Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths - United States, 2013-2019

Abstract

Deaths involving synthetic opioids other than methadone (synthetic opioids), which largely consist of illicitly manufactured fentanyl; psychostimulants with abuse potential (e.g., methamphetamine); and cocaine have increased in recent years, particularly since 2013 (1,2). In 2019, a total of 70,630 drug overdose deaths occurred, corresponding to an age-adjusted rate of 21.6 per 100,000 population and a 4.3% increase from the 2018 rate (20.7) (3). CDC analyzed trends in age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, heroin, and prescription opioids during 2013-2019, as well as geographic patterns in synthetic opioid- and psychostimulant-involved deaths during 2018-2019. From 2013 to 2019, the synthetic opioid-involved death rate increased 1,040%, from 1.0 to 11.4 per 100,000 age-adjusted (3,105 to 36,359). The psychostimulant-involved death rate increased 317%, from 1.2 (3,627) in 2013 to 5.0 (16,167) in 2019. In the presence of synthetic opioid coinvolvement, death rates for prescription opioids, heroin, psychostimulants, and cocaine increased. In the absence of synthetic opioid coinvolvement, death rates increased only for psychostimulants and cocaine. From 2018 to 2019, the largest relative increase in the synthetic opioid-involved death rate occurred in the West (67.9%), and the largest relative increase in the psychostimulant-involved death rate occurred in the Northeast (43.8%); these increases represent important changes in the geographic distribution of drug overdose deaths. Evidence-based prevention and response strategies including substance use disorder treatment and overdose prevention and response efforts focused on polysubstance use must be adapted to address the evolving drug overdose epidemic.

FIGURE 1

Age-adjusted rates* of drug overdose deaths involving prescription opioids, heroin, cocaine, psychostimulants with abuse potential, and synthetic opioids other than methadone^, — United States, 2013–2019 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 were classified using the International Classification of Diseases, Tenth Revision. 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 natural and semisynthetic opioids (T40.2) or methadone (T40.3). ^¶ Drug overdose deaths, as defined, that involve heroin (T40.1). ** Drug overdose deaths, as defined, that involve cocaine (T40.5). ^†† Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). ^§§ Drug overdose deaths, as defined, that involve 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 2019, 6.3% of drug overdose deaths did not include information on the specific type of drug(s) involved.

FIGURE 2

Age-adjusted rates* of drug overdose deaths involving prescription opioids, heroin, cocaine, and psychostimulants with abuse potential, with (A) and without (B) synthetic opioids other than methadone^, — United States, 2013–2019 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 were classified using the International Classification of Diseases, Tenth Revision. 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 natural and semisynthetic opioids (T40.2) or methadone (T40.3). ^¶ Drug overdose deaths, as defined, that involve heroin (T40.1). ** Drug overdose deaths, as defined, that involve cocaine (T40.5). ^†† Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). ^§§ Drug overdose deaths, as defined, that involve 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 2019, 6.3% of drug overdose deaths did not include information on the specific type of drug(s) involved.

FIGURE 3

Percentage* and relative change in age-adjusted rates^,,, of drug overdose deaths involving synthetic opioids other than methadone (A, B) and psychostimulants with abuse potential (C, D)^,* — United States, 2018–2019 Source: National Vital Statistics System, Mortality File. https://wonder.cdc.gov/ Abbreviation: DC = District of Columbia. *State-level analyses of the percentage of drug overdose deaths involving synthetic opioids excluded one state and involving psychostimulants excluded two states that did not meet the following criteria: >80% of drug overdose death certificates named at least one specific drug in 2019 and ≥10 deaths occurred in 2019 in the specific drug category. ^† Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. ^§ Z-tests were used if the number of deaths was ≥100 in both 2018 and 2019, and p<0.05 was statistically significant. Nonoverlapping confidence intervals (CIs) based on the gamma method were used if the number of deaths was <100 in 2018 or 2019. The method of comparing CIs is a conservative method for statistical significance; caution should be observed when interpreting a nonsignificant difference when the lower and upper limits being compared overlap only slightly. https://www.cdc.gov/nchs/data/NVSR/NVSR61/NVSR61_04.pdf ^¶ States with a statistically significant change in age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone during 2018–2019 were Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kentucky, Minnesota, Mississippi, New Mexico, New York, Ohio, Tennessee, Texas, Virginia, Washington, and Wisconsin. States with a statistically significant change in age-adjusted rate of drug overdose deaths involving psychostimulants with abuse potential during 2018–2019 were Arizona, California, Florida, Indiana, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, and Wisconsin. ** State-level analyses comparing death rates from 2018 to 2019 excluded nine states that did not meet the following criteria: >80% of drug overdose death certificates named at least one specific drug in 2018 and 2019 and ≥20 deaths occurred during 2018 and 2019 in the drug category examined. ^†† Deaths were classified using the International Classification of Diseases, Tenth Revision. 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 synthetic opioids other than methadone (T40.4). ^¶¶ Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). *** Because deaths might involve more than one drug, some deaths are included in more than one category. In 2019, 6.3% of drug overdose deaths did not include information on the specific type of drug(s) involved.