U.S. Overdose Deaths, 2017–2018: Prescription Opioid Deaths Fell, Synthetic Opioid Deaths Kept Rising

Of the 70,237 U.S. drug overdose deaths in 2017, about two-thirds — 47,600 — involved an opioid. In recent years the rise had been driven mainly by synthetic opioids other than methadone. CDC looked at what changed in 2018.

The headline

In 2018, drug overdoses killed 67,367 people in the United States — 4.1% fewer than in 2017. Of those deaths, 46,802 (69.5%) involved an opioid.

Deaths could involve more than one kind of opioid and are counted under each. State comparisons cover the 38 states and DC whose death certificates named the drugs involved often enough; nationally, the drug wasn't specified on 12% of overdose death certificates in 2017 and 8% in 2018.

All opioids

Rates fell among women; people aged 15–34 and 45–54; non-Hispanic whites; in small metro, micropolitan and rural (noncore) areas; and in the Midwest and South. They rose among people 65 and older, non-Hispanic Black people and Hispanic people, and in the Northeast and West.

• Fell in 11 states and DC — most in relative terms in Iowa (−30.4%), most in absolute terms in Ohio (−9.6 per 100,000).
• Rose in three states — most in Missouri (+18.8%, +3.1).
• Highest rate: West Virginia, 42.4 per 100,000.

Prescription opioids: down 13.5%

Rates fell among men and women, people aged 15–64, non-Hispanic whites, Hispanics and non-Hispanic American Indians and Alaska Natives, and at every level of urbanization; they fell in the Midwest, South and West and held steady in the Northeast. Seventeen states saw declines and none a significant increase. The biggest relative drop was in Ohio (−40.5%); the biggest absolute drop — and the highest rate, 13.1 per 100,000 — in West Virginia (−4.1).

Heroin: down 4.1%

Rates fell among men and women, people aged 15–34 and non-Hispanic whites, and in large central and fringe metro areas; they fell in the Midwest and rose in the West. They fell in seven states and DC and rose in three.

Synthetic opioids: up 10%

Rates rose among men and women, everyone 25 and older, non-Hispanic whites, non-Hispanic Black people, Hispanic people and non-Hispanic Asian/Pacific Islanders, and in large central, large fringe, medium and small metro counties; they rose in the Northeast, South and West and held steady in the Midwest. They rose in 10 states and fell in two.

Why the numbers moved

From 1999 to 2018, opioids were involved in 446,032 U.S. deaths.

• Prescription opioid deaths drove the overall opioid decline. Opioid prescriptions filled peaked in 2012 and have fallen since, and efforts to cut high-dose prescribing have helped.
• Heroin deaths may be falling because fewer people are starting heroin, the market is shifting from heroin to fentanyl, more people using heroin are getting treatment, and naloxone is easier to get.
• Synthetic opioid deaths are most likely rising because illicitly manufactured fentanyl and fentanyl analogs are spreading through the drug supply. The Drug Enforcement Administration found fentanyl was the synthetic opioid most often identified in seizures in the first half of 2017, and fentanyl reports rose in every region in 2014–2018.

The picture is getting more complicated: methamphetamine use is resurging, especially among people who use opioids, and opioids are being mixed with methamphetamine and cocaine in the illicit supply. Deaths rose among Black and Hispanic Americans, pointing to the need for culturally tailored efforts that address social determinants of health and structural factors.

What's needed

CDC's Overdose Data to Action, a three-year cooperative agreement, funds health departments in 47 states, DC, two territories and 16 cities and counties to:

• get faster data on all overdoses and better toxicology to spot polysubstance deaths;
• link people to treatment for opioid use disorder;
• strengthen prescription drug monitoring programs and health system interventions;
• partner with public safety.

Beyond that: keep encouraging safe prescribing (following CDC's guideline for opioids in chronic pain, and using non-opioid and non-drug pain treatments), expand naloxone distribution and medication-assisted treatment, tackle polysubstance use, and coordinate surveillance of the illicit drug supply to catch emerging threats.

Limits

Postmortem toxicology testing varies by place and has improved, which may account for some increases. How often death certificates name the drugs varies by state and year. Some heroin deaths may be recorded as morphine deaths, since heroin breaks down into morphine. Race may be misclassified, especially for American Indians/Alaska Natives and Asian/Pacific Islanders. State results cover only 38 states and DC.

Sources

Based on Wilson N, Kariisa M, Seth P, Smith H IV, Davis NL, "Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018," MMWR volume 69, number 11, Centers for Disease Control and Prevention; a work of the United States government in the public domain.