Current Status of Overdose and Poisoning Death Rates in the United States
The leading cause of drug overdose deaths in the United States is illegally manufactured synthetic opioids, particularly fentanyl, which is often mixed with other substances and has driven a 200% increase in opioid-related overdose deaths since 2000. 1
Current Overdose Death Statistics
- In 2019, approximately 82.6 million Americans aged 12 years or older were using prescription opioids, with 9.7 million of these prescriptions being misused 2
- The national age-adjusted death rate from drug overdoses more than tripled from 6.1 per 100,000 in 1999 to 21.6 per 100,000 in 2019 1
- In 2014,47,055 people died from drug overdoses in the United States, with 28,647 (60.9%) involving opioids 3
- By 2017, drug overdose deaths increased to 70,237, with approximately two-thirds (47,600) involving opioids 4, 5
- In 2018, there was a slight 4.1% decline to 67,367 drug overdose deaths, with 46,802 (69.5%) involving opioids 4
Patterns and Trends in Overdose Deaths
Opioid Involvement
- Synthetic opioids (primarily illicitly manufactured fentanyl) continue to drive increases in overdose deaths, with a 10% increase from 2017 to 2018 4
- From 2017 to 2018, deaths involving prescription opioids decreased by 13.5%, and heroin deaths decreased by 4.1% 4
- Among overdose deaths in early 2019 (24 states and DC):
- 48.9% involved opioids without stimulants
- 32.6% involved both opioids and stimulants
- 12.7% involved stimulants without opioids 6
Geographic and Demographic Distribution
- Significant geographic variation exists, with the highest overdose death rates in West Virginia, Delaware, Maryland, Pennsylvania, Ohio, and New Hampshire 1
- The epidemic most severely affects adults aged 25-54 years 1
- The crisis worsened during the COVID-19 pandemic, with increases in opioid-related mortality in over 40 states 1
Risk Factors and Contributing Elements
- Methadone has been found to account for as much as one-third of opioid-related overdose deaths despite representing less than 2% of opioid prescriptions outside of treatment programs 2
- Concurrent use of benzodiazepines and opioids significantly increases overdose risk, with studies finding evidence of benzodiazepine use in 31%-61% of fatal opioid overdose cases 2
- Higher opioid dosages are strongly associated with increased overdose risk:
- Compared to doses <20 MME/day, doses of 50-<100 MME/day increase overdose odds by 1.9-4.6 times
- Doses ≥100 MME/day increase overdose odds by 2.0-8.9 times 2
Prevention Opportunities
- Approximately 62.7% of overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention 6
- About 10% of overdose decedents had been released from an institutional setting in the month preceding the fatal overdose 7
- Bystanders were present in approximately 40% of overdose deaths, but naloxone was rarely administered by laypersons 7
Substance Use Patterns
- Heroin use was prevalent in 745,000 individuals, with the majority (404,000) also misusing prescription opioids 2
- About one-third of those who misuse opioids obtain them directly from a physician's prescription, while 57% obtain them from a friend or relative who had been prescribed opioids 1
- Illicitly manufactured fentanyl (IMF), heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths in early 2019 6
Recommended Approaches
- Naloxone distribution should be prioritized for persons misusing opioids or using high-dosage prescription opioids and their family members and friends 7
- Expanded treatment and support for persons who have experienced a non-fatal overdose 7
- Enhanced surveillance data collection to better understand the substances involved in and circumstances surrounding opioid overdose deaths 7
- Comprehensive prevention strategies addressing the rapid overdose progression associated with synthetic opioids and the increasing co-involvement of stimulants 6
When discussing the current overdose crisis with colleagues, it's critical to emphasize that while prescription opioid deaths have begun to stabilize or decrease, synthetic opioids (particularly illicitly manufactured fentanyl) continue to drive the epidemic, often in combination with other substances like stimulants.