Opioid Overdose Deaths in 2017
Of the nearly 47,000 opioid-related overdose deaths in 2017, approximately 17% involved prescription opioids only, while the majority (58.7%) involved illicit opioids only, and 18.5% involved both prescription and illicit opioids. 1
Breakdown of the 47,600 Opioid Deaths
The specific numbers translate to approximately:
- 8,250 deaths (17.4%) involved prescription opioids exclusively 1
- 27,900 deaths (58.7%) involved illicit opioids only (primarily heroin and illicitly manufactured fentanyl) 1
- 8,800 deaths (18.5%) involved both prescription and illicit opioids 1
- 2,650 deaths (5.5%) could not be classified by opioid type 1
Critical Context About the Shifting Epidemic
The 2017 data represents a pivotal transition point where illicitly manufactured fentanyl (IMF) overtook prescription opioids as the primary driver of opioid mortality. 2 From 2013 to 2017, drug overdose death rates increased 90%, driven primarily by synthetic opioids (predominantly IMF and fentanyl analogs), not prescription medications. 3
The Three-Wave Pattern
The opioid epidemic evolved through distinct phases:
- Wave 1 (1990s-2010): Prescription opioid deaths peaked at over 11,000 annually by 2012, when 255 million opioid prescriptions were written 4
- Wave 2 (2010-2013): Heroin deaths escalated as users transitioned from prescription opioids, reaching 14,495 deaths in 2017 4
- Wave 3 (2013-present): Synthetic opioid deaths surged due to IMF contamination of the illicit drug supply 2, 4
Important Clinical Implications
By 2017, two-thirds of all drug overdose deaths (67.8%) involved an opioid, but the nature of these deaths had fundamentally changed from prescription-driven to illicit fentanyl-driven mortality. 2 This distinction is critical because:
- Prescription opioid deaths began declining after 2017 3, 5
- Synthetic opioid deaths continued increasing by 10% from 2017 to 2018 despite overall opioid death decreases 5
- IMF was involved in approximately two-thirds of all opioid deaths by early 2018 3
Polysubstance Involvement
A critical finding often overlooked: 62.6% of all opioid deaths in 2018 co-occurred with at least one common nonopioid drug, with benzodiazepines present in 31-61% of fatal opioid overdoses. 6, 3 This polysubstance pattern substantially increases mortality risk, with benzodiazepine co-involvement increasing death rates 3- to 10-fold compared to opioids alone. 6
Geographic and Demographic Patterns
The hardest-hit states in 2017 were concentrated in Appalachia and the Northeast, with West Virginia (51.5 per 100,000), Delaware (43.8 per 100,000), and Maryland (37.2 per 100,000) experiencing the highest age-adjusted death rates. 7 The epidemic disproportionately affected individuals aged 25-54 years, with opioids causing 20% of all deaths in the 24-35 age group. 7