Blog & News
50-State Infographics Provide an Updated Overview of the Evolving Opioid CrisisJuly 15, 2020:
Though still in the midst of the coronavirus pandemic, the United States continues to grapple with other national public health emergencies, such as the opioid crisis. Indeed, many public health experts have voiced concerns about the potential effects of COVID-19 on mental health and associated issues, including the rates of suicide deaths, alcohol-related deaths, and opioid and related drug overdose deaths, commonly referred to as “deaths of despair.”
SHADAC researchers have been researching these topics using vital statistics data, recently publishing an analysis of national and state suicide death rates, as well as producing this set of updated two-page infographics focused on opioid and opioid-related drug overdose deaths using the latest annual data for all 50 states and the District of Columbia. SHADAC also makes all of the 2018 data used in those infographics publicly available through our State Health Compare online data tool.*
Click on a state below to see its two-page infographic or download all state's infographics here.
Background: U.S. trends in drug overdose deaths
As data have increasingly shown, the opioid crisis has continued to evolve beyond just the different classes of opioids—such as natural and semi-synthetic opioids, synthetic opioids, and heroin—to include two types of non-opioid illicit drugs that have commonly been reported in combination with opioid overdoses: cocaine and psychostimulants (such as methamphetamine).
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, but reached their own plateau in 2015. Since around 2013, it is deaths from synthetic opioids (such as fentanyl) that have experienced the largest increases—a trend that continued in 2018, with the national rate from this drug category (9.9 deaths per 100,000 people) registering nearly three times as high as natural and semi-synthetic opioids (3.8 per 100,000 people) and almost double that of heroin (4.7 per 100,000 people).
Around the same time that death rates from heroin and synthetic opioids began to increase, deaths from cocaine and psychostimulants (e.g., methamphetamine) also began to rise; due in part, evidence has strongly suggested, to deaths involving multiple drugs.1 In 2018, overdose death rates for both drugs reached new highs at 4.5 per 100,000 people for cocaine and 3.9 per 100,000 people for psychostimulants.
State variation in overdose deaths
While it is important to understand the national toll of the crisis, the story at the state level shows the dynamics of this public health crisis can vary widely, both in the prevalence of overdose deaths and the types of drugs associated with those deaths.
Opioid Overdose Deaths
Although most states have experienced measurable increases in opioid overdose deaths between 2017 and 2018, the scale of the crisis has seen wide variation. For example, while the rate for the state with the number of deaths from synthetic opioids in 2018, West Virginia, decreased from 37.4 per 100,000 people in 2017 to 34.0 per 100,000 in 2018, this rate was still nearly 30 times the rate of the lowest state, Texas (1.2 deaths per 100,000 people).
The types of opioids most commonly associated with overdoses can also vary across states. For example, as in 2017, Utah had the second-highest rate of deaths from natural and semi-synthetic opioids in 2018, at 9.6 deaths per 100,000 people; however, contrary to the U.S. trajectory, the state’s rate of deaths from synthetic opioids remained relatively steady, at 3.1 per 100,000 people in 2017 and 2.9 per 100,000 in 2018—well below the U.S. rate of 9.9 per 100,000 people (up significantly from 9.0 per 100,000 in 2017).
Overdose Deaths from Cocaine and Psychostimulants
The scale of overdose deaths from non-opioid illicit drugs also varies widely across states. For example, the 2018 overdose death rate from cocaine was highest in Delaware at 15.9 per 100,000; the state jumped four places to overtake the District of Columbia (17.6 deaths per 100,000 people in 2017), and Delaware’s rate was 17 times that of Arkansas and Minnesota (0.9 deaths per 100,000 people).
In 2018, the state with the highest overdose death rate from psychostimulants was again West Virginia at 19.3 per 100,000 people, a significant increase from 13.6 deaths per 100,000 people in 2017; West Virginia’s rate was more than 19 times the rate of 1.0 deaths per 100,000 people in New York.
Regional Patterns in Drug Overdose Death Rates
Despite the evidence of state variation in drug overdose death rates, further analysis illustrates some broader patterns across regions that have remained fairly consistent between 2017 and 2018:
Heroin and synthetic opioids
Death rates from heroin and synthetic opioids are generally higher east of the Mississippi River, particularly among states in the Northeast, the Appalachian region, and the industrial Midwest.
