Drug overdose deaths are an unfortunate reality in the U.S., especially as these numbers continue to grow. While most people don’t intend to overdose, the reality is that everyone who engages in substance abuse is vulnerable. The question of how to prevent overdoses is complex, and is made even more difficult with the rise in synthetic opioids, poly-drug use, and medical prescriptions.
- 1.9 - 6.9
- 7 - 13
- 13.1 - 18.1
- 18.2 - 23.2
- 23.3 - 28.3
- 28.4 - 33.4
Tracking Trends in Drug Overdose Deaths
Overdose Trends in the U.S.
According to the Centers for Disease Control (CDC), drug overdoses were the number one cause of injury-related deaths in the U.S. in 2019. While overdose rates peaked in 2017 and then declined the following year, those numbers increased again in 2019 when the country reached 70,000 deaths.
Recent provisional CDC data is also showing that overdose rates rose sharply between February and May 2020 during the coronavirus pandemic. Experts predict that the total overdose deaths for the year could be as high as 90,000, which is up significantly from 2019.
To put this landscape into perspective, 841,000 people have died from a drug overdose since 1999. In 2019 alone, more than 70,000 overdose deaths were reported. These rates are only increasing in most areas, especially regarding opioids and opioid combinations. Other stark figures worth mentioning are that:
- Drug overdoses are now the leading cause of injury deaths in the U.S.
- Among people aged 25 to 64, drug overdoses cause more deaths than motor vehicle accidents.
- The total number of overdose deaths is still significantly higher than other preventable causes of death such as HIV/AIDS, car accidents, and gun deaths.
While these stats are staggering, there are ways to prevent fatal overdoses from occurring. In this article, we map out the overdose trends across the U.S. as well as provide information on how drug overdoses occur and how to prevent them.
Other current trends include:
- The highest overdose death rates occur in individuals aged 25 to 44.
- Studies show that over 70% of overdoses in 2019 (a total of 49,860) were due to opioid-related drugs — particularly fentanyl. These rates are up significantly from 3,442 deaths in 1999 to 17,029 in 2017.
- Psychostimulant overdoses from drugs like methamphetamine have skyrocketed from 547 in 1999 to 16,167 in 2019.
- Overdose deaths involving cocaine and opioid combinations have been rising steadily each year (from 3,822 in 1999 to 15,883 in 2019).
- Anti-depressant overdose death rates increased from 1,749 in 1999 to 5,269 in 2019.
- On a lighter note, overdose deaths related to benzodiazepines declined from 11,537 in 2017 to 9,711 in 2019.
- Heroin overdose deaths also declined somewhat from 15,469 in 2016 to 14,019 in 2019 (this could be partly due to the rise in fentanyl use).
- Between 2018 and 2019, the largest increase in death rates involving synthetic opioids like fentanyl occurred in the western United States (67.9%).
- In 2019, the biggest increase in overdose death rates involving psychostimulants like meth occurred in the northeast United States (43.8%).
Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2019 on CDC WONDER Online Database, released in 2020. Data are from the Multiple Cause of Death Files, 1999-2019, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
1. As of April 3, 2017, the underlying cause of death has been revised for 125 deaths in 2014. More information: http://wonder.cdc.gov/wonder/help/ucd.html#2014-Revision.
2. Circumstances in Georgia for the years 2008 and 2009 have resulted in unusually high death counts for the ICD-10 cause of death code R99, “Other ill-defined and unspecified causes of mortality.” Caution should be used in interpreting these data. More information: http://wonder.cdc.gov/wonder/help/ucd.html#Georgia-Reporting-Anomalies.
3. Circumstances in New Jersey for the year 2009 have resulted in unusually high death counts for the ICD-10 cause of death code R99, “Other ill-defined and unspecified causes of mortality” and therefore unusually low death counts in other ICD-10 codes, most notably R95, “Sudden Infant Death Syndrome” and X40-X49, “Unintentional poisoning.” Caution should be used in interpreting these data. More information: http://wonder.cdc.gov/wonder/help/ucd.html#New-Jersey-Reporting-Anomalies.
4. Circumstances in California resulted in unusually high death counts for the ICD-10 cause of death code R99, “Other ill-defined and unspecified causes of mortality” for deaths occurring in years 2000 and 2001. Caution should be used in interpreting these data. More information: http://wonder.cdc.gov/wonder/help/ucd.html#California-Reporting-Anomalies.
5. These items in the results table are not fully selected: Drug-induced causes. The Query Description lists the actual values selected.
6. Death rates are flagged as Unreliable when the rate is calculated with a numerator of 20 or less. More information: http://wonder.cdc.gov/wonder/help/ucd.html#Unreliable.
7. The populations used to calculate standard age-adjusted rates are documented here: More information: http://wonder.cdc.gov/wonder/help/ucd.html#2000 Standard Population.
8. The method used to calculate age-adjusted rates is documented here: More information http://wonder.cdc.gov/wonder/help/ucd.html#Age-Adjusted Rates.
