Percentage of Overdose Deaths Involving Prescription Opioids in 2018

In 2018, approximately 32% of opioid-involved overdose deaths in the United States involved prescription opioids. 1, 2, 3

Breakdown of 2018 Opioid Overdose Death Statistics

According to the most recent data from the Centers for Disease Control and Prevention:

In 2018, there were approximately 67,367 total drug overdose deaths in the United States 3
Of these, 46,802 (69.5%) involved opioids 3
Prescription opioids were involved in about one-third of these opioid-related deaths 1, 2

The pattern of opioid involvement in overdose deaths can be categorized as follows:

17.4% of opioid overdose decedents tested positive for prescription opioids only 2
58.7% tested positive for illicit opioids only (heroin, illicitly manufactured fentanyl, and fentanyl analogs) 2
18.5% tested positive for both prescription and illicit opioids 2
5.5% of deaths could not be classified by opioid type 2

From 2017 to 2018, there were notable changes in opioid overdose patterns:

Deaths involving all opioids decreased by 2% 3
Deaths involving prescription opioids specifically decreased by 13.5% 3
Deaths involving heroin decreased by 4.1% 3
However, deaths involving synthetic opioids (primarily illicitly manufactured fentanyl) increased by 10% 3

Several important risk factors were identified in the data:

Approximately 10% of overdose decedents had been released from an institutional setting in the month preceding their fatal overdose 2
Bystanders were present in approximately 40% of overdose deaths, yet naloxone was rarely administered by laypeople 2
62.6% of all opioid deaths in early 2018 co-occurred with at least one common non-opioid drug (such as benzodiazepines, cocaine, or methamphetamine) 4

These findings highlight several important considerations for healthcare providers:

The risk of overdose increases substantially with higher opioid dosages, particularly above 50 MME/day 5
Concurrent use of benzodiazepines and opioids significantly increases overdose risk, with studies finding evidence of concurrent benzodiazepine use in 31%-61% of opioid overdose decedents 5
Methadone has been associated with disproportionate numbers of overdose deaths relative to prescribing frequency, accounting for as much as a third of opioid-related overdose deaths despite representing less than 2% of opioid prescriptions 5

Based on these findings, key prevention strategies include:

Prioritizing naloxone distribution to persons using opioids and their family/friends 2
Expanding treatment and support for persons who have experienced a non-fatal overdose 2
Improving linkage to and engagement in risk-reduction services 4
Providing evidence-based treatment for persons with opioid and other substance use disorders, with attention to polysubstance use 4
Using Prescription Drug Monitoring Programs (PDMPs) to reduce doctor shopping and overdoses 1