Drug overdose deaths surged in the United States during the first year of the COVID-19 pandemic, increasing by 30.6% in just 12 months. The growth was widespread throughout the country, with forty states experiencing statistically significant increases in their drug overdose death rates from 2019 to 2020. Those ranged from the smallest increase of 12.9 percent in Connecticut (from 34.7 deaths per 100,000 people in 2019 to 39.1 in 2020) to the largest increase of 54.8 percent in Mississippi (from 13.6 deaths per 100,000 people in 2019 to 21.2 in 2020).
Statistically significant state-level increases in drug overdose death rates, 2019-2020
Much of the growth in drug overdose deaths was driven by synthetic opioids such as fentanyl, which increased more than 50 percent from 2019 to 2020 (see below). Fentanyl has become a key product for international drug traffickers, often finding its way as an adulterant in other drugs like heroin and cocaine, and even as an ingredient in counterfeits of common opioid prescription pills such as Oxycontin. The emergence of fentanyl in the U.S. illicit drug trade is a newer phenomenon beginning in the past decade, and it has recently spread from eastern states to increasingly affect states in the western half of the country as well.
Changes in drug overdose deaths in the U.S., 2019 to 2020
A family of drugs called “psychostimulants”—mostly methamphetamine—also drove a large increase in deaths in 2020, up nearly 50 percent since 2019. Deaths involving methamphetamine and other psychostimulants have grown dramatically in the past few years. The increased death toll involving psychostimulants is likely caused by two factors: First, the methamphetamine trafficked in the U.S. today is generally much more potent than methamphetamine sold in the past, raising the potential risk of overdoses caused by methamphetamine. Second, methamphetamine today is often contaminated with, or used alongside, synthetic opioids, raising the risk of an overdose involving the use of multiple drugs simultaneously.
Of the main drugs involved in overdoses2, only heroin was associated with a decline in deaths during 2020—falling by less than 10 percent since 2019. Meanwhile, overdose deaths involving prescription opioids increased more than 20 percent, reversing a trend of relatively stable or even declining death rates over several years. Cocaine overdose deaths similarly increased by more than 20 percent in 2020.
Resources from SHADAC
SHADAC produced briefs that provide high-level information about opioids and opioid addiction, present the historical context for the epidemic of opioid-related addiction and mortality in the United States, and examine trends in opioid-related mortality across the country and among population subgroups as well as among the states.
Overdose Crisis in Transition: Changing National and State Trends in a Widening Drug Death Epidemic (2018 Briefs)
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths from 2000 to 2017 (Briefs)
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2016 (Briefs)
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2015 (Briefs and Maps)
Strategies to Increase Access to Medications for Opioid Use Disorder during the COVID-19 Pandemic and Beyond SHADAC researchers Carrie Au-Yeung and Lynn Blewett, along with Hennepin Healthcare researcher Tyler Winkelman, authored a new Milbank Foundation policy brief that examines the federal and state policies changes put in place to improve access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic, during which time MOUD became especially challenging to access because MOUD patients are typically required to have as many as six in-person clinic visits a week.
Issue Brief Examines Ohio Strategy to Improve Opioid Prescribing Through Payment Reform A collaborative issue brief between SHADAC and the Center for Health Care Strategies (CHCS) with support from the Center for Medicare & Medicaid Innovation (CMMI). SHADAC senior research fellow Colin Planalp profiles the innovative work in Ohio to link the state’s payment and delivery system reforms with another important policy priority: interventions to curtail the opioid crisis.
SHADAC annually produces a series of two-page infographics produced for each of the 50 states as well as the U.S. that highlight key findings for trends in drug overdose deaths. Using the latest available data from SHADAC's State Health Compare, the two-page profiles examine state-level variations in opioid overdose deaths by opioid drug type, as well as by two types of non-opioid illicit drugs that are commonly involved in opioid overdoses: cocaine and psychostimulants. The infographics also show how each state's overdose rates compare to the national average and provide a high-level comparison of all 50 states' overdose rates broken down by each drug type.
