Mental Health Disorders Among People Who Died of Drug Overdose, 2022

Drug overdoses killed nearly 107,000 people in the United States in 2021 and nearly 108,000 in 2022. People with mental health conditions face a higher risk of overdose, fatal and nonfatal. The DSM-5 counts both substance use disorders and non–substance-related mental health disorders — depression, anxiety, bipolar disorder and others — as mental health conditions, and the two often occur together: they share risk factors, and each can influence the other, as when someone uses substances to cope with symptoms. In 2022, 23.1% of U.S. adults reported a mental health disorder in the past year, and 8.4% had both a mental health disorder and a substance use disorder.

This CDC report used the State Unintentional Drug Overdose Reporting System (SUDORS), which draws on death certificates, toxicology reports and medical examiner and coroner reports, to describe people who died of unintentional or undetermined-intent overdoses in 2022 and had a non–substance-related mental health disorder (here, "mental health disorder"). Substance use disorders themselves were excluded from that group, since they are likely to be overrepresented among overdose deaths.

How common

Among 63,424 overdose deaths in 43 states and the District of Columbia, 21.9% of those who died had a reported mental health disorder. The most common were:

• depressive disorders — 12.9%;
• anxiety disorders — 9.4%;
• bipolar disorder — 5.9%.

Who they were

Compared with those who had no reported disorder, people with one were more often female (40.0% vs. 25.9%) and non-Hispanic White (71.1% vs. 61.4%), and less often non-Hispanic Black (15.9% vs. 24.8%) or Hispanic (8.8% vs. 10.3%). These differences may partly reflect disparities in diagnosis: women have historically been more likely to seek mental health care, stigma around mental health care may be stronger in Black communities, and providers' diagnoses may carry racial and ethnic bias. More of those with a disorder had a known history of opioid use or misuse (42.4% vs. 29.8%).

The drugs involved

Overall, 82.2% of the deaths involved opioids, mostly illegally made fentanyl and fentanyl analogs (75.2% of all deaths). Deaths among people with a mental health disorder more often involved:

Missed chances

About a quarter (24.5%) of people with a mental health disorder had at least one potential opportunity for intervention in the month before death, compared with 14.6% of those without:

Potential intervention opportunities in the month before death, among overdose decedents with and without a reported mental health disorder, 2022. CDC, MMWR.

• release from prison or jail, a residential treatment facility or a psychiatric hospital — 11.2% vs. 7.8%;
• being in treatment for a substance use disorder — 10.1% vs. 4.5%;
• an emergency department or urgent care visit — 9.5% vs. 4.7%;
• a nonfatal overdose — 4.1% vs. 2.7%.

Each is a point where overdose prevention might have happened.

What could help

• Screen for both. Consistent with U.S. Preventive Services Task Force recommendations to screen adults in primary care for unhealthy drug use, anxiety and depression, screen for substance use disorders when a mental health disorder is diagnosed, and for mental health and substance use disorders when opioids, antidepressants or benzodiazepines are prescribed.
• Prescribe with overdose risk in mind, particularly antidepressants and benzodiazepines for patients with a known or suspected substance use disorder.
• Act at the touchpoints. Expand screening, treatment, referral and harm reduction in emergency departments, urgent care, jails and prisons, and treatment programs — for example, peer navigators linking people leaving jail to treatment — and include mental health screening in care after a nonfatal overdose.
• Integrate care and train providers. People with substance use and mental health disorders face similar barriers, including stigma, access and cost, and some providers are uncomfortable addressing mental health with patients who use drugs. Integrated treatment, retention in care and harm reduction could save lives.

Limitations

The data cover 43 or 44 jurisdictions and some or all of 2022. Mental health disorders are likely undercounted, because some are undiagnosed and source documents vary in completeness — possibly differently across groups. Data on mental health treatment were unavailable, a substance use disorder may sometimes have been recorded as an unspecified mental health disorder, and disorders reported by nonmedical sources, such as witnesses, may not reflect a DSM-5 diagnosis.

Sources

• Dinwiddie AT, Gupta S, Mattson CL, O'Donnell J, Seth P. "Reported Non–Substance-Related Mental Health Disorders Among Persons Who Died of Drug Overdose — United States, 2022." MMWR 73(34). CDC.