Overdose deaths involving stimulants, mainly cocaine and methamphetamine, have climbed in the United States since 2011. Deaths involving cocaine rose from 4,681 in 2011 to 29,449 in 2023, and those involving psychostimulants with abuse potential (mostly methamphetamine) from 2,266 to 34,855. Provisional data show declines in 2024, but deaths stayed well above 2011 levels. Most of the growth came from deaths in which opioids were also involved, though stimulant deaths without opioids rose too.
CDC researchers used two data systems:
- the State Unintentional Drug Overdose Reporting System (SUDORS), which draws on death certificates, toxicology and medical examiner or coroner reports from 49 states and the District of Columbia, to describe stimulant deaths from January 2021 through June 2024;
- the National Vital Statistics System (NVSS), which covers every U.S. death certificate, to track national death rates by drug and by race and ethnicity from 2018 through 2023.
Which stimulants
Of 309,274 overdose deaths in the SUDORS states from January 2021 to June 2024, 59.0% involved a stimulant: 31.2% methamphetamine, 30.0% cocaine and 3.8% both. Prescription stimulants (1.6%), synthetic cathinones (0.7%) and MDMA/MDA (0.4%) were rarely involved.
Share of overdose deaths involving each stimulant (bars) and share of those deaths that also involved opioids (markers), 49 states and DC, January 2021–June 2024. CDC.
Most stimulant deaths (73.0%) also involved opioids, including 79.1% of cocaine deaths and 68.8% of methamphetamine deaths. Only 14.5% of all overdose deaths involved stimulants alone. Drug-checking programs rarely found opioids in stimulant products, which suggests that most people who died with both in their system had used separate stimulant and opioid products on purpose. People who use both have reported doing so to ease opioid withdrawal or to offset the sedation opioids cause, but using both can raise the risk of overdose.
Two groups of deaths
The stimulant deaths split into 133,293 (43.1% of all overdose deaths) that also involved opioids and 49,209 (15.9%) that did not. In both groups about 70% of those who died were men. The two groups differed in other ways:
| Stimulants, no opioids | Stimulants and opioids | |
|---|---|---|
| Aged 45 or older | 66.5% | 44.2% |
| Known history of cardiovascular disease | 38.7% | 21.2% |
| Seen in an emergency department for the fatal overdose | 33.1% | 18.4% |
| Evidence of past opioid use | 11.6% | 35.8% |
| Ever treated for mental health or substance use disorders | 14.9% | 23.4% |
About 10% of all U.S. adults have a history of cardiovascular disease. Stimulant overdoses often show up as cardiovascular events such as stroke, can disrupt control of body temperature, and can cause mental health symptoms, and long-term stimulant use is linked to cardiovascular disease, which raises overdose risk further. Asking about stimulant use during routine care could identify people at risk of a stimulant-induced cardiovascular event.
Rates by race and ethnicity
From 2018 to 2023, national death rates per 100,000 people rose from 4.5 to 8.6 for cocaine and from 3.9 to 10.4 for psychostimulants.
Age-adjusted overdose death rates involving cocaine or psychostimulants, with and without opioids, by race and ethnicity, 2018–2023. CDC.
- American Indian or Alaska Native people: the psychostimulant death rate rose from 11.0 to 32.9 and stayed above the cocaine rate throughout.
- Black people: the cocaine death rate rose from 9.1 to 24.3 and stayed above the psychostimulant rate throughout.
- Native Hawaiian or Pacific Islander people: the psychostimulant rate rose from 7.4 to 16.3.
- White, Asian and Hispanic people: rates were lower but also rose.
In every group, the biggest increases were in deaths involving both stimulants and opioids. Over the same years, reported methamphetamine use among American Indian or Alaska Native people, cocaine use among Black people, and opioid use in both groups stayed fairly steady, which points to more potent drugs or unequal access to health care and treatment. Illegally made fentanyls spread later than in eastern drug markets to southern markets, where Black people disproportionately live, and western markets, where American Indian or Alaska Native people disproportionately live; the recent rise in combined deaths in these groups may reflect those market changes.
What could help
- Recognizing stimulant overdoses. Their signs differ from opioid overdoses. Teaching people who use drugs, their families and friends, and clinicians to spot them, such as cardiovascular events or psychosis, could speed the response.
- Treating both drugs. Opioid overdose reversal drugs do not reverse stimulant effects, so a combined overdose may also need treatment for agitation or seizures and cooling. Stimulant use also complicates treatment for opioid use disorder, and guidance for treating both is limited.
- Better treatment for stimulant use disorder. There is no reversal drug for stimulant overdose and no approved medication for stimulant use disorder. Contingency management, a behavioral approach that rewards steps toward recovery such as abstinence, is the most effective treatment but is underused. Low-barrier care and better links to care, for example during an emergency visit for a nonfatal overdose, could help people start and stay in treatment.
- Reaching people opioid programs miss. Those who died of stimulants without opioids were older and less often had a history of opioid use, so they may need different outreach and stimulant-specific advice.
The authors also warned that the 2024 decline in overdose deaths mainly reflected fewer deaths from synthetic opioids such as illegally made fentanyls, and that the difficulty of treating stimulant and opioid use disorders together could slow that decline.
Limits
Stimulant deaths are likely undercounted: some are certified as cardiovascular deaths without an overdose code, and toxicology testing varies and does not routinely look for newer stimulants. Circumstance details depend on investigative reports and are likely underestimated, race and ethnicity may be misclassified, and some large states were left out of the circumstance analysis.
Sources
- Tanz LJ, Miller KD, Dinwiddie AT, et al. Drug Overdose Deaths Involving Stimulants — United States, January 2018–June 2024. MMWR Morb Mortal Wkly Rep 74(32). https://www.cdc.gov/mmwr/volumes/74/wr/mm7432a1.htm
- CDC, National Center for Health Statistics, provisional drug overdose death counts: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- The report's discussion rounds some of its own figures ("approximately 50,000" and "almost 45%"); this page uses the exact counts from its results.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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