Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential - United States, 2003-2017

Abstract

In 2016, a total of 63,632 persons died from drug overdoses in the United States (1). Drug overdose deaths involving cocaine, psychostimulants with abuse potential (psychostimulants), or both substances combined increased 42.4% from 12,122 in 2015 to 17,258 in 2016.* Psychostimulants with abuse potential include drugs such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), and caffeine. From 2015 to 2016, cocaine-involved and psychostimulant-involved death rates increased 52.4% and 33.3%, respectively (1). A total of 70,237 persons died from drug overdoses in the United States in 2017; approximately two thirds of these deaths involved an opioid (2). CDC analyzed 2016-2017 changes in age-adjusted death rates involving cocaine and psychostimulants by demographic characteristics, urbanization levels, U.S. Census region, 34 states, and the District of Columbia (DC). CDC also examined trends in age-adjusted cocaine-involved and psychostimulant-involved death rates from 2003 to 2017 overall, as well as with and without co-involvement of opioids. Among all 2017 drug overdose deaths, 13,942 (19.8%) involved cocaine, and 10,333 (14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 for both drug categories across demographic characteristics, urbanization levels, Census regions, and states. In 2017, opioids were involved in 72.7% and 50.4% of cocaine-involved and psychostimulant-involved overdoses, respectively, and the data suggest that increases in cocaine-involved overdose deaths from 2012 to 2017 were driven primarily by synthetic opioids. Conversely, increases in psychostimulant-involved deaths from 2010 to 2017 occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years. Provisional data from 2018 indicate that deaths involving cocaine and psychostimulants are continuing to increase.^† Increases in stimulant-involved deaths are part of a growing polysubstance landscape. Increased surveillance and evidence-based multisectoral prevention and response strategies are needed to address deaths involving cocaine and psychostimulants and opioids. Enhancing linkage to care, building state and local capacity, and public health/public safety collaborations are critical components of prevention efforts.

FIGURE 1

Age-adjusted rates of drug overdose deaths involving cocaine with and without synthetic opioids other than methadone (synthetic opioids) and any opioids — United States, 2003–2017^, Source: National Vital Statistics System, Mortality File. https://wonder.cdc.gov/. * Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. ^† Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdoses are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). ^§ Drug overdose deaths, as defined, that involve cocaine (T40.5). ^¶ Drug overdose deaths, as defined, that involve any opioid (T40.0–T40.4 and T40.6) and synthetic opioids other than methadone (T40.4). ** Because deaths might involve more than one drug, some deaths are included in more than one category. In 2017, 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these deaths might have involved opioids or stimulants. ^†† Joinpoint regression examining changes in trends during 2003–2017 indicated that cocaine-involved overdose death rates remained stable from 2003 to 2006, then decreased annually by 10.8% (95% confidence interval [CI] = −18.1 to −3.0) from 2006 to 2012, followed by a 28.5% (CI = 19.8–37.9) annual increase from 2012 to 2017. Death rates involving cocaine and any opioid remained stable from 2003 to 2013, then increased annually by 41.6% (CI = 29.1–55.2) from 2013 to 2017. Death rates involving cocaine and synthetic opioids remained stable from 2003 to 2012, then increased annually by 114.2% (CI = 82.5–151.5) from 2012 to 2017. Death rates involving cocaine without any opioid remained stable from 2003 to 2006, then decreased annually by 13.8% (CI = −21.5 to −5.3) from 2006 to 2012, followed by a 14.9% (CI = 4.8–26.1) annual increase from 2012 to 2017. Death rates involving cocaine without synthetic opioids increased annually by 11.4% (CI = 2.1–21.6) from 2003 to 2006, then decreased annually by 14.9% (CI = −22.2 to −7.0) from 2006 to 2010, followed by a 6.9% annual increase (CI = 4.4–9.4) from 2010 to 2017.

FIGURE 2

Age-adjusted rates of drug overdose deaths involving psychostimulants with abuse potential (psychostimulants) with and without synthetic opioids other than methadone (synthetic opioids) and any opioids — United States, 2003–2017^, Source: National Vital Statistics System, Mortality File. https://wonder.cdc.gov/. * Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. ^† Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdoses are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). ^§ Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). ^¶ Drug overdose deaths, as defined, that involve any opioid (T40.0-T40.4, and T40.6) and synthetic opioids other than methadone (T40.4). ** Because deaths might involve more than one drug, some deaths are included in more than one category. In 2017, 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these deaths may have involved opioids or stimulants. ^†† Joinpoint regression examining changes in trends during 2003–2017 indicated that psychostimulant-involved overdose death rates remained stable from 2003 to 2010, then increased annually by 28.6% (95% confidence interval [CI] = 25.5–31.8) from 2010 to 2017. Death rates involving psychostimulants and any opioid increased annually by 6.9% (CI = 1.0–13.1) from 2003 to 2010, then increased annually by 28.2% (CI = 18.2–39.1) from 2010 to 2015, followed by a 50.8% (CI = 31.6–72.8) annual increase from 2015 to 2017. Death rates involving psychostimulants and synthetic opioids were greater than zero only during 2010–2017. From 2010 to 2015, these rates increased annually by 44.7% (CI = 2.8–103.5), followed by a 142.8% (CI = 43.7–310.2) annual increase from 2015 to 2017. Death rates involving psychostimulants without any opioids remained stable from 2003 to 2008, then increased annually by 22.3% (CI = 20.6–24.0) from 2008 to 2017. Death rates involving psychostimulants without synthetic opioids remained stable from 2003 to 2008, then increased annually by 22.3% (CI = 20.7–23.9) from 2008 to 2017.