Natural and semi-synthetic opioids
Higher death rates from natural and semi-synthetic opioids are more geographically dispersed than those from heroin and synthetic opioids. While some eastern U.S. states have particularly high rates of deaths from natural and semi-synthetic opioids (e.g., Maryland, Tennessee, and West Virginia), there are other states in the western U.S. that also have similarly high death rates from these drugs (e.g., Utah, New Mexico, and Nevada).
An examination of cocaine death rates reveals a pattern similar to that of death rates from heroin and synthetic opioids, with states east of the Mississippi River exhibiting higher rates of cocaine overdose deaths.
Death rate patterns from psychostimulants appear to be almost the opposite of those for heroin and synthetic opioids, with relatively low death rates in the Northeast and particularly high rates of deaths in the western U.S. and the Southeast. Only two states—Kentucky and West Virginia—show strong overlaps between psychostimulant and heroin and synthetic opioid deaths.
Some early data from the CDC show encouraging signs that progress is being made in the fight against opioids, with the national drug overdose rate declining from 2017 to 20182; however, examining trends at the state level show a more nuanced picture. While improvements have been found in key states such as Ohio, which saw significant decreases in nearly every drug category (heroin, natural and semi-synthetic opioids, synthetic opioids, and cocaine) from 2017 to 2018, other states such as Delaware have seen historic increases in their rates of overdose deaths from synthetic opioids, heroin, and cocaine (the state now ranks highest among all 50 states in the latter two drug categories) for this same time period. Because of the opioid crisis’s history of evolving and changing, it will be important to continue monitoring data on drug overdoses to track whether death rates continue to decline or experience a resurgence—possibly driven by new drugs.
Further Reading and Resources
The Opioid Epidemic in the United States
SHADAC Resource, March 2020 (Updated)
The Evolving Opioid Epidemic: Observing the Changes in the Opioid Crisis through State-level Data
SHADAC Webinar, September 2019
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths from 2000 to 2017
SHADAC Briefs, June 2019
1 Kariisa, M., Scholl, L., Wilson, N., Seth, P., & Hoots, B. (2019, May 3). Drug overdose deaths involving cocaine and psychostimulants with abuse potential—United States, 2003-2017. MMWR, 68(17), 388-395. DOI: http://dx.doi.org/10.15585/mmwr.mm6817a3
Drug Enforcement Administration (DEA) Strategic Intelligence Section. (2020). 2019 National Drug Threat Assessment [DEA-DCT-DIR-007-20]. Retrieved from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf
Insufficient evidence exists as to whether the pattern of non-opioid illicit substances is driven primarily by unintentional contamination (e.g., drug traffickers accidentally mixing fentanyl into cocaine due to sloppy packaging) or intentional mixing of different drug types (e.g., drug traffickers purposefully blending methamphetamine and fentanyl into counterfeit prescription pills).
2 Hedegaard, H., Miniño, A.M., & Warner, M. (2020). Drug overdose deaths in the United States, 1999-2018 [Data brief No. 356]. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf
Blog & News
U.S. Suicide Death Rate Reached Record High in 2018: SHADAC Briefs Examine the Numbers among Subgroups and StatesJune 16, 2020:
The suicide death rate for the United States reached another historic high in 2018, rising to 14.2 deaths per 100,000 people from 14.0 in 2017, according to new vital statistics data from the U.S. Centers for Disease Control and Prevention (CDC). This newest jump continues a decades-long increase in death rates from suicide in the U.S.—a trend that predates the current COVID-19 pandemic, which early evidence indicates is taking a significant toll on mental health.
According to a recent national poll by the Kaiser Family Foundation, more than half of respondents (56%) reported that worry or stress related to the pandemic has led to at least one negative effect on their mental health, such as trouble sleeping or eating, increased alcohol use, or worsening chronic conditions. While experts will look to suicide rates as one important indicator of the mental health impact of COVID-19, data on suicide deaths for the current period will not be available until next year at the earliest. In the meantime, new data from 2018, estimates of which can be found on the SHADAC State Health Compare web tool, provide an updated baseline to help understand potential changes during COVID-19.