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (2018 Infographics)
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (2017 Infographics)
Overdose Crisis in Transition: Changing Trends in a Widening Drug Death Epidemic (Webinar) A webinar hosted by SHADAC on November 24, 2020, focused on analyzing and discussing changes in overdose deaths in more recent years, especially in 2018. Using the latest available data, Senior Research Fellow Colin Planalp detailed changing trends—both in terms of substances and subpopulations of concern—across the nation and among the states.
The Evolving Opioid Epidemic: Observing Changes in the Opioid Crisis through State-level Data (Webinar) A webinar hosted by SHADAC on September 4, 2019, examined the U.S. opioid epidemic through national and state-level data on drug overdose deaths, including opioids such as prescription painkillers, heroin, and synthetic opioids, and non-opioids (but related drugs) such ase cocaine and psychostimulants (e.g., methamphetamine). Senior Research Fellow Colin Planalp detailed changing trends in the opioid crisis and how the specifics vary across states—both in the scale of the epidemic and differences in the top substances of concern. Research Fellow Robert Hest also demonstrated how users could access and utilize the data on overdose deaths available on State Health Compare, which are drawn from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Drug Enforcement Administration (DEA).
Exploring the New State-Level Opioid Data on SHADAC's State Health Compare (Webinar) A webinar hosted by SHADAC on September 5, 2018, explored opioid data at the state level between 2000 and 2016. Senior Research Fellow Colin Planalp discussed trends in overdose deaths by drug type (heroin, prescription painkillers, etc.) and, using data from State Health Compare, also looked at which states have the highest rates of opioid-related deaths and which states have experienced the largest increases in overdose death rates. Research Fellow Robert Hest also demonstrated how users could access and utilize the data on overdose deaths available on State Health Compare, which are drawn from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Drug Enforcement Administration (DEA).
For the 50-state analysis on drug overdoses we produced this year, SHADAC also created a map that houses each state's individual information. Click on a state below to see each state's infographics.
Opioid and Non-Opioid Illicit Drug Overdose Rates for all 50 States, 2000-2018
For the two national and state-level opioid trend briefs we produced in 2016, SHADAC also created two slider maps covering the 2000 to 2015 time period for heroin-related and non-heroin opioid-related overdose deaths.
|Heroin-Related Overdose Deaths, 2000-2015||Non-heroin Opioid-Related Overdose Deaths, 2000-2015|
Sales of Opioid Painkillers
This measure includes data on sales of the prescription opioid painkillers oxycodone and hydrocodone. Prescription sales data are available for each state and the nation from 2000 through 2019 and are measured in annual kilograms of oxycodone and hydrocodone sold per 100,000 people. Data comes from the U.S. Drug Enforcement Agency's (DEA) Automated Reports and Consolidated Ordering System (ARCOS) Retail Drug Summary Reports.
Opioid-Related and Other Drug Poisoning Deaths
This measure includes data on opioid-related and other drug poisoning (overdose) deaths broken down by five drug types: Natural and semi-synthetic opioids, synthetic opioids, heroin, cocaine, and psychostimulants. Data comes from the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics via the CDC WONDER Database, and estimates are available for each state and the nation from 2000 through 2018.
 U.S. Centers for Disease Control and Prevention, National Center for Health Statistics. (2017). Drug Poisoning Mortality: United States, 1999-2015. Available at: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality
 U.S. Centers for Disease Control and Prevention. (2019, January 4). Drug and Opioid-Involved Overdose Deaths — United States, 2013-2017. Morbidity and Mortality Weekly Report, 67(5152), 1419-1427. Available at: https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w
 U.S. Centers for Disease Control and Prevention. (2016, December 30). Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010-2015. Morbidity and Mortality Weekly Report, 65(50-51), 1445-1452. Available at: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
 U.S. Food and Drug Administration. (2017). Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse. Available at: https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm