In 2023, around 72,776 people in the United States died from a drug overdose that involved fentanyl. This was the second-highest number of fentanyl overdose deaths ever recorded in the United States, and a significant increase from the number of deaths reported in 2019. Fentanyl overdoses are now the driving force behind the opioid epidemic, accounting for the majority of overdose deaths in the United States. What is fentanyl? Fentanyl is an extremely potent synthetic opioid similar to morphine, but more powerful. It is a prescription drug but is also manufactured illegally and is sometimes mixed with other illicit drugs such as heroin and cocaine, often without the user’s knowledge. The potency of fentanyl makes it very addictive and puts users at a high risk for overdose. Illegally manufactured fentanyl has become more prevalent in the United States in recent years, leading to a huge increase in drug overdose deaths. In 2022, the rate of drug overdose death involving fentanyl was 22.7 per 100,000 population, compared to a rate of just one per 100,000 population in the year 2013. Fentanyl overdoses by gender and race/ethnicity As of 2022, the rate of drug overdose deaths involving fentanyl in the United States is over two times higher among men than women. Rates of overdose death involving fentanyl were low for both men and women until around the year 2014 when they began to quickly increase, especially for men. In 2022, there were around 19,880 drug overdose deaths among women that involved fentanyl compared to 53,958 such deaths among men. At that time, the rate of fentanyl overdose deaths was highest among non-Hispanic American Indian or Alaska Natives and lowest among non-Hispanic Asians. However, from the years 2014 to 2018, non-Hispanic whites had the highest fentanyl overdose death rates.

The graph illustrates the number of deaths from fentanyl in the United States from 1999 to 2022. The x-axis represents the years, spanning from '99 to '22, while the y-axis displays the annual number of fentanyl-related fatalities. Over this 24-year period, deaths rise dramatically from 730 in 1999 to a peak of 73,838 in 2022. Notable milestones include an increase to 1,742 deaths in 2005, a significant jump to 9,580 in 2015, and a sharp escalation to 70,601 deaths by 2021. The data reveals a consistent and severe upward trend in fentanyl-related deaths, particularly accelerating in the mid-2010s. This information is presented in a line graph format, effectively highlighting the dramatic increase in fatalities due to fentanyl across the United States over the specified years.

From 1999 to 2022, the number of drug overdose deaths among U.S. females increased from ***** in 1999 to ****** in 2022. Globally, drug use is a general problem. As of 2021, there were an estimated *** million global drug consumers and **** million drug addicts. Opioid use in the United States Among many demographics, drug overdose deaths continue to rise in the United States. Opioids are the most commonly reported substance in drug-related deaths. The number of drug-related deaths in the U.S. due to opioids has dramatically increased since the early 2000s. In 2017, then-President Donald Trump declared a national emergency over the opioid crisis in the United States. Since then, there have been joint efforts among various governmental departments to address the opioid crisis through education and outreach. Substance use treatment Substance abuse treatment is vital in reducing the number of drug overdose deaths in the United States. As of 2020, the state of California had the largest number of substance abuse treatment facilities . However, many states in the U.S. have less than 100 substance abuse treatment facilities.

Data on drug overdose death rates, by drug type and selected population characteristics. Please refer to the PDF or Excel version of this table in the HUS 2019 Data Finder (https://www.cdc.gov/nchs/hus/contents2019.htm) for critical information about measures, definitions, and changes over time. SOURCE: NCHS, National Vital Statistics System, numerator data from annual public-use Mortality Files; denominator data from U.S. Census Bureau national population estimates; and Murphy SL, Xu JQ, Kochanek KD, Arias E, Tejada-Vera B. Deaths: Final data for 2018. National Vital Statistics Reports; vol 69 no 13. Hyattsville, MD: National Center for Health Statistics.2021. Available from: https://www.cdc.gov/nchs/products/nvsr.htm. For more information on the National Vital Statistics System, see the corresponding Appendix entry at https://www.cdc.gov/nchs/data/hus/hus19-appendix-508.pdf.

