Drug Overdose Deaths Have Likely Surpassed 100,000 in the US

Drug overdoses have likely already surpassed 100,000 annually in the United States, according to a new analysis from Drug Helpline. Researchers examined local, state, government, police, industry and media reports to form a stark view of a crisis accelerating at alarming speed.

In 2019, before the COVID-19 pandemic began, there were nearly 71,000 drug overdose deaths in the United States. ^[1] The latest data from the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics notes an alarming rise in this already worrisome figure. Data released in October 2021 by the CDC has reported more than 96,000 drug overdose deaths in the US in the 12-month period ending March 2021.

This reflects a nearly 30% increase over the previous year. It is provisional data and warrants further investigation. The update covers the deadliest period of the pandemic in the US, when cases, hospitalizations, and deaths surged during late 2020 and early 2021. The real numbers could be worse. The CDC estimates that predicted deaths due to drug overdoses from March 2020 to March 2021 could be over 99,000, when you take into account delayed reporting. ^[2]

Given that the CDC’s predicted number for drug overdose deaths in March 2021 was 99,106, and with a steady increase since 2020, drug overdose deaths in the US may already have edged past 100,000 on a rolling annual basis. The overwhelming majority of data suggests the crisis continues to get worse rather than better.

Some states have fared better than others. In particular, South Dakota, New Jersey, and New Hampshire saw a decline in the number of overdose deaths between March 2020 and March 2021. The largest decline occurred in South Dakota, where overdose deaths fell by over 17%.

The news is not so good from Vermont. The state saw a staggering 85% increase in overdose deaths in the 12-month period ending March 2021.

When you break down the data set according to the type of drugs involved, opioids came out at the top of the chart, accounting for the highest number of overdose deaths. In past years, opioids—mainly synthetic opioids other than methadone—have been the key drivers of overdose deaths, accounting for over 70% of lives lost to drug overdoses.

Experts say the uncertainty and stress associated with the global health crisis during COVID-19 has led to an increase in drug consumption as a coping mechanism. Combined with reduced access to life-saving treatments for substance use disorders, this has led to a tragic rise in drug overdose deaths. According to Dr. Nora Volkow, the COVID-19 pandemic has “created a devastating collision of health crises in America.”

Data from the 2020 National Drug Threat Assessment by the Drug Enforcement Administration (DEA)

The 2020 National Drug Threat Assessment (NDTA) report from the DEA offers a strategic analysis of the drug situation in the US during 2019 and the first half of 2020. The COVID-19 pandemic placed restrictions on travel and led to US border closures and the closure of non-essential businesses. This posed challenges for criminal organizations involved in drug trading during the first half of 2020, which was reflected in fluctuating prices, availability, and distribution of drugs in the global markets. ^[3] Key findings from the report are as follows.

Illicit Opioids and Heroin

• Based on crime laboratory data from the National Forensic Laboratory Information System (NFLIS), heroin availability is on the decline. In 2019, there was a 13% decrease in heroin reports compared to 2018.
• Fentanyl availability increased by 12% in 2019 compared to 2018.
• The four states with the most fentanyl and heroin reports are New Jersey, New York, Ohio, and Pennsylvania.
• The increased presence of fentanyl and heroin in these markets results in higher rates of overdose deaths related to these drugs.
• In 2018, there were nearly 15,000 total heroin overdose deaths, including approximately 9,000 heroin overdoses with fentanyl and 6,000 overdose deaths involving heroin without fentanyl.
• As of January 2020, 49 states in the US identified the presence of fentanyl-laced counterfeit pills, and 38 states reported deaths attributed to these pills. This was considerably higher than 22 states reporting deaths related to such pills in April 2018.

Methamphetamine

• The COVID-19 pandemic has disproportionately affected methamphetamine markets compared to other drugs, based on reports from DEA Field Divisions, in terms of pricing in the wholesale and retail markets.
• In 2019, the DEA seized over 53,000 kilograms of methamphetamine nationwide. This was 55% more than in 2018.
• According to the CDC, there were over 12,000 overdose deaths attributed to psychostimulants in 2018, reflecting a 23% increase over 2017 and an 874% increase since 2008.
• The primary producers and suppliers of methamphetamine in the US are Mexican transnational criminal organizations (TCOs). Clandestine meth labs in the US cannot compete with the quantity or quality of the drug produced on an industrial scale in Mexico. In 2019, nearly 85% of all methamphetamine labs seized in the US were small-scale operations capable of producing less than 2 ounces of methamphetamine.
• Mexican TCOs have taken the COVID-19 pandemic as an opportunity to increase methamphetamine prices, citing an exaggerated short supply of ingredients. The DEA believes the assertions of limited availability are not credible, given that there was a 2-year inventory of the drug in Mexico before the pandemic began.