Two new SHADAC briefs draw on this data to present trends and variations in suicide death rates across the nation, among the states, and by subpopulation breakdowns from 2000 to 2018. The briefs paint a picture of the current landscape of suicide deaths—highlighting geographic areas and demographic groups that warrant particular attention as mental health stressors increase nationwide.
The first brief looks at national trends and demographics in suicide deaths, and the second brief looks at state trends and variations. Below are highlighted findings from the two briefs.
National Trends and Demographics in Suicide Death Rates from 2000 to 2018
The 2018 U.S. suicide death rate of 14.2 per 100,000 people represents a 37% increase from the 2000 rate of 10.4 deaths per 100,000 people—an additional 3.8 deaths per 100,000 people per year. This increase represents about 110,000 more lives lost than if the U.S. suicide rate had remained steady.
The increase in suicide deaths has not followed a consistent trend; rather, growth has accelerated more recently. From 2000 to 2009 the suicide death rate grew by 13 percent, but from 2009 to 2018 the rate grew by 21 percent.
Suicide Deaths by Age
- In 2018, children age 10-14 had the lowest suicide rate, at 2.9 per 100,000. This was the only rate we examined that was lower than the overall rate of 14.8 per 100,000.1 However, this age group experienced the largest increase in suicide rates from 2000 to 2018, at 95 percent.
- Adults age 55-64 had the highest suicide death rate in 2018, at 20.2 per 100,000.
Suicide Deaths by Sex
- In 2018, the suicide rate for males was 22.8 per 100,000, while the suicide rate for females was 6.2 per 100,000. However, the suicide rate increased more for females (56 percent) than for males (28 percent) from 2000 to 2018.
Suicide Deaths by Race/Ethnicity
- In 2018, American Indians and Alaska Natives had the highest suicide death rate at 22.1 per 100,000 people, significantly higher than the overall population rate of 14.2 per 100,000. Whites had the second-highest rate at 18.0 per 100,000, which was also significantly higher than the overall rate.
- Asians and Pacific Islanders, Blacks, and Hispanics registered similar rates of suicide death in 2018 (7.0, 7.2, and 7.4 per 100,000, respectively), all of which were significantly lower than the overall population rate.
- Rates of death from suicide have increased significantly across all races and ethnicities from 2000 to 2018. However, suicide death rates increased more rapidly among American Indians and Alaska Natives than among other groups, with American Indians and Alaska Natives seeing an 86 percent increase in suicide deaths since 2000.
For further analysis, including an examination of suicide death rates by urbanization and cause of death (i.e., firearm vs. non-firearm), see the full SHADAC issue brief on suicide rates at the national level.
State Trends and Variation in Suicide Death Rates from 2000 to 2018
State-level trends in suicide death rates suggested a pattern of acceleration similar to the national one described above: From 2000 to 2009, 22 states experienced statistically significant increases in their suicide rates, whereas from 2009 to 2018, 41 states experienced significant increases.
- 41 states and the District of Columbia experienced significant increases in suicide death rates between 2000 and 2018. Increases ranged from a low of 14 percent in Maryland, where rates grew from 9.0 to 10.2 suicide deaths per 100,000 people, to a high of 97 percent in the District of Columbia, where rates grew from 3.8 to 7.5 deaths per 100,000.2
- Wyoming had the highest 2018 suicide rate at 25.2 deaths per 100,000 people, and the District of Columbia had the lowest rate at 7.5 deaths per 100,000 people.
- Twelve states and the District of Columbia had suicide death rates in 2018 that were significantly lower than the overall U.S. rate (14.2 deaths per 100,000 people), 9 had rates that were statistically equivalent to the U.S. rate, and 29 had rates that were significantly higher than the U.S. rate.
For further analysis, including an examination of state-level suicide death rates by cause of death, see the full SHADAC issue brief on suicide rates at the state level.
About the Data
SHADAC accesses vital statistics data from the Centers for Disease Control and Prevention, National Center for Health Statistics, via the CDC WONDER Database.
