In the nation's opioid epidemic, the carnage is far from over.
A new projection of opioid overdose death rates suggests that even if there is steady progress in reducing prescription narcotics abuse nationwide, the number of fatal overdoses -- which reached 47,600 in 2017 -- will rise sharply in the coming years.
By 2022, such deaths would peak at about 75,400, and begin to level off afterward, according to the forecast.
That's the rosiest scenario. Under conditions that are only slightly less optimistic, the U.S. could have 81,700 opioid overdose deaths per year by 2025.
If the supply of prescription painkillers stops declining and there are other setbacks, researchers predict that yearly opioid overdose deaths could rise as high as 200,000 per year by 2025.
The opioid epidemic "is not finished growing," said Jagpreet Chhatwal of Harvard Medical School and Massachusetts General Hospital, who led the research. "It's far from over. And it's far from moving in the right direction."
Almost two decades after the widening use of prescription painkillers began to fuel an epidemic of addiction, opiates kill an average of 130 people a day in the U.S., according to the Centers for Disease Control and Prevention.
The driving force of the epidemic has changed. These days, an increasing proportion of overdose victims first got hooked on street drugs like heroin. And since 2016, the explosive growth of fentanyl -- an illicit opiate that is highly lethal -- has worsened the epidemic.
Meanwhile, many Americans who were first exposed to opiates by prescription have continued to misuse the drugs over many years, said Dr. Donald Burke, who studies the American drug epidemic at the University of Pittsburgh and was not involved in the new research. Until these people either are treated or die of overdoses, they form a "reservoir" of potential victims for the spiraling epidemic, he said.
The new modeling effort, published Friday in the journal JAMA Network Open, finds that slowing the epidemic's upward trajectory before 2025 will require broad-based action, and more than a bit of luck.