now," Schuchat said. "What you are seeing in Columbus is for sure occurring in other areas."
Daniel Raymond, deputy director of the Harm Reduction Coalition, said that initially the opioid overdose rates "were primarily driven by prescription painkillers — they weren't concentrated in urban areas."
"But the recent rises are mostly driven by heroin, and particularly fentanyl, and the latter seems particularly prevalent in urban drug markets," said Raymond, whose organization is based in New York City. "That's certainly true in places like Ohio and Philadelphia, which are seeing a lot of fentanyl-involved overdose deaths. That doesn't mean the problems have waned in smaller cities and rural areas, which are also seeing fentanyl, but we are seeing increasing vulnerability in major urban centers."
The only bright spot — and it's a dim one at that — was that the CDC found decreases in opioid overdoses in states like West Virginia, New Hampshire and Kentucky that have been leading the nation in the category.
"We hope this is a positive sign," said Schuchat, who credited leadership, particularly in West Virginia, with taking bold steps to combat the crisis. "But we have to be cautious in the areas that have reported decreases."
"Sometimes places that have had such high rates have no place to go" but down, she added.
The new CDC "Vital Signs" report was released a week after Attorney General Jeff Sessions issued a "statement of interest" in support of local governments that are suing the big pharmaceutical makers and distributors, accusing them of swamping many states with prescription painkillers and turning millions of Americans into junkies.
Skeptics said Sessions' move — like Trump's much-hyped opioid commission — is all talk and not much action.
The new CDC numbers come from analysis of emergency room data from 16 states, including some hardest hit by the plague — Delaware, Illinois, Indiana, Kentucky, Massachusetts, Maine, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.
The CDC found:
Emergency rooms in half of the states surveyed reported "substantial" increases in opioid overdoses, with mammoth jumps in Wisconsin (109 percent), Delaware (105 percent), Illinois (66 percent), Indiana (35 percent), Maine (34 percent) and North Carolina (31 percent).
The Midwest, in particular, saw a 70 percent increase in opioid overdoses.
The only state with a "statistically significant decrease" was Kentucky (15 percent). "The decrease in Kentucky may reflect some fluctuations in drug supply," Schuchat said.
"Nonsignificant" decreases of 10 percent or less were reported in Massachusetts, New Hampshire, Rhode Island and West Virginia.
The highest rate of increases were in large metro areas, which the CDC defines as a population of 1 million or more "and covering a major city."
Every demographic group saw a substantial increase in overdose rates, including men (30 percent), women (24 percent), people ages 25 to 34 (31 percent), 35 to 54 (36 percent), and 55 or older (32 percent).