This data presents counts of provisional drug overdose deaths by selected drugs and U.S. Department of Health and Human Services (HHS) public health regions, based on provisional mortality data from the National Vital Statistics System. This data is limited to drug overdose deaths with an underlying cause of death assigned to International Statistical Classification of Diseases, 10th Revision (ICD-10) code numbers X40-X44 (unintentional), X60-X64 (suicide), X85 (homicide), or Y10-Y14 (undetermined intent). Specific drugs were identified using methods for searching literal text from death certificates. The provisional data are based on a current flow of mortality data and include reported 12 month-ending provisional counts of drug overdose deaths by jurisdiction of occurrence and specified drug. Provisional drug overdose death counts presented on this page are for “12-month ending periods,” defined as the number of deaths occurring in the 12-month period ending in the month indicated. For example, the 12-month ending period in June 2022 would include deaths occurring from July 1, 2021, through June 30, 2022. Evaluation of trends over time should compare estimates from year to year (June 2021 and June 2022), rather than month to month, to avoid overlapping time periods. It is important to note that the data represent counts of deaths, and not mortality ratios or rates, which are the standard measure used to compare groups, and therefore should not be used to determine populations at disproportionate risk of drug overdose death.

ObjectiveU.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both.MethodsWe use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015–2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends.ResultsMortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality.ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods.ConclusionThe reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.

This dashboard provides in-depth analysis surrounding events and characteristics of individuals who experienced non-fatal and/or fatal opioid overdoses in the District of Columbia. It includes data on ambulance transports for overdoses, fatalities, naloxone distribution, harm reduction efforts and the results of our used syringe testing. Data is aggregated at the neighborhood and ward levels. Data on fatal opioid overdoses will include deaths from 2021-2024. Data on non-fatal opioid overdoses will include incidents from 2021-2024. Note: Fatal opioid overdose data are delayed by approximately 90 days due to toxicological testing.

Deaths as a result of drug overdoses in Portugal amounted to ** in 2019, which is the second highest number of annual deaths reported in the provided time interval. In 2011, drug deaths fell to only **, before reaching ** just four years later. In 2020, drug-induced deaths were counted at **. In 2021, there were ** deaths by overdose, the highest value recorded. Low death rate compared to Europe When compared with the rest of Europe, Portugal has a fairly low incidence of drug deaths. A rate of ** drug deaths per million population (pmp) means that Portugal only had a higher drug death rate than a few countries in the continent, and a significantly lower rate than the ** deaths pmp in Norway, which is the highest in Europe. In 2001, Portugal became the first country in the world to decriminalize the consumption of drugs. The low amount of drug deaths in Portugal is usually attributed to this policy of decriminalization. Breakdown of drugs consumed The class of drugs that caused the highest share of individuals seeking treatment in Portugal, in 2021, were cannabis, with approximately ** percent of Portuguese drug treatment entrants seeking treatment primarily due to the use of this drug class. With a slightly lower share, opioids caused **** percent of drug treatment entries in Portugal. In 2022, Portugal had approximately ****** individuals in opioid substitution treatment, which was the sixth-highest in Europe.

We collect data and report statistics on opioid, stimulant, and other substance use and their impact on health and well-being.

The 2021 annual report of the fatal overdose trends in Tennessee.

A listing of each accidental death associated with drug overdose in Connecticut from 2012 to 2021. A "Y" value under the different substance columns indicates that particular substance was detected.

Data are derived from an investigation by the Office of the Chief Medical Examiner which includes the toxicity report, death certificate, as well as a scene investigation.

The “Morphine (Not Heroin)” values are related to the differences between how Morphine and Heroin are metabolized and therefor detected in the toxicity results. Heroin metabolizes to 6-MAM which then metabolizes to morphine. 6-MAM is unique to heroin, and has a short half-life (as does heroin itself). Thus, in some heroin deaths, the toxicity results will not indicate whether the morphine is from heroin or prescription morphine. In these cases the Medical Examiner may be able to determine the cause based on the scene investigation (such as finding heroin needles). If they find prescription morphine at the scene it is certified as “Morphine (not heroin).” Therefor, the Cause of Death may indicate Morphine, but the Heroin or Morphine (Not Heroin) may not be indicated.

“Any Opioid” – If the Medical Examiner cannot conclude whether it’s RX Morphine or heroin based morphine in the toxicity results, that column may be checked.

The graph displays the number of drug overdose deaths in the U.S. from 2003 to 2023, with the x-axis representing the years and the y-axis showing the total overdose deaths each year. The data reveals a steady increase in deaths from 25,785 in 2003 to over 107,000 in 2022, highlighting the growing severity of the overdose crisis. The highest number of deaths occurred in 2022 (107,941), while 2023 saw a slight decrease to 105,007 deaths. A sharp rise is observed between 2015 and 2021, coinciding with the opioid epidemic and increased fentanyl-related overdoses. The data underscores the urgent need for stronger prevention and intervention efforts.

ObjectiveU.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both.MethodsWe use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015–2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends.ResultsMortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality.ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods.ConclusionThe reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.

