The Numbers Behind America’s Opioid Epidemic
Drug overdoses are the leading cause of death for Americans under the age of 50, who are now more likely to die from a drug overdose than from car accidents or firearms. The United States has the dubious distinction of having the highest percentage of drug-related deaths in the world.
While opioid abuse is a nationwide problem, there are specific areas that are being hit harder by this epidemic. Using the location data above, from NORC at the University of Chicago, we can see clusters of counties that have an extremely high rate of overdose deaths. Between 2012 and 2016, West Virginia, Kentucky, and Ohio saw a combined 18,000 deaths related to opioid abuse.
A sharp increase in prescribed opioid-based painkillers and the rise of illegal fentanyl – which is up to 50 times stronger than heroin – has unleashed the worst public health crisis in American history.
It’s a problem that can be tough to understand, but by delving into the data, some key observations emerge.
Doctors Prescribed a lot of Pain Killers
Beginning in the 1980s, prescription opioids like oxycodone and hydrocodone were heavily marketed as a treatment for pain, and at the time, the risk of addiction to these substances was downplayed. Opioid prescriptions nearly tripled between 1991 and 2011.
Sales of these powerful painkillers are beginning to drop, in part because the risk of addiction has now been widely publicized. Another decelerating factor is the crackdown on clinics and pharmacies that were over-dispensing painkillers, in some cases directly feeding the elicit drug market.
In 2015, nearly 100 million Americans were prescribed painkillers by their doctor. A recent survey showed one-third of people who abused prescription painkillers in the past year got pills directly from a physician.
This abundance of pills impacts the community at large when excess pills are sold, stolen, or simply given to others. In fact, receiving painkillers from a friend or family member was the most common gateway to abusing opioids.
Fentanyl is Killing a lot of People
If doctors have been prescribing opioids for decades, what is causing this recent spike in overdoses? The answer, for the most part, is fentanyl.
This synthetic opioid presents a problem because it’s extremely potent – it only takes about 2 milligrams to overdose on the drug. Since much of the fentanyl on the market is sourced illegally, doses can and do exceed this amount on a regular basis.
As a result, overdose deaths related to opioids have skyrocketed in recent years:
Overdoses are the tip of the Iceberg
The thousands of overdose deaths around the country are the most extreme symptom of the opioid epidemic, but the problem runs much deeper.
In 2017, there were over 11 million “opioid misusers” in the United States. To put that number in perspective, that’s equivalent to the entire population of Ohio. In fact, the problem is so widespread, that it’s suspected to be influencing workforce participation rates.
The health care burden of the crisis is also staggering. The cost of opioid abuse ranges from $10,000 to $20,000 in annual medical costs per patient.
The hard truth is that, unless bold action is taken, the opioid epidemic is projected to claim nearly 500,000 lives over the next decade.
Infographic: Which Rare Diseases Are The Most Common?
Rare diseases affect upwards of 350 million people worldwide. This infographic breaks down their types and prevalence, and estimated related drug sales.
Infographic: Which Rare Diseases Are The Most Common?
Pharmaceuticals have come a long way since the apothecary days of prescribing cocaine drops for toothaches, or dispensing tapeworm diet pills.
Today, medical breakthroughs like antibiotics and vaccines save millions of lives, and contribute to the industry’s mammoth size. Yet even with rapid advancements, a select group of rare diseases still fly under the radar — and together, they affect over 350 million people worldwide.
What Are Rare Diseases?
Today’s infographic from Raconteur breaks down occurrence rates of notable rare diseases, and their collective impact on pharmaceutical drug sales. But first, let’s look at how they’re defined.
Diseases are considered rare, or “orphan” if they affect only a small proportion of the population. In general, it’s estimated that 1 in 17 people will be afflicted by a rare disease in their lifetime. At the same time, as many as 7,000 rare diseases exist, with more discovered every year.
A report by the global investment bank Torreya looks at the most common types of rare diseases that are a focus for therapeutic companies around the world:
- Multiple sclerosis emerges above all others, at 90 patients per 100,000 people.
- Narcolepsy—intermittent, uncontrollable episodes of sleepiness—affects 50 patients per 100,000.
- Primary biliary cholangitis, the damage of bile ducts in the liver, affects 40 people in 100,000.
- Rounding out the top five orphan diseases are Fabry disease (30 patients per 100,000), and cystic fibrosis (25 patients per 100,000).
One catch behind these stats? There’s actually no universal definition of what constitutes a rare disease. This means prevalence data like the above is often inconsistent, making it difficult to record the precise rate of natural occurrence.
The Cost of Rare Diseases
This gap in knowledge comes at a price—many rare diseases have constrained options for treatment. Orphan drugs are often commercially underdeveloped, as their limited end-market usage means they aren’t usually profitable enough for traditional research.
In the United States, government-backed incentives such as tax credits for R&D costs and clinical trials are speeding up the pathways from drug to market. Other places like the EU, Japan, and Australia are also following suit.
