These two populations are not the same. There is some overlap between the two, but that does not mean they can be lumped together for the purpose of a generalized conclusion. Instead, epidemiological investigations look at a target population, that is to say the group of people about which conclusions will be drawn.



Again, these are distinct populations. The target population for reducing car crash fatalities is not the same as the target population for reducing opioid overdose fatalities.



As a result, a general comparison between the odds of dying of an opioid overdose versus a car crash is not statistically meaningful. Moreover, such comparisons misconstrue risk management and may lead to poor allocation of resources.



For instance, in 2017 there were 2,008 fatal overdoses with Benadryl and 1,250 with tramadol, according to the CDC. But this does not mean that Benadryl is more dangerous than tramadol. Far more people use Benadryl than tramadol, and usually without a prescription or monitoring. Ranking one as inherently more dangerous than the other would not lead to good public health policy.



Further, the risk of opioid overdose rises when people use other substances like alcohol, benzodiazepines or cocaine. Similarly, the risk of fatal car crashes rises when driving under the influence or other risky driving behaviors are involved. Because most people do not do these things, they are at the low end of the range of risk in the population at risk.



State laws like California’s AB 2760 requiring naloxone co-prescribing may help reduce opioid overdoses, but only if they reach people at greater risk. And resources committed to people at low risk may be taking resources away from people at high risk.



So although the National Safety Council’s report may be technically accurate, it is flawed and misleading. Most people are much more likely to die in a car crash because they are exposed to that risk on a regular basis. Only a small number of people are more likely to die of an opioid overdose, and risk reduction strategies need to be directed to them.

The NSC is a nonprofit that promotes itself as a "data-driven organization," but this is not the first time it has provided misleading information about opioids. As PNN has reported, an NSC memorial to opioid victims that toured the country last year overestimated the number of Americans who overdosed on prescription opioids by about 25 percent.

Good public health policy involves assessing the relative risks for the population at risk and adopting effective harm reduction policies. Sweeping statements that confuse a population at risk with the population at large can only lead to bad policies. And we’ve seen enough of those.