9. Deaths for persons of unknown age are included in counts and crude rates but are not included in age-adjusted rates.
Limitations of the Data
While drug overdose data is useful, there are limitations in terms of the way this information is gathered. To start, drug overdose deaths can be difficult to categorize. For example, in approximately 1 in 5 cases, death certificates do not list the specific drugs that were in the person’s system. Even in cases where a drug is indicated, some of these are coded into broader categories which makes drug specifying difficult.
Another limitation to the data is the complexity of multiple drug use. Many overdoses are due to toxic drug combinations such as heroin and methadone or heroin and cocaine. These combinations can make it difficult to determine which drug(s) were responsible for the overdose.
Also, some synthetic opioids such as fentanyl do not yet have a designated code. This makes estimating fentanyl-related deaths difficult, although toxicology reports from coroners or medical examiners are often utilized instead.
Causes of the Overdose Crisis
The overdose crisis is a complicated issue involving personal, economic, and social considerations. Numerous factors are involved in addiction and the ways that drugs are distributed, administered, and prescribed.
Perhaps one of the most noticeable causes of the overdose crisis in the U.S. is the high rates of prescriptions written each year for drugs such as Adderall, Xanax, Vicodin, Ritalin, and Oxycodone. While blame cannot be solely attributed to the pharmaceutical companies and doctors for administering these drugs, rates for prescriptions of these highly abusable drugs have risen steadily over the years.
For example, in 2009 the number of prescriptions written was 3.95 billion, whereas that number rose to 4.22 billion in 2019. This increase in prescriptions is due to several factors, such as increased medical marketing and growing numbers of mental health conditions such as anxiety and depression. Therefore, demand has also risen with supply.
Poverty & Economics
Drug overdoses are also common in areas where there are high levels of poverty and economic displacement. Areas with low social support and job opportunity can lead individuals to turn to drugs and other substances as a way to cope. While there are numerous drug and alcohol treatment centers across the U.S., it can be difficult to support the high numbers of people who fall into cycles of addiction.
Rise in Fentanyl Use
Synthetic opioids such as fentanyl have also caused a huge spike in overdose death rates in recent years. This is because fentanyl is 50 to 100 times more potent than heroin, so overdoses can occur within seconds to minutes. Unsurprisingly, individuals can easily overdose on this drug if they are unfamiliar with safe dosages or if they are taking it unknowingly.
As most fentanyl is sold and produced illegally, the drug is often mixed with other illicit drugs such as heroin, cocaine, and MDMA. Luckily, first responders are starting to gain access to drugs like Naloxone that block the effects of opioids. However, these drugs need to be administered quickly when an overdose occurs.
How Do Overdoses Happen?
Overdoses happen when the body is overwhelmed by a substance (or a mixture of substances). While some overdoses are accidental, others are intentional. They will typically involve substances such as alcohol, illicit drugs, prescription medications, over-the-counter medicines, and more. The likelihood and severity of overdoses depend on factors such as a person’s age, body size, metabolism, and the amount and type of substances they ingested.
Sadly, many overdoses are fatal unless medical intervention is received at the right time. In most cases, overdose deaths are the result of respiratory failure, but it’s worth noting that the effects are different for each type of drug. Below are a few signs to watch out for if you or someone you know is at risk of an overdose.
Opioid overdoses involve the body’s natural opioid receptors, which are located in the brain, the nervous system, and the gastrointestinal tract. When a person ingests too much of an opioid substance, the body’s opioid receptors become blocked, and they fail to function properly. It is at this stage that an overdose can happen as the body can slow down to the point where a person stops breathing.
The rate and speed of this opioid effect differs depending on the type of substance or substances that were used simultaneously.
Key signs that indicate an opioid overdose include:
- Pinpoint pupils
- Loss of consciousness
- Difficulty breathing
- Pale face and skin
- Limp body
- Blue or purple fingernails and lips
- Inability to speak
Drugs that affect the central nervous system are called ‘depressants’ and include substances such as benzodiazepines and alcohol. Depressants are known for their sedative effect as they lower blood pressure and body temperature and slow heart rate and breathing.
When a person takes too much of a depressant, it can overwhelm these systems and lead to adverse effects such as respiratory failure, coma, or death.
Signs of a depressant overdose include:
- Slowed heart rate
- Extreme drowsiness
- Difficulty breathing
- Loss of balance
- Muscle weakness
On the opposite end of depressants are stimulants, such as methamphetamines or cocaine. These substances also affect the central nervous system by increasing blood pressure, body temperature, heart rate, and breathing.
Rather than slowing everything down, a stimulant overdose speeds up and overwhelms bodily systems to the point that they break down.
Signs of a stimulant overdose include:
- Jerking or rigid limbs
- High fever or sudden increase in body temperature
- Rapidly increasing pulse
- Loss of consciousness (or sporadic consciousness)
- Seizures or convulsions
- Chest pain
- Excessive sweating
- Disorientation or mental confusion
- Cardiac arrest
- Irregular or shallow breathing
Alcohol overdoses occur when a person drinks more than their body can process. While this varies depending on age, gender, body size, and other drug use, an average person can safely process about 1 unit of alcohol per hour (equivalent to one-third of a glass of wine or half a pint of beer).