In total, it’s estimated that pharma companies focused on rare diseases are worth about half a trillion in enterprise value, roughly equal to 17.5% of the value of Big Pharma:
- Non-oncology value: $315.7B
- Oncology value: $193.1B
- Total enterprise value: $508.8B
Source: Torreya Report. Market values are for the top 31 pure play rare disease therapeutic companies.
The average cost of an orphan drug per U.S. patient annually can climb to near $151,000 (a whopping 4.5 times that of a non-orphan drug, at $34,000). That’s why the pharma industry is urgently advancing rare disease therapeutics across different categories.
Dominant Orphan Drug Sales
According to other estimates, orphan drugs are set to capture over one-fifth of global prescription sales by 2024. Blood, central nervous system, and respiratory-related drugs are currently the top therapeutic categories and are expected to keep this status into the future.
The figures below break down global orphan drug sales by therapy category, and their present and estimated future market share. Note that oncology-related orphan drug sales are excluded from this table.
|Therapy Category||2018 Sales||Market Share||2024E Sales||Market Share||Change in Market Share|
|Central nervous system (CNS)||$11.1B||16.3%||$20.3B||17.1%||0.8%|
Source: EvaluatePharma. Industry sales are based on the top 500 pharma and biotech companies.
Much is still unknown about rare diseases in the health community. Frequent misdiagnosis, and up to an average of 8 years for an accurate diagnosis, continue to be a problem for patients.
There are two sides to the situation. On one, tech giants like Microsoft are providing digital health solutions to speed up diagnosis, through machine learning and blockchain-based patient registry.
On the other, many skeptics question whether the industry is interested in finding cures for rare diseases at all, especially when they account for a significant portion of industry revenues.
Is curing patients a sustainable business model?
Visualizing Over A Century of Global Fertility
Global fertility has almost halved in the past century. Which countries are most resilient, and which have experienced the most dramatic changes over time?
Visualizing Over A Century of World Fertility
In just 50 years, world fertility rates have been cut in half.
This sea change can be attributed to multiple factors, ranging from medical advances to greater gender equity. But generally speaking, as more women gain an education and enter the workforce, they’re delaying motherhood and often having fewer children in the process.
Today’s interactive data visualization was put together by Bo McCready, the Director of Analytics at KIPP Texas. Using numbers from Our World in Data, it depicts the changes in the world’s fertility rate—the average number of children per woman—spanning from the beginning of the 20th century to present day.
A Demographic Decline
The global fertility rate fell from 5.25 children per woman in 1900, to 2.44 children per woman in 2018. The steepest drop in this shift happened in a single decade, from 1970 to 1980.
In the interactive graphic, you’ll see graphs for 200 different countries and political entities showing their total fertility rate (FTR) over time. Here’s a quick summary of the countries with the highest and lowest FTRs, as of 2017:
|Top 10 Countries||Fertility rate||Bottom 10 Countries||Fertility Rate|
|🇳🇪 Niger||7.13||🇹🇼 Taiwan||1.22|
|🇸🇴 Somalia||6.08||🇲🇩 Moldova||1.23|
|🇨🇩 Democratic Republic of Congo||5.92||🇵🇹 Portugal||1.24|
|🇲🇱 Mali||5.88||🇸🇬 Singapore||1.26|
|🇹🇩 Chad||5.75||🇵🇱 Poland||1.29|
|🇦🇴 Angola||5.55||🇬🇷 Greece||1.3|
|🇧🇮 Burundi||5.53||🇰🇷 South Korea||1.33|
|🇺🇬 Uganda||5.41||🇭🇰 Hong Kong||1.34|
|🇳🇬 Nigeria||5.39||🇨🇾 Cyprus||1.34|
|🇬🇲 Gambia||5.29||🇲🇴 Macao||1.36|
At a glance, the countries with the highest fertility are all located in Africa, while several Asian countries end up in the lowest fertility list.
The notable decade of decline in average global fertility can be partially traced back to the actions of the demographic giants China and India. In the 1970s, China’s controversial “one child only” policy and India’s state-led sterilization campaigns caused sharp declines in births for both countries. Though they hold over a quarter of the world’s population today, the effects of these government decisions are still being felt.
Population Plateau, or Cliff?
The overall decline in fertility rates isn’t expected to end anytime soon, and it’s even expected to fall past 2.1 children per woman, which is known as the “replacement rate”. Any fertility below this rate signals fewer new babies than parents, leading to an eventual population decline.
Experts predict that world fertility will further drop from 2.5 to 1.9 children per woman by 2100. This means that global population growth will slow down or possibly even go negative.
Africa will continue to be the only region with significant growth—consistent with the generous fertility rates of Nigeria, the DRC, and Angola. In fact, the continent is expected to house 13 of the world’s largest megacities, as its population expands from 1.3 billion to 4.3 billion by 2100.
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