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Alabama Opioid Summary

Revised March 2019

Overdose Deaths Involving Opioids

In 2017, there were 422 overdose deaths­­­ involving opioids in Alabama—a rate of 9.0 deaths per 100,000 persons and over half the national rate of 14.6 deaths per 100,000 persons. The greatest increase in opioid deaths occurred among cases involving synthetic opioids (mainly fentanyl), with a rise from 16 deaths in 2012 to 198 in 2017 (Figure 1). Heroin involved deaths also increased dramatically from 40 deaths in 2013 to 122 in 2014 but have remained unchanged through 2017. There were 167 deaths involving prescription opioids in 2017, an increase from 124 in 2016.

See textFigure 1. Number of overdose deaths involving opioids in Alabama, by opioid category. Drug categories presented are not mutually exclusive, and deaths might have involved more than one substance. Source: CDC WONDER.

Opioid Pain Reliever Prescriptions

In 2017, Alabama providers wrote 107.2 opioid prescriptions for every 100 persons (Figure 2). This was the highest prescribing rate in the country and was almost twofold greater than the average U.S. rate of 58.7 prescriptions. Still, this represents a 25 percent decline in Alabama opioid prescriptions, since 2013 (CDC).

The rate of overdose deaths involving opioid prescriptions has not followed this trend and rose from 2.1 to 3.4 deaths per 100K persons in the same 5-year period (Figure 2).

See textFigure 2. Alabama rate of overdose deaths involving prescription opioids and the opioid prescribing rate. Source: CDC and CDC WONDER.

Neonatal Abstinence Syndrome (NAS)

NAS or neonatal opioid withdrawal syndrome (NOWS) may occur when a pregnant woman uses drugs such as opioids during pregnancy. A recent national study showed a fivefold increase in the incidence of NAS/NOWS between 2004 and 2014, from 1.5 cases per 1,000 hospital births to 8.0 cases per 1,000 hospital births―that is one baby born with NAS/NOWS every 15 minutes in the United States. During the same period, hospital costs for NAS/NOWS births increased from $91 million to $563 million, after adjusting for inflation (Figure 3). State specific data on the rate of babies born with NAS/NOWS in Alabama is unavailable.

See textFigure 3. NAS/NOWS Incidence Rate and Hospital Costs for Treatment in the United States. Source: T N.A.Winkelman, et al., 2018.

HIV Prevalence and HIV Diagnoses Attributed to Injection Drug Use (IDU)

See textFigure 4. Alabama: Estimated percent of male vs. female with new HIV diagnoses, by transmission category, 2016. Source: CDC and www.AIDSVU.org.
  • U.S. Incidence: In 2016, 9 percent (3,480) of the 39,589 new diagnoses of HIV in the United States were attributed to IDU. Among males, 6.3 percent (2,530) of new cases were transmitted via IDU or male-to-male contact and IDU. Among females, 2.3 percent (950) were transmitted via IDU (CDC).
  • U.S. Prevalence: In 2016, 991,447 Americans were living with a diagnosed HIV infection—a rate of 306.6 cases per 100,000 persons. Among males, 19.9 percent (150,466) contracted HIV from IDU or male-to-male contact and IDU while 21 percent (50,154) of females were living with HIV attributed to IDU (CDC).
  • State Incidence: Of the new HIV cases in 2016, 533 occurred in Alabama. Of those, 5.6 percent occurred in males and were attributed to IDU or male-to-male contact and IDU. Among females, 7.9 percent of new HIV cases were attributed to IDU (Figure 4) (AIDSVu).
  • State Prevalence: In 2015, an estimated 12,316 persons were living with a diagnosed HIV infection in Alabama—a rate of 302 cases per 100,000 persons. Of those, 12.6 percent occurred in males and were attributed to IDU or male-to-male contact and IDU. Among females, 15 percent were living with HIV attributed to IDU (AIDSVu).

Hepatitis C (HCV) Prevalence and HCV Diagnoses Attributed to Injection Drug Use1

  • U.S. Incidence: In 2016, there were an estimated 41,200 new cases of acute HCV(CDC). Among case reports that contain information about IDU, 68.6 percent indicated use of injection drugs (CDC).
  • U.S. Prevalence: An estimated 2.4 million Americans are living with HCV based on 2013-2016 annual averages (CDC).
  • State Incidence: There were approximately 32 new cases of acute HCV (0.7 per 100,000 persons) reported in Alabama in 2016 (CDC).
  • State Prevalence: In Alabama, there are an estimated 31,300 persons living with Hepatitis C (2013-2016 annual average), a rate of 840 cases per 100,000 persons (HepVu).

The National Institute of Health Funds Center of Excellence in Pain Education

This is the logo for the NIH Pain Consortium: Centers of Excellence in Pain Education.

Alabama is home to one of the eleven Centers of Excellence in Pain Education (CoEPEs): The University of Alabama at Birmingham. The CoEPEs act as hubs for the development, evaluation, and distribution of pain management curriculum resources for medical, dental, nursing, pharmacy and other schools to improve how health care professionals are taught about pain and its treatment.

Additional Resources

NIH RePORTER FY2018 NIH-funded projects related to opioid use and use disorder in Alabama: 1


  1. Not all states collect or report data on the incidence or prevalence of Hepatitis C or on how Hepatitis C is transmitted. When available, the data will be included.
  2. Actual acute cases estimated to be 13.9 times the number of reported cases in any year.

This page was last updated March 2019

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