Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants - 24 States and the District of Columbia, January-June 2019

Abstract

Introduction: Provisional estimates indicate that drug overdose deaths increased in 2019 after a slight decrease in 2018. In 2018, overdose deaths primarily involved opioids, with continued increases in deaths involving illicitly manufactured fentanyls (IMFs). Deaths involving stimulants such as cocaine and methamphetamine are also increasing, mainly in combination with opioids.

Methods: CDC analyzed data on drug overdose deaths during January-June 2019 from 24 states and the District of Columbia (DC) in the State Unintentional Drug Overdose Reporting System to describe characteristics and circumstances of opioid- and stimulant-involved overdose deaths.

Results: Among 16,236 drug overdose deaths in 24 states and DC, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants. Approximately 80% of overdose deaths involved one or more opioid, and IMFs were involved in three of four opioid-involved overdose deaths. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths. More than three in five (62.7%) overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention.

Conclusions and implications for public health practice: Identifying opportunities to intervene before an overdose death and implementing evidence-based prevention policies, programs, and practices could save lives. Strategies should address characteristics of overdoses involving IMFs, such as rapid overdose progression, as well as opioid and stimulant co-involvement. These efforts should be complemented by efforts to prevent initiation of prescription opioid and stimulant misuse and illicit drug use.

FIGURE 1

Distribution of opioid/stimulant involvement in drug overdose deaths, by geographic region — State Unintentional Drug Overdose Reporting System (SUDORS), 25 jurisdictions, January–June 2019 *Midwestern: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Northeastern: Connecticut, Maine, Massachusetts, New Jersey, Pennsylvania, Rhode Island, and Vermont; Southern: Delaware, District of Columbia, Georgia, Kentucky, North Carolina, Oklahoma, Tennessee, and West Virginia; Western: Alaska, Nevada, Utah, and Washington. ^† Pairwise chi-squared testing found statistically significant differences (p<0.01) for each pairwise comparison of regions.

FIGURE 2

Percentage of drug overdose deaths involving the 10 most common combinations of opioids and stimulants (mutually exclusive), by involvement of illicitly manufactured fentanyls (IMFs) — State Unintentional Drug Overdose Reporting System (SUDORS), 25 jurisdictions, January–June 2019^, Abbreviation: Rx = prescription. * Drug overdose deaths involving IMFs with no other opioids or stimulants was the most frequent combination among Northeastern (24.3%), Midwestern (21.2%), and Southern (15.4%) jurisdictions. ^† Drug overdose deaths involving methamphetamine with no other opioids or stimulants was the most frequent combination among Western jurisdictions (22.1%).

FIGURE 3

Potential opportunities for intervention, by opioid/stimulant involvement — State Unintentional Drug Overdose Reporting System (SUDORS), 25 jurisdictions, January–June 2019^,,,, Abbreviation: SUD = substance use disorder. * Sample for this figure limited to deaths for which the medical examiner/coroner report was available, at least one overdose-specific circumstance field was abstracted, and none of the fields for characteristics had missing data. N = 15,295 (94.2% of the total 16,236 sample). ^† Pairwise chi-squared testing for at least one potential opportunity, recent release from institution, previous overdose, and ever treated for SUD found statistically significant differences (p<0.01) for all comparisons except opioid/no stimulant versus opioid/stimulant and stimulant/no opioid versus no opioid/no stimulant. ^§ Pairwise chi-squared testing for mental health diagnosis found statistically significant differences (p<0.01) for all comparisons. ^¶ Pairwise chi-squared testing for bystander present found statistically significant differences (p<0.01) for opioid/no stimulant, opioid/stimulant, and stimulant/no opioid versus no opioid/no stimulant. ** Pairwise chi-squared testing for fatal drug use witnessed found statistically significant differences (p<0.01) for all comparisons except opioid/no stimulant versus no opioid/no stimulant and stimulant/no opioid versus no opioid/no stimulant.