The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis.

The US mortality rate has gone up three years in a row from 2014 to 2017 (Murphy, Xu, Kochanek, & Arias, 2016, 2018; National Center for Health Statistics, 2017). Correspondingly, life expectancy at birth has declined; the first triple year decline since World War One and the devastating influenza pandemic one hundred years ago (Tejada Vera B, 2017). Most of the top ten causes of death are declining year over year; however, the third leading cause of death, unintentional injuries, has climbed in rate and rank since 2014 (Murphy et al., 2016). Driving this are deaths due to drug poisoning which exceeded 70,000 in 2017 (Hedegaard H, 2018). Annual deaths due to drug overdoses now exceed those from motor vehicle deaths, gun violence and even HIV at the height of the 1990s HIV epidemic (J Katz, 2017).