Cocaine

• As of October 2020, the pandemic had not severely impacted the trafficking of cocaine in the US. The primary supply source of cocaine for US markets is Colombia.
• There was a 14% decrease in cocaine reports submitted to the NFLIS in 2019 compared to 2018. The 2019 figure was half the reported amount of the cocaine peak in 2006.
• Between 2010 and 2018, the number of overdose deaths involving cocaine has increased by 251%.
• In 2018, there were nearly 15,000 deaths from drug overdoses involving cocaine.
• The US states with the highest number of drug poisoning deaths involving cocaine are New York, Florida, Ohio, Pennsylvania, New Jersey, and Illinois.

Controlled Prescription Drugs

• Prescription opioids claimed nearly 15,000 lives in the US in 2018, averaging 41 deaths every day.
• Prescription opioids are involved in 32% of all opioid overdose deaths.
• Notably, there was a 13.5% decrease in drug overdose deaths involving prescription opioids from 2017 to 2018. Deaths involving prescription opioids have increased alarmingly from 1999, when 4,000 deaths were attributed to this class of drugs.
• In 2018, West Virginia reported the highest number of overdose deaths due to prescription opioids, at a rate of approximately 13 per 100,000 people.
• Data shows that 9.7 billion dosage units of opioid controlled prescription drugs (CPDs) were manufactured and dispensed in 2019. This is the first time since 2010 that annual opioid prescriptions have dropped below 10 billion.
• Hydrocodone and oxycodone products made up around 78% of all opioid CPDs in 2019.
• Arkansas and Alabama have the highest opioid prescription rates. Hawaii and New York have the lowest opioid prescription rates.
• The DEA increased the aggregate production quota by 15% in 2020 for morphine, fentanyl, and other opioid drugs to account for increased medical demands during the COVID-19 pandemic.
• The DEA also adjusted prescription guidelines for medical professionals during the pandemic. For example, practitioners were granted state reciprocity for neighboring states to dispense controlled substances. Telemedicine regulations were also extended, giving more flexibility in prescribing these medicines without direct contact. However, there is fear that these flexibilities could lead to increased abuse and misuse.

Marijuana

• Marijuana remains illegal under federal law. It is the most commonly abused illicit drug in the US.
• In 2019, there was a 21% decrease in the number of marijuana reports submitted to the NFLIS compared to 2018. Yet cannabis/THC was only second to methamphetamine in the number of NFLIS reports.

New Psychoactive Substances (NPSs)

• Synthetic cannabinoids and synthetic cathinones are the most common new psychoactive substances available and abused in the US. They have similar effects to controlled substances and are marketed as legal alternatives to controlled substances.
• In 2019, the Poison Control Center reported a 42% decrease in calls about synthetic cannabinoid exposure compared to 2018. This was an 85% decrease compared to the record-high number of calls in 2015.
• In 2019, there was a 28% decrease in NFLIS reports of synthetic cathinones.
• As previously popular NPSs are controlled, more are developed and rise in popularity.
• Two NPSs—flualprazolam and isotonitazene—have gained attention in 2019 and 2020 due to their implication in overdose deaths.

