State-Level History of Overdose Deaths Involving Stimulants in the United States, 1999‒2020

Abstract

Objectives. To examine the state-level history of US overdose deaths involving stimulants with and without opioids from 1999 to 2020. Methods. We used death certificate data from the National Center for Health Statistics to categorize deaths into 4 groups of interest: cocaine with and without opioids, and psychostimulants with and without opioids. We used a Bayesian multiple change point model to describe the timing and magnitude of changes in overdose death rates involving stimulants for each state and year. Results. There was little change in the death rates of cocaine without opioids. Death rates involving cocaine and opioids sharply increased around 2015, particularly in the Northeast and Mid-Atlantic. We also observed steady increases in deaths involving psychostimulants without opioids just before 2010, particularly in states in the West and South. Deaths involving psychostimulants with opioids increased around 2015 with largest increases concentrated in Appalachian states. Conclusions. There is significant geographic heterogeneity in the co-involvement of stimulants in the US overdose crisis. Results can inform public health efforts to inform state-level overdose efforts such as naloxone distribution. (Am J Public Health. 2023;113(9):991-999. https://doi.org/10.2105/AJPH.2023.307337).

FIGURE 1—

Estimates of the Overdose Death Rates per 100 000 Residents: United States, 1999–2020 Note. Vertical axis is truncated at 15 per 100 000. Full series for West Virginia and Washington, DC, are available in Appendix Figure A.

FIGURE 2—

Estimated Overdose Death Rates per 100 000 Residents From (a) Cocaine Without Opioids, (b) Cocaine With Opioids, (c) Psychostimulants Without Opioids, and (d) Psychostimulants With Opioids: United States, 1999–2020 Note. Sites are sorted by Centers for Medicare and Medicaid Services region.

FIGURE 3—

Estimated Log Odds of a Change in the Overdose Death Rate for Each US State From 1999–2020 Note. Red points represent a posterior probability that the death rate increased from the previous year of greater than 0.9 and blue points represent a posterior probability that the rate decreased from the previous year of greater than 0.9.