In 2021, there were 19,250 cocaine overdose deaths in the United States that involved concurrent use of opioids, while there were 5,236 deaths from cocaine overdose with no opioid involvement. This statistic illustrates the number of cocaine overdose deaths in the United States from 2011 to 2021, by concurrent opioid involvement.

This data visualization presents county-level provisional counts for drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. County-level provisional counts include deaths occurring within the 50 states and the District of Columbia, as of the date specified and may not include all deaths that occurred during a given time period. Provisional counts are often incomplete and causes of death may be pending investigation resulting in an underestimate relative to final counts (see Technical Notes).

The provisional data presented on the dashboard below include reported 12 month-ending provisional counts of death due to drug overdose by the decedent’s county of residence and the month in which death occurred.

Percentages of deaths with a cause of death pending further investigation and a note on historical completeness (e.g. if the percent completeness was under 90% after 6 months) are included to aid in interpretation of provisional data as these measures are related to the accuracy of provisional counts (see Technical Notes). Counts between 1-9 are suppressed in accordance with NCHS confidentiality standards. Provisional data presented on this page will be updated on a quarterly basis as additional records are received.

Technical Notes

Nature and Sources of Data

Provisional drug overdose death counts are based on death records received and processed by the National Center for Health Statistics (NCHS) as of a specified cutoff date. The cutoff date is generally the first Sunday of each month. National provisional estimates include deaths occurring within the 50 states and the District of Columbia. NCHS receives the death records from the state vital registration offices through the Vital Statistics Cooperative Program (VSCP).

The timeliness of provisional mortality surveillance data in the National Vital Statistics System (NVSS) database varies by cause of death and jurisdiction in which the death occurred. The lag time (i.e., the time between when the death occurred and when the data are available for analysis) is longer for drug overdose deaths compared with other causes of death due to the time often needed to investigate these deaths (1). Thus, provisional estimates of drug overdose deaths are reported 6 months after the date of death.

Provisional death counts presented in this data visualization are for “12 month-ending periods,” defined as the number of deaths occurring in the 12 month period ending in the month indicated. For example, the 12 month-ending period in June 2020 would include deaths occurring from July 1, 2019 through June 30, 2020. The 12 month-ending period counts include all seasons of the year and are insensitive to reporting variations by seasonality. These provisional counts of drug overdose deaths and related data quality metrics are provided for public health surveillance and monitoring of emerging trends. Provisional drug overdose death data are often incomplete, and the degree of completeness varies by jurisdiction and 12 month-ending period. Consequently, the numbers of drug overdose deaths are underestimated based on provisional data relative to final data and are subject to random variation.

Cause of Death Classification and Definition of Drug Deaths

Mortality statistics are compiled in accordance with the World Health Organizations (WHO) regulations specifying that WHO member nations classify and code causes of death with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on use of the classification. Causes of death for data presented on this report were coded according to ICD guidelines described in annual issues of Part 2a of the NCHS Instruction Manual (2). Drug overdose deaths are identified using underlying cause-of-death codes from the Tenth Revision of ICD (ICD–10): X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined).

Selection of Specific Jurisdictions to Report

Provisional counts are presented by the jurisdiction where the decedent resides (e.g. county of residence). Data quality and timeliness for drug overdose deaths vary by reporting jurisdiction. Provisional counts are presented, along with measures of data quality: the percentage of records where the manner of death is listed as “pending investigation”, and a note for specific jurisdictions with historically lower levels of data completeness (where provisional 2019 data were less than 90% complete after 6 months).

Percentage of Records Pending Investigation

Drug overdose deaths often require lengthy investigations, and death certificates may be initially filed with a manner of death “pending investigation” and/or with a preliminary or unknown cause of death. When the percentage of records reported as “pending investigation” is high for a given jurisdiction, the number of drug overdose deaths is likely to be underestimated. Counts of drug overdose deaths may be underestimated to a greater extent in jurisdictions or counties where more records in NVSS are reported as “pending investigation” for the six most recent 12 month-ending periods.

Historical Completeness

The historical percent completeness of provisional data is obtained by dividing the number of death records in the NVSS database for each jurisdiction and county after a 6-month lag for deaths occurring in 2019 by the number of deaths eventually included in the final data files. Counties with historically lower levels of provisional data completeness are flagged with a note to indicate that the data may be incomplete in these areas. However, the completeness of provisional data may change over time, and therefore the degree of underestimation will not be known until data are finalized (typically 11-12 months after the end of the data year).