State-Wise Drug Overdose Deaths in the US between March 2020 and March 2021

According to the CDC, the overall percentage change for the entire United States from March 2020 to March 2021 is a 30.8% increase in drug overdose deaths. Vermont saw the highest increase, with drug overdose deaths rising by an alarming 85%. South Dakota fared the best and showed an approximately 17% decrease in drug overdose deaths. The predicted drug overdose deaths in each US state for the 12-month period ending March 2021 are as follows: ^[2]

Vermont

Predicted deaths March 2020: 114

Predicted deaths March 2021: 211

Percentage change: +85.1

West Virginia

Predicted deaths March 2020: 965

Predicted deaths March 2021: 1,564

Percentage change: +62.1

Kentucky

Predicted deaths March 2020: 1,447

Predicted deaths March 2021: 2,273

Percentage change: +57.1

Louisiana

Predicted deaths March 2020: 1,388

Predicted deaths March 2021: 2,168

Percentage change: +56.2

Tennessee

Predicted deaths March 2020: 2,305

Predicted deaths March 2021: 3,476

Percentage change: +50.8

California

Predicted deaths March 2020: 6,948

Predicted deaths March 2021: 10,408

Percentage change: +49.8

Mississippi

Predicted deaths March 2020: 420

Predicted deaths March 2021: 623

Percentage change: +48.3

Virginia

Predicted deaths March 2020: 1,599

Predicted deaths March 2021: 2,332

Percentage change: +45.8

South Carolina

Predicted deaths March 2020: 1,254

Predicted deaths March 2021: 1,827

Percentage change: +45.7

Nebraska

Predicted deaths March 2020: 149

Predicted deaths March 2021: 217

Percentage change: +45.6

North Carolina

Predicted deaths March 2020: 2,479

Predicted deaths March 2021: 3,556

Percentage change: +43.4

Minnesota

Predicted deaths March 2020: 827

Predicted deaths March 2021: 1,177

Percentage change: +42.3

Washington

Predicted deaths March 2020: 1,324

Predicted deaths March 2021: 1,857

Percentage change: +40.3

Oregon

Predicted deaths March 2020: 637

Predicted deaths March 2021: 893

Percentage change: +40.2

Alaska

Predicted deaths March 2020: 117

Predicted deaths March 2021: 164

Percentage change: +40.2

Nevada

Predicted deaths March 2020: 710

Predicted deaths March 2021: 992

Percentage change: +39.7

Georgia

Predicted deaths March 2020: 1,465

Predicted deaths March 2021: 2,042

Percentage change: +39.4

Colorado

Predicted deaths March 2020: 1,174

Predicted deaths March 2021: 1,633

Percentage change: +39.1

Arkansas

Predicted deaths March 2020: 385

Predicted deaths March 2021: 535

Percentage change: +39.0

Texas

Predicted deaths March 2020: 3,343

Predicted deaths March 2021: 4,593

Percentage change: +37.4

Kansas

Predicted deaths March 2020: 387

Predicted deaths March 2021: 531

Percentage change: +37.2

Indiana

Predicted deaths March 2020: 1,798

Predicted deaths March 2021: 2,438

Percentage change: +35.6

Alabama

Predicted deaths March 2020: 810

Predicted deaths March 2021: 1,094

Percentage change: +35.1

New Mexico

Predicted deaths March 2020: 655

Predicted deaths March 2021: 871

Percentage change: +33.0

Arizona

Predicted deaths March 2020: 2,110

Predicted deaths March 2021: 2,735

Percentage change: +29.6

Florida

Predicted deaths March 2020: 6,021

Predicted deaths March 2021: 7,805

Percentage change: +29.6

New York

Predicted deaths March 2020: 2,451

Predicted deaths March 2021: 3,130

Percentage change: +27.7

Ohio

Predicted deaths March 2020: 4,348

Predicted deaths March 2021: 5,491

Percentage change: +26.3

District of Columbia

Predicted deaths March 2020: 418

Predicted deaths March 2021: 518

Percentage change: +23.9

Maine

Predicted deaths March 2020: 420

Predicted deaths March 2021: 518

Percentage change: +23.3

Oklahoma

Predicted deaths March 2020: 650

Predicted deaths March 2021: 798

Percentage change: +22.8

Rhode Island

Predicted deaths March 2020: 335

Predicted deaths March 2021: 407

Percentage change: +21.5

Wisconsin

Predicted deaths March 2020: 1,293

Predicted deaths March 2021: 1,559

Percentage change: +20.6

Michigan

Predicted deaths March 2020: 2,435

Predicted deaths March 2021: 2,924

Percentage change: +20.1

Missouri

Predicted deaths March 2020: 1,655

Predicted deaths March 2021: 1,980

Percentage change: +19.6

Maryland

Predicted deaths March 2020: 2,385

Predicted deaths March 2021: 2,838

Percentage change: +19.0

Utah

Predicted deaths March 2020: 557