Except where otherwise indicated, rates of suicide deaths presented here are age-adjusted. Rates and standard errors were obtained from the CDC Wonder Database using ICD-10 cause-of-death codes U03 (Suicide terrorism); X60-X84 (Intentional self-harm); and Y87.0 (Sequelae of intentional self-harm).
Explore the Data
Suicide death rate data from the CDC WONDER Database can be accessed on SHADAC’s State Health Compare data tool. Data are available for the years 1999 to 2018 for the U.S. and all 50 states and the District of Columbia, and can be analyzed by age, sex, race/ethnicity, metropolitan status, and firearm vs. non-firearm cause of death.
Like the Kaiser Family Foundation (KFF), SHADAC recently fielded a survey that asked a nationally representative sample of U.S. adults about changes in their stress levels in response to the COVID-19 pandemic as well as how they were coping with coronavirus-related stress. Results from the survey echoed the troubling findings from KFF, with over 90% of respondents reporting increased stress levels, and nearly 74% correspondingly reporting increased use of coping mechanisms in response to rising stress—including those with negative consequences, such as eating more (and more unhealthy foods) and increased alcohol consumption, smoking, and vaping.
1 When analyzing suicide rates by age groups, the rates cannot be age-adjusted as for other portions of this analysis. Because of that, we use an overall U.S. suicide rate that is not age-adjusted when analyzing age groups, so that rate varies slightly from the rate presented elsewhere in this analysis.
2 Although the District of Columbia’s suicide rates are relatively low compared to other states, its suicide death rates also are relatively volatile year-to-year. For example, its suicide death increased about 70 percent from 2000 to 2001, whereas its rate decreased about 40 percent from 2008 to 2009.
Suicide Rates on the Rise: Examining Continuing Trends and Variation across the Nation and in the States from 2000 to 2018
Among the numerous impacts resulting from the arrival of the coronavirus pandemic, early evidence from several recent national polls suggests that the COVID-19 crisis is taking a significant toll on mental health in the United States.1 While we will not be able to fully comprehend the extent of this toll until data on one important indicator of mental health, rates of suicide deaths, is released for the current period, examining estimates from 2018 (the most recent data year available) provides an important baseline from which to begin understanding potential shifts in the landscape of mental health and “deaths of despair” such as suicide as a result of COVID-19.
Death rates from suicide in the United States have been increasing at an alarming pace, rising from 10.4 to 14.2 per 100,000 people from 2000 to 2018 (an increase of 37 percent). This increase represents about 110,000 additional lives lost than if the U.S. suicide rate had remained steady. Suicide has killed over 700,000 people since 2000—more than the number killed by another, more well-known national epidemic, opioids, during the same time period
Suicide deaths have not only increased significantly over the past nearly two decades, but their growth is continuing a pattern of acceleration in more recent years: From 2000 to 2009 the suicide death rate grew by 13 percent, but from 2009 to 2018 the rate grew by 21 percent.
As part of an analysis aiming to shed more light on this growing public health concern, SHADAC researchers have produced two issue briefs that provide high-level information regarding trends in suicide deaths from 2000 to 2018. Each brief presents historical context for the troubling recent acceleration in the rise of suicide rates and mortality in the United States, and examines trends in suicide-related mortality across the nation and states, and among specific population subgroups. Click on the briefs below to download.
Data on Suicide Deaths are available from SHADAC’s State Health Compare tool and were recently updated to include estimates from 2018, the latest data year available. This measure can be viewed by demographics including age, gender, race/ethnicity, metropolitan status, and cause of death. Estimates on State Health Compare come from the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics via the CDC WONDER Database.
National Suicide Prevention Lifeline: 1-800-273-8255
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. For more suicide prevention resources, visit https://suicidepreventionlifeline.org/
1 Kirzinger, A., Hamel, L., Muñana C., Kearney, A., & Brodie, M. (2020, April 24). KFF Health Tracking Poll – Late April 2020: Coronavirus, Social Distancing, and Contact Tracing. Retrieved from https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/
Planalp, C., Alarcon, G., & Blewett, L. (2020, May 26). 90 percent of U.S. adults report increased stress due to pandemic. Retrieved from https://shadac.org/SHADAC_COVID19_Stress_AmeriSpeak-Survey