In 2023, there were around 97,231 deaths in the United States due to unintentional drug overdose. Drug overdose, motor vehicle traffic accidents, and falls are the leading causes of unintentional injury death in the United States.

Unintentional injuries claimed the lives of ******* Americans in 2023, marking a slight decrease from the previous year. This figure represents a significant public health concern. While heart disease and cancer typically top the list of mortality causes, unintentional injuries were the ***** leading cause of death in 2023. Poisoning emerges as a major contributor Among the various types of unintentional injuries, poisoning stands out as a particularly deadly threat. In 2023, approximately ******* deaths were attributed to unintentional poisoning, accounting for nearly half of all accident-related fatalities. That year, the death rate due to poisoning reached **** per 100,000 population. Unintentional drug overdose deaths account for a majority of poisoning deaths in the United States, with opioids, and in particular fentanyl, currently fueling these high numbers. Home safety remains a critical concern The home environment, often considered a safe haven, continues to be a significant site for unintentional injury-related deaths. In 2021 and 2022, the rate of such fatalities occurring at home peaked at **** per 100,000 population. Most unintentional injury deaths at home occur among elderly people, with falls accounting for the majority of such deaths among this age group.

In 2023, the death rate from drug overdose in the United States stood at around 29 per 100,000 population, while the death rate from motor vehicle traffic accidents was 12.5 per 100,000 population. Drug overdose, motor vehicle traffic accidents, and falls are the leading causes of unintentional injury death in the United States.

Background: Drug overdoses and motor vehicle (MV) crashes are leading causes of unintentional injury death in the US, resulting in over 100,000 fatalities in 2017. Research has established that opioids affect driving ability and that crash-related injuries often result in opioid prescribing. Despite known associations, current approaches for studying these intertwined public health problems typically involve separate analyses using discrete databases. Purpose: To assess collection of relevant data elements and evaluate the linkage potential of prescription drug monitoring programs (PDMP) with crash databases, and to determine knowledge gaps that can be addressed through effective linkage. Methods: Standardized templates were used to abstract specific data elements and attributes of MV crash and PDMP databases for all 50 states and DC. Abstracted PDMP elements included accessibility of PDMP data and schedules of controlled substances monitored in each state, while crash-related elements included whether crash reports document the type of drug test administered at the scene and the granularity of test results recorded. Results: A majority of PDMPs (94%) are authorized to release data for research purposes. Schedules II-V controlled substances are tracked in 76% of PDMPs, with the remaining tracking II-IV. Drug-related elements captured in crash reports varied considerably by state. Eighty-six percent of states document the type of drug test administered; however, 54% of states only record whether a drug test was positive or negative, with less than a third of states citing specific drugs. Collection of personal identifiers is required in all crash and PDMP databases, suggesting high potential for effective linkage. Conclusions: Lack of integration between crash and PDMP databases hinders advancement of the evidence base on the interconnected causes of unintentional injury death. While crash reports and PDMPs possess their own sets of strengths and weaknesses, linkage of these two data sources could fill critical research gaps

This data contains provisional counts for drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. Counts for the most recent final annual data are provided for comparison. National 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 (see Technical notes) resulting in an underestimate relative to final counts. To address this, methods were developed to adjust provisional counts for reporting delays by generating a set of predicted provisional counts (see Technical notes). Starting in June 2018, this monthly data release will include both reported and predicted provisional counts.

The provisional data include: (a) the reported and predicted provisional counts of deaths due to drug overdose occurring nationally and in each jurisdiction; (b) the percentage changes in provisional drug overdose deaths for the current 12 month-ending period compared with the 12-month period ending in the same month of the previous year, by jurisdiction; and (c) the reported and predicted provisional counts of drug overdose deaths involving specific drugs or drug classes occurring nationally and in selected jurisdictions. The reported and predicted provisional counts represent the numbers of deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.

Several data quality metrics, including the percent completeness in overall death reporting, percentage of deaths with cause of death pending further investigation, and the percentage of drug overdose deaths with specific drugs or drug classes reported are included to aid in interpretation of provisional data as these measures are related to the accuracy of provisional counts (see Technical notes). Reporting of the specific drugs and drug classes involved in drug overdose deaths varies by jurisdiction, and comparisons of death rates involving specific drugs across selected jurisdictions should not be made (see Technical notes). Provisional data will be updated on a monthly 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 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. 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 (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 2017 would include deaths occurring from July 1, 2016, through June 30, 2017. The 12-month ending period counts include all seasons of the year and are insensitive to reporting variations by seasonality. Counts for the 12-month period ending in the same month of the previous year are shown for comparison. 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. Methods to adjust provisional counts have been developed to provide predicted provisional counts of drug overdose deaths, accounting for delayed reporting (see Percentage of records pending investigation and Adjustments for delayed reporting).

Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period. Therefore, they should not be considered comparable with final data and are subject to change.

Cause-of-death classification and definition of drug deaths
Mortality statistics are compiled in accordance with World Health Organization (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 in 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). Drug overdose deaths involving selected drug categories are identified by specific multiple cause-of-death codes. Drug categories presented include: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol (T40.4); cocaine (T40.5); and psychostimulants with abuse potential, which includes methamphetamine (T43.6). Opioid overdose deaths are identified by the presence of any of the following MCOD codes: opium (T40.0); heroin (T40.1); natural opioid analgesics (T40.2); methadone (T40.3); synthetic opioid analgesics other than methadone (T40.4); or other and unspecified narcotics (T40.6). This latter category includes drug overdose deaths where ‘opioid’ is reported without more specific information to assign a more specific ICD–10 code (T40.0–T40.4) (3,4). Among deaths with an underlying cause of drug overdose, the percentage with at least one drug or drug class specified is defined as that with at least one ICD–10 multiple cause-of-death code in the range T36–T50.8.

Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs. For example, a death that involved both heroin and fentanyl would be included in both the number of drug overdose deaths involving heroin and the number of drug overdose deaths involving synthetic opioids other than methadone.

Selection of specific states and other jurisdictions to report
Provisional counts are presented by the jurisdiction in which the death occurred (i.e., the reporting jurisdiction). Data quality and timeliness for drug overdose deaths vary by reporting jurisdiction. Provisional counts are presented for reporting jurisdictions based on measures of data quality: the percentage of records where the manner of death is listed as “pending investigation,” the overall completeness of the data, and the percentage of drug overdose death records with specific drugs or drug classes recorded. These criteria are defined below.

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. For jurisdictions reporting fewer than 1% of records as “pending investigation”, the provisional number of drug overdose deaths occurring in the fourth quarter of 2015 was approximately 5% lower than the final count of drug overdose deaths occurring in that same time period. For jurisdictions reporting greater than 1% of records as “pending investigation” the provisional counts of drug overdose deaths may underestimate the final count of drug overdose deaths by as much as 30%. Thus, jurisdictions are included in Table 2 if 1% or fewer of their records in NVSS are reported as “pending investigation,” following a 6-month lag for the 12-month ending periods included in the dashboard. Values for records pending investigation are updated with each monthly release and reflect the most current data available.

Percent completeness

NCHS receives monthly counts of the estimated number of deaths from each jurisdictional vital registration offices (referred to as “control counts”). This number represents the best estimate of how many

Rank, number of deaths, percentage of deaths, and age-specific mortality rates for the leading causes of death, by age group and sex, 2000 to most recent year.

Opioid abuse is now the primary cause of accidental deaths in the United States. Studies over several decades established the cyclical nature of abused drugs of choice, with a current resurgence of heroin abuse and, more recently, fentanyl’s emergence as a major precipitant of drug-related deaths. To better understand abuse trends and to explore the potential lethality of specific drug–drug interactions, we conducted statistical analyses of forensic toxicological data from the Wayne County Medical Examiner’s Office from 2012–2016. We observed clear changes in opioid abuse over this period, including the rapid emergence of fentanyl and its analogs as highly significant causes of lethality starting in 2014. We then used Chi-square Automatic Interaction Detector (CHAID)-based decision tree analyses to obtain insights regarding specific drugs, drug combinations, and biomarkers in blood most predictive of cause of death or circumstances surrounding death. The presence of the non-opioid drug acetaminophen was highly predictive of drug-related deaths, likely reflecting the abuse of various combined acetaminophen-opioid formulations. The short-lived cocaine adulterant levamisole was highly predictive of a short post-cocaine survival time preceding sudden non-drug-related death. The combination of the opioid methadone and the antidepressant citalopram was uniformly linked to drug death, suggesting a potential drug–drug interaction at the level of a pathophysiological effect on the heart and/or drug metabolism. The presence of fentanyl plus the benzodiazepine midazolam was diagnostic for in-hospital deaths following serious medical illness and interventions that included these drugs. These data highlight the power of decision tree analyses not only in the determination of cause of death, but also as a key surveillance tool to inform drug abuse treatment and public health policies for combating the opioid crisis.