Predicted deaths March 2021: 656

Percentage change: +17.8

Illinois

Predicted deaths March 2020: 3,057

Predicted deaths March 2021: 3,577

Percentage change: +17.0

Pennsylvania

Predicted deaths March 2020: 4,680

Predicted deaths March 2021: 5,462

Percentage change: +16.7

Montana

Predicted deaths March 2020: 141

Predicted deaths March 2021: 164

Percentage change: +16.3

Wyoming

Predicted deaths March 2020: 81

Predicted deaths March 2021: 93

Percentage change: +14.8

Iowa

Predicted deaths March 2020: 374

Predicted deaths March 2021: 429

Percentage change: +14.7

Hawaii                                                              

Predicted deaths March 2020: 249

Predicted deaths March 2021: 282

Percentage change: +13.3

North Dakota

Predicted deaths March 2020: 107

Predicted deaths March 2021: 121

Percentage change: +13.1

Idaho

Predicted deaths March 2020: 250

Predicted deaths March 2021: 280

Percentage change: +12.0

Connecticut

Predicted deaths March 2020: 1,306

Predicted deaths March 2021: 1,422

Percentage change: +8.9

Massachusetts

Predicted deaths March 2020: 2,272

Predicted deaths March 2021: 2,411

Percentage change: +6.1

Delaware

Predicted deaths March 2020: 458

Predicted deaths March 2021: 458

Percentage change: 0.0

New Jersey

Predicted deaths March 2020: 2,922

Predicted deaths March 2021: 2,892

Percentage change: −1.0

New Hampshire

Predicted deaths March 2020: 391

Predicted deaths March 2021: 380

Percentage change: −2.8

South Dakota

Predicted deaths March 2020: 93

Predicted deaths March 2021: 77

Percentage change: −17.2

Effects of the COVID-19 Pandemic on the Opioid Crisis

Worldwide, some 500,000 people die due to drug use every year. Over 70% of these deaths are opioid related. In the United States, the number of people dying from an opioid overdose increased by 120% from 2010 to 2018. Synthetic opioids (fentanyl and its analogs) accounted for two-thirds of opioid-related deaths in 2018.

The COVID-19 pandemic has led to a further increase in opioid-related deaths in the US, mostly involving fentanyl and other synthetic opioids. ^[4] One study from Rhode Island has shown that: ^[5]

• The death rate from drug overdose increased in 2020 compared to 2019 (US national average 30.8%).
• Deaths involving synthetic opioids increased significantly in 2020 compared to 2019.
• The rate of drug overdose deaths increased significantly in men (77%) and non-Hispanic White people (80%).
• The rate of deaths due to drug overdoses increased significantly among single people.
• There was a significant increase in the proportion of overdose deaths in people who had experienced job loss.
• Deaths occurring in personal residences increased significantly during the pandemic, while the proportion of deaths pronounced in a hospital setting declined.

The data from Rhode Island shows several trends of people who died from drug overdose in 2020 versus 2019. The findings confirm that while rates of deaths due to overdose were increasing in 2019, they saw an even greater increase during the COVID-19 pandemic. The Rhode Island findings are consistent with findings in other parts of the US.

Researchers hypothesize that measures put in place to control the spread of COVID-19, for example, social distancing and stay-at-home orders, led to social isolation, decreased support, and increased drug use, with a consequent increase in the risk of overdose death. This is corroborated by the finding that a large number of deaths from drug overdose in 2020 occurred in a personal residence. There was a significant decrease in the proportion of deaths occurring in hospitals. This is believed to be due to a decrease in non-COVID-19 hospital admissions in 2020; people were also reluctant to go to the ER during the pandemic.

The findings also showed that a large percentage of deaths from drug overdoses involved people who had prior diagnoses of depression and anxiety. This is consistent with previous findings of a high prevalence of anxiety and depression among people who die of a drug overdose.

The key finding of the study is that four primary factors associated with the COVID-19 pandemic—increased isolation, mental stressors, economic insecurity,and a lethality of drug supply—have given rise to the emerging alarming trends in deaths from drug overdose.

Publication date: October 21, 2021

Last updated: March 8, 2023