70,237 Overdose Deaths in 2017: How Synthetic Opioids Drove the Epidemic's Current Wave

70,237 people died of drug overdoses in the United States in 2017, and 47,600 (67.8%) of those deaths involved an opioid. From 1999 through 2017, overdoses killed 702,568 Americans, 399,230 (56.8%) of them with opioids involved. What changed after 2013 was the drug: the epidemic's current wave is driven by synthetic opioids other than methadone, above all illicitly manufactured fentanyl (IMF) and fentanyl analogs.

2016 to 2017, by drug

Categories overlap, since one death can involve several drugs. In 2016, synthetic opioids were involved in 23.7% of prescription-opioid deaths, 37.4% of heroin deaths and 40.3% of cocaine deaths — the epidemic growing more complex as prescription and illicit drugs mix.

Across the states, 2013–2017

Overdose death rates rose significantly in 35 states and the District of Columbia. Of the 20 states whose death certificates named specific drugs reliably enough to track synthetic opioids, 15 had significant increases in synthetic-opioid death rates.

Age-adjusted overdose death rates, and rates involving synthetic opioids, by state, 2013 and 2017. CDC.

IMF deaths had been concentrated east of the Mississippi River, but recent increases reached eight states to the west: Arizona, California, Colorado, Minnesota, Missouri, Oregon, Texas and Washington.

Who was hit, 2016 to 2017

All opioids. Deaths rose among men and women, among people 25 and older, and among white, Black and Hispanic people.

• Largest relative rise: Black people, 25.2%; by age, people 65 and older, 17.2%.
• Largest absolute rise: men aged 25–44, up 4.6 per 100,000.
• By place: medium metro counties had the largest absolute increase (1.9 per 100,000), micropolitan counties the largest relative one (14.9%).
• 15 states rose significantly, led by North Carolina (28.6%), Ohio (19.1%) and Maine (18.7%).

Synthetic opioids pushed deaths up in every demographic category and at every urbanization level. The highest rate was among men aged 25–44: 27.0 per 100,000. The largest relative increases were among Black (60.7%) and American Indian/Alaska Native (58.5%) people. 23 states and DC rose significantly, fastest in Arizona (122.2%), North Carolina (112.9%) and Oregon (90.9%); the highest rates were in West Virginia (37.4), Ohio (32.4) and New Hampshire (30.4).

Prescription opioids held steady overall but moved within groups: down 13.2% among men aged 15–24, up 10.5% among people 65 and older. Five states fell significantly (Maine, Maryland, Oklahoma, Tennessee, Washington) and one rose (Illinois) — the extremes were Illinois up 29.7% and Maine down 39.2%. The highest rates: West Virginia (17.2), Maryland (11.5) and Utah (10.8).

Heroin declined in many groups — most among people aged 15–24 (15.0%), especially young men (17.5%) — but rose among people 65 and older (16.7%), 55–64 (11.6%) and Black people (8.9%). Five states fell significantly (Maryland, Massachusetts, Minnesota, Missouri, Ohio) and three rose (California, Illinois, Virginia); Ohio fell most (31.9%) and Virginia rose most (21.8%). The highest rates: DC (18.0), West Virginia (14.9) and Connecticut (12.4).

What CDC called for

Provisional 2018 data hinted at improvement in some indicators, pending final data. The report's case was for faster, more local data and for acting on it:

• CDC funds 32 states and DC to collect more timely and complete overdose data, including better toxicology testing; prevention in 42 states and DC; and, with emergency funding, surveillance and response in 49 states, DC and four territories.
• Safe prescribing under CDC's guideline for opioids in chronic pain, with access to nonopioid and nonpharmacologic pain treatment.
• More naloxone, wider access to medication-assisted treatment, stronger public health–public safety partnerships, and health systems that link people to treatment and harm-reduction services.

Limits

Autopsy testing varies by time and place, and better toxicology may explain some increases. Death certificates named no specific drug in 15% of overdose deaths in 2016 and 12% in 2017, and the share naming at least one ranged from 54.7% to 99.3% by state, so most state comparisons use only states with good reporting. Heroin deaths may be undercounted as morphine, and race misclassification may understate deaths among American Indian/Alaska Native and Asian/Pacific Islander people.

Sources

Based on Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G, "Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017," MMWR Morbidity and Mortality Weekly Report volume 67, numbers 51–52, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy was cut short; the missing text is from the report's full text in PubMed Central (PMC6334822).