Over the past two decades, the United States has experienced a growing crisis of substance abuse and addiction that is illustrated most starkly by the rise in deaths from drug overdoses. Since 2000, the annual number of drug overdose deaths has quadrupled from 17,500 to 70,000 in 2017.1,2 Most of these deaths involved opioids, including heroin, prescription painkillers, and synthetic opioids such as fentanyl.3 In the years since the U.S. Centers for Disease Control and Prevention (CDC) declared overdoses from prescription painkillers an “epidemic” in 2011, the opioid overdose crisis has evolved rapidly from a problem tied mostly to prescription opioid painkillers to one increasingly driven by illicitly trafficked heroin and synthetic opioids. More recently, early evidence suggests that the problem also may be spreading beyond opioids to other illicit drugs, such as cocaine and methamphetamine.
The rise of the opioid crisis is commonly attributed to an increase in the prescribing of opioid painkillers, which was driven by a confluence of several factors including several journal articles published in the 1980s which touted opioids as an effective painkiller without a high risk of addiction, followed by an increase in urging health professionals to recognize and treat pain more effectively in the 1990s and 2000s, and the Food and Drug Administration’s approval in 1995 of the blockbuster prescription opioid painkiller OxyContin, which the FDA has since called a “focal point of opioid abuse issues.”4
SHADAC researchers have been tracking state-level variation and trends in the opioid crisis since 2016. Our goal is to make data available to the public and to state policymakers so they can better understand the impacts of the opioid epidemic in their individual states and develop tailored solutions to address their unique situations.
At the national level, data on opioid overdose deaths show multiple, evolving phases of the drug overdose epidemic. From 2000 to approximately 2011, the growth in opioid overdose deaths was driven primarily by natural and semi-synthetic opioids (i.e., prescription opioid painkillers); but that death rate has since largely plateaued. Beginning around 2011, deaths from heroin began to increase more rapidly and were responsible for the highest overdose death rates in 2015. Since around 2013, however, deaths from synthetic opioids, such as fentanyl, have grown precipitously. By 2017, the overdose death rate from synthetic opioids was nearly double the rate for all other drug types. Around the same time that death rates from heroin and synthetic opioids began to increase, deaths from cocaine and psychostimulants also began to increase. Some evidence suggests that this relationship is driven, at least in part, by an increase in deaths that involve multiple drugs.
Although, much like the United States as a nation, most states have experienced measurable increases in opioid overdose deaths since 2000, both the scale of the crisis and the types of opioids most commonly associated with overdoses have varied widely across states. The eastern portion of the U.S. tends to have particularly high rates of overdose deaths from heroin, synthetic opioids, while states with high death rates from prescription opioids are less concentrated and found throughout the country. Non-opioid drugs that increasingly appear related to the opioid crisis also display regional variation, with the highest death rates from cocaine found among eastern states, while high death rates from psychostimulants are generally more common among western states.
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths from 2000 to 2017 (Briefs) Two briefs produced by SHADAC 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, using data from 2000-2017. This year the brief expanded to include, for the first time, overdose data on two additional types of illicit drugs, cocaine and psychostimulants (e.g., methamphetamine), which are the most commonly involved in opioid overdoses,
New 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.
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2016 (Briefs) Two briefs produced by SHADAC 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, using data from 2000-2016.
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths, 2000-2015 (Briefs and Maps) Two briefs produced by SHADAC 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, using data from 2000-2015.
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (Infographics) 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 from 2000-2017. Using 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.
Exploring the New State-Level Opioid Data on SHADAC's State Health Compare: Webinar A webinar hosted by SHADAC on September 5, 2018, which 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 2017 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 2017.
 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