Stimulants in Synthetic Opioid Overdose Deaths, by Occupation and Industry, 2022

Synthetic opioids, mostly fentanyl, now drive most U.S. opioid overdose deaths, and the share of those deaths that also involve a stimulant — cocaine, or “psychostimulants” such as methamphetamine — more than doubled between 2018 and 2022. Some people who use opioids say they add stimulants to counter fentanyl’s sedating effect and stay alert and functional, particularly at work. A CDC team looked for patterns by occupation and industry.

The data

The researchers analyzed 2022 death certificate data from the National Vital Statistics System for U.S. residents aged 15–64 who died of overdoses involving synthetic opioids, coded by the person’s usual occupation and industry. They measured how often cocaine or psychostimulants (methamphetamine, amphetamine, methylphenidate, MDMA and similar drugs) were also involved. Military occupations were excluded.

What they found

Of 69,893 synthetic opioid overdose deaths, 53.6% also involved a stimulant. The share was highest in farming, fishing and forestry occupations (57.5%) and the mining industry (55.9%), and lowest among health care practitioners (46.7%) and in utilities (43.4%).

A pattern emerged in which stimulant:

Occupations. Share of synthetic opioid overdose deaths also involving each stimulant.

Cocaine and psychostimulant involvement by occupation, 2022. Image from CDC’s page.

By industry, psychostimulants were most common in mining (42.5%), agriculture, forestry, fishing and hunting (39.3%), management of companies (37.5%), construction (33.0%) and arts, entertainment and recreation (32.7%). Cocaine was most common in health care and social assistance (31.8%), management of companies (31.3%), finance and insurance (31.2%), administrative and support services (30.8%) and real estate (30.4%).

Cocaine and psychostimulant involvement by industry, 2022. Image from CDC’s page.

In short, psychostimulants were more common in physically demanding, manual work, and cocaine in less strenuous work.

Possible explanations

• Effects. Psychostimulants such as methamphetamine last longer than cocaine and may better counter opioid drowsiness in physically demanding jobs; some workers in construction and landscaping report using methamphetamine to dull the pain of labor-intensive work.
• Cost. Physically demanding jobs often pay less, and methamphetamine tends to be cheaper than cocaine.
• Geography. Psychostimulant-involved opioid deaths have risen fastest in Appalachia, where mining employment is high; cocaine-involved overdoses are more common in cities, where jobs such as finance are concentrated.

Limitations

• Death certificates do not record why someone used both drugs.
• A person’s usual occupation may differ from their job at the time of death.
• The results apply only to overdoses involving synthetic opioids — though these accounted for about 70% of U.S. overdose deaths as of 2023.
• Differences between groups were often small.
• The study was exploratory, generating hypotheses that need confirming.

What it means

Workplace programs may help. NIOSH’s Workplace Supported Recovery initiative guides employers in hiring and keeping people with substance use disorders, connecting them to treatment, and reducing work-related risks such as injuries and job stress. Such programs, and harm-reduction efforts to prevent fatal overdoses, may need to be tailored to the kinds of stimulants used in different occupations and industries.

Sources

Based on Lundstrom EW, Macmadu A, Steege AL, Groenewold M, "Synthetic Opioid and Stimulant Co-Involved Overdose Deaths by Occupation and Industry — United States, 2022," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.