If a person drinks more than the body can process, it can lead to alcohol poisoning.
- Signs of alcohol poisoning include:
- Mental confusion
- Slow breathing (fewer than 8 breaths per minute)
- Irregular breathing (10 seconds or more between breaths)
- Hypothermia, bluish skin color, paleness
Who is Most at Risk of an Overdose Death?
There are several risk factors involved in overdoses connected with age, lifestyle, and drug use. Statistically, people between the ages of 25 and 64 have a higher risk of dying from an overdose than a traffic accident. People in this age group are at a high risk of overdose, especially if they combine substances such as alcohol, benzodiazepines, and other prescription drugs. But there are certain subsets of people that are even more at risk.
Individuals Who Relapse
Other individuals at risk of overdoses are those who relapse from an addiction. As the body quickly loses its tolerance once a drug is discontinued, people mistakenly think they can handle the doses they previously took. This tolerance issue applies especially to opioid and psychostimulant (e.g. methamphetamine) relapses, as people can erroneously take more than their body can handle.
Individuals Who Engage in Poly-Drug Use
People who use multiple substances (“poly-drug use”) are also at risk for overdoses, especially if they forget how much they’ve taken. This often occurs in social situations where multiple drugs are available or when drugs are intentionally mixed to produce a greater high. However, some of these drug combinations are particularly dangerous.
For example, “speedballing” (a combination of cocaine and heroin) is dangerous for several reasons. The first is that the two drugs cancel each other out, creating opposing effects in the body. As one is a stimulant and the other a depressant, they can lead to overdoses when a person mistakenly thinks they are soberer than they are. Another dangerous consequence is that heroin is longer-lasting and can cause respiratory failure when the cocaine wears off.
Individuals with Co-Occurring Conditions
Underlying or co-occurring conditions (physical and mental) are another cause of overdoses. People who take opioids and have lung problems or heart conditions, for example, are at risk of adverse complications like heart attack, stroke, or respiratory failure, as these conditions and the drugs will affect their blood pressure and levels of oxygen.
Individuals with depression or other mental health conditions are also at risk, especially if they are suicidal. These individuals are more likely to overdose on one or more drugs to deliberately harm themselves.
Small children (especially under the age of 5) are also in danger of accidental overdose as they are known to swallow substances out of curiosity. If medications are left within a child’s reach without supervision, there is a risk that they will be harmed by accidental ingestion.
Due to the number of factors involved in substance addiction, preventing overdoses can be complicated. However, evidence-based harm reduction and treatment interventions are effective ways of providing education, information, support, and prevention to those who are most at risk.
Methadone and Buprenorphine
Advances in medicine have made it possible to treat opioid addiction and reduce its use. Medications such as methadone and buprenorphine enable people to safely taper off opioids like heroin and fentanyl by blocking cravings and preventing uncomfortable withdrawal symptoms. This opioid agonist therapy (OAT) is a cost-effective way to increase patient retention in treatment, decrease opioid use, as well as cut down on infectious diseases, criminal activity, and overdose deaths.
Naloxone is a fast-acting generic drug that quickly reverses an opioid overdose by restoring an individual’s respiratory system. The drug been used by doctors and emergency rooms for over 40 years, and one of its key benefits is that it has no potential for abuse.
While the drug has been successful at saving many people from fatal overdoses, additional funding is still needed to provide full access to first responders, those who are using drugs, and their friends and family.
Good Samaritan Laws
“Good Samaritan” laws can also be effective community deterrents for overdoses. These laws provide partial immunity from drug offense prosecution for people who call for help at the scene of an overdose.
While Good Samaritan laws are available in 40 states and the District of Columbia, they need to be expanded so that the barriers to calling 911 are reduced as much as possible. This includes limitations to arrests, parole violations, and immigration or child welfare consequences.
Supervised Consumption Services
Centers that provide supervised consumption services (SCS) are another useful community deterrent. Also known as overdose prevention centers, SCSs provide supervised injection and drug consumption spaces in a safe, clinical setting.
These centers are designed to reduce the harm associated with drug use, especially in communities or populations that are difficult to reach, and they have a proven track record for effectively reducing overdose deaths and infectious diseases.
Unfortunately, due to various legal barriers and the unwillingness of many cities to host SCSs, they’re not as common in most of the United States as they are in other developed countries. Public acceptance and a reduction of legal barriers surrounding SCSs would go a long way towards reducing the impact of overdoses on all people.
As illicit drugs often contain harmful adulterants or are “cut” with other substances, drug testing is another useful overdose deterrent. This includes pill testing or adulterant screening which allows a person to find out if a substance is what it’s purported to be. Drug tests enable people to make informed decisions about the drugs they’re taking and spread the word about potential risks to others.
Drug-testing kits are sold to the public by organizations like DanceSafe, and fentanyl testing strips and syringe exchange programs are available at some public health departments.
Drug Overdose Resources
If you are concerned that you or a loved one may be at risk of an overdose, you are not alone.
Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment.
With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website.
Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.