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Opioid-related and other drug poisoning deaths per 100,000 people

Measure Overview

The ongoing opioid epidemic in the United States continues to claim thousands of lives every year as a result of opioid-related drug poisoning (i.e., overdose). Some of these overdose deaths are caused by prescription opioids, while others are caused by illicitly-trafficked “counterfeit” opioids. The illegal opioid heroin, along with cocaine and psychostimulants (e.g., Ritalin, Adderall) cause thousands of overdose deaths in the U.S. every year and play a major role in the current opioid epidemic, whether the drugs are ingested in combination with or trafficked alongside opioids. Drug overdose from opioids and related drugs is an extensive and complex public health issue that will likely take many years to resolve. As such, it is vital to monitor rates of opioid-related and other drug poisoning deaths to understand how this issue affects different demographic groups and determine which populations would particularly benefit from targeted outreach efforts.

State Health Compare provides annual, state-level rates of opioid-related and other drug poisoning deaths per 100,000 people based on vital statistics data from the Centers for Disease Control and Prevention’s (CDC) WONDER Database. Annual estimates are available from 1999 on, and can be broken down by different drug categories: cocaine, heroin, natural and semi-synthetic opioids, psychostimulants, synthetic opioids, all opioids, and all drugs.

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Notes

Age-adjusted rates of drug-poisoning deaths, including those associated with certain opioids (natural and semi-synthetic opioids [e.g., hydrocodone, oxycodone], synthetic opioids [e.g., fentanyl], and heroin), and other selected drugs. Rates and standard errors obtained from the CDC WONDER Database using ICD-10 underlying cause-of-death codes X40–X44 (unintentional death), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (death of undetermined intent) with multiple cause-of-death codes of T40.0 (opium), T40.1 (heroin), T40.2 (other opioids [i.e., natural and semi-synthetic opioids]), T40.3 (methadone), T40.4 (other synthetic opioids [i.e., those other than methadone]), T40.5 (cocaine) T40.6 (other and unspecified opioids) and T43.6 (psychostimulants with abuse potential). Deaths from specific types of drugs are not mutually exclusive (e.g., an overdose death may involve both heroin and synthetic opioids); because of that, death rates cannot be accurately summed across categories for a total rate. However, the categories all drugs and all opioids de-duplicate overdose death instances that involve multiple drugs. N/A indicates that data are suppressed because the rate is based on 20 or fewer deaths. In some years, deaths related to drug overdoses may be under-reported because of an unusually high number of death certificates with a cause listed as "pending" (e.g., Ohio and West Virginia in 2009). More information is available here.

Definitions

Age-adjusted rates of deaths caused by drug poisoning (i.e., overdose), including those caused by natural and semi-synthetic opioids, synthetic opioids (non-methadone), the illegal opioid heroin, cocaine, and psychostimulants.

Natural and semi-synthetic opioids: This category includes common prescription painkiller pills (e.g., hydrocodone and oxycodone). It includes deaths from painkillers that were legitimately manufactured, prescribed and sold, as well as those that may have been improperly prescribed or diverted from their intended source. It also may include deaths from “counterfeit” painkiller pills that were illicitly trafficked.

Synthetic opioids: This category include synthetic opioids (e.g., fentanyl). However, it excludes methadone, a synthetic opioid that is used both as a painkiller and as a U.S. Food and Drug Administration-approved medication for treating opioid use disorder. It includes deaths from synthetic that were legitimately manufactured, prescribed and sold, as well as those that may have been improperly prescribed or diverted from their intended source. It also includes deaths from illicitly trafficked synthetic opioids, which may be sold inaccurately (i.e., sold as heroin when it actually is fentanyl) or combined with other drugs (i.e., mixed into heroin or counterfeit painkiller pills to increase their potency).

Heroin: This category includes only heroin, which has no legal medical use in the United States and is exclusively trafficked illicitly. However, heroin may be mixed with other drugs (e.g., synthetic opioids).

Cocaine: This category includes only cocaine, which is commonly used as an illicit recreational drug but also has some approved legal medical uses in the United States (e.g., as an anesthetic). Although cocaine is legally classified as a narcotic in the U.S., it is not pharmacologically an opioid. However, it is sometimes trafficked alongside or even mixed with illicit opioids such as heroin and fentanyl.

Psychostimulants: This category includes various stimulant drugs, including legal prescription medications commonly used to treat attention deficit hyperactivity disorder (ADHD), such as Ritalin (methylphenidate) and Adderall (amphetamine); and methamphetamine, which has approved legal medical uses in the United States but is commonly illicitly manufactured and/or trafficked and used recreationally. Similar to prescription opioid painkillers, prescription psychostimulants are sometimes diverted from their intended medical use and abused. These psychostimulants are not opioids but are sometimes trafficked alongside or even mixed with illicit opioids such as heroin and fentanyl.

All drugs: This category includes overdose deaths involving any drugs, including opioids, cocaine, psychostimulants and other drugs that aren't explicitly discussed (e.g., other prescription and over-the-counter medications, and other illicit substances). Note: This category uses the overdose underlying cause-of-death codes described above but does not specify any particular multiple cause-of-death codes.

All opioids: This category includes overdose deaths involving any opioid, including natural and semi-synthetic opioids, synthetic opioids, heroin, as well as other opioids not broken out separately, such as opium, methadone, and other/unspecified opioids.

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