Differences between Final and Provisional Data

There may be differences between provisional and final data for a given data year (e.g., 2020). Final drug overdose death data published annually through NCHS statistical reports (3) and CDC WONDER undergo additional data quality checks and processing. Provisional counts reported here are subject to change as additional data are received.

Source

NCHS, National Vital Statistics System. Estimates for 2020 and 2021 are based on provisional data. Estimates for 2019 are based on final data (available from: https://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm).

References

1. Spencer MR, Ahmad F. Timeliness of death certificate data for mortality surveillance and provisional estimates. National Center for Health Statistics. 2016. Available from: https://www.cdc.gov/nchs/data/vsrr/report001.pdf
2. National Vital Statistics System. Instructions for classifying the underlying cause of death. In: NCHS instruction manual; Part 2a. Published annually.
3. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. 2020. Available from: https://www.cdc.gov/nchs/products/databriefs/db356.htm

Suggested Citation

Ahmad FB, Anderson RN, Cisewski JA, Rossen LM, Warner M, Sutton P. County-level provisional drug overdose death counts. National Center for Health Statistics. 2021.

Designed by MirLogic Solutions Corp: National Center for Health Statistics.

This statistic displays the number of deaths resulting from a drug overdose in Slovakia from 2006 to 2021. In 2021, drug overdoses led to ** fatalities in Slovakia, a decrease from the previous year.

In 2021, there were around six cocaine overdose deaths per 100,000 population in the United States that involved concurrent use of opioids, compared to around only 1.5 deaths per 100,000 population from cocaine overdose with no opioid involvement. This statistic illustrates the rate of cocaine overdose deaths in the United States from 2011 to 2021, by concurrent opioid involvement.

Drug-related mortality is a complex phenomenon, which accounts for a considerable percentage of deaths among young people in many European countries. The EMCDDA, in collaboration with national experts, has defined an epidemiological indicator with two components at present: deaths directly caused by illegal drugs (drug-induced deaths) and mortality rates among problem drug users. These two components can fulfil several public health objectives, notably as an indicator of the overall health impact of drug use and the components of this impact, identify particularly risky patterns of use, and potentially identify new risks.

There are around 50 statistical tables in this dataset. Each data table may be viewed as an HTML table or downloaded in spreadsheet (Excel format).

This study's objective is to assess how state-level COVID-19 mitigation policies have affected psychological health and related mortality from drug overdose and suicide among working age and older adults. Research to date has investigated how state-level COVID-19 policies in the United States--specifically those limiting in-person activities (e.g., stay-at-home orders, school closures) and those providing economic support (e.g., direct cash payments, eviction moratoria)--were associated with drug overdose mortality rates among U.S. working-age adults (25-64 years) during 2020 (Wolf et al., 2024). Research has also identified shifts in the predictive importance of key contextual variables--including socioeconomic conditions, racial-ethnic composition, population health profiles, and physician supply--for all-cause mortality, drug poisoning, and COVID-19-related deaths (Montez et al., 2024). The ICPSR provides variable-level metadata for the data associated with this study. The actual data may only be available from the Principal Investigator directly. The variable descriptions available through ICPSR also include information regarding the source of each variable listed, as does the Data Source field of these metadata.

This dataset provides model-based provisional estimates of the weekly numbers of drug overdose, suicide, and transportation-related deaths using “nowcasting” methods to account for the normal lag between the occurrence and reporting of these deaths. Estimates less than 10 are suppressed. These early model-based provisional estimates were generated using a multi-stage hierarchical Bayesian modeling process to generate smoothed estimates of the weekly numbers of death, accounting for reporting lags. These estimates are based on several assumptions about how the reporting lags have changed in recent months across different jurisdictions, and the resulting estimates differ from other sources of provisional mortality data. For now, these estimates should be considered highly uncertain until further evaluations can be done to determine the validity of these assumptions about timeliness. The true patterns in reporting lags will not be known until data are finalized, typically 11–12 months after the end of the calendar year. Importantly, these estimates are not a replacement for monthly provisional drug overdose death counts, or quarterly provisional mortality estimates. For more detail about the nowcasting methods and models, see: Rossen LM, Hedegaard H, Warner M, Ahmad FB, Sutton PD. Early provisional estimates of drug overdose, suicide, and transportation-related deaths: Nowcasting methods to account for reporting lags. Vital Statistics Rapid Release; no 11. Hyattsville, MD: National Center for Health Statistics. February 2021. DOI: https://doi.org/10.15620/ cdc:101132