The CDC’s National Vital Statistics Report issued on December 12, 2018 entitled Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016 reported: “From 1999 through 2016, the age-adjusted rate of drug overdose deaths in the United States more than tripled from 6.1 per 100,000 to 19.8 per 100,000.” The number of drug overdose deaths per year increased 54%, from 41,340 deaths in 2011 to 63,632 deaths in 2016.
Among drug overdose deaths that mentioned at least one specific drug, the 10 most frequently mentioned drugs during 2011–2016 included fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine. Oxycodone ranked first in 2011, heroin during 2012–2015, and fentanyl in 2016. The rate of drug overdose deaths involving fentanyl and fentanyl analogs doubled each year from 2013 through 2016, from 0.6 per 100,000 in 2013 to 1.3 in 2014, 2.6 in 2015, and 5.9 in 2016.
From 2011 through 2016, the age-adjusted rate of drug overdose deaths involving heroin more than tripled, as did the rate of drug overdose deaths involving methamphetamine. During the study period, cocaine consistently ranked second or third. The rate of overdose deaths involving methadone decreased from 1.4 per 100,000 in 2011 to 1.1 in 2016.
Deaths involving more than one referent drug (e.g., a death involving both heroin and cocaine) were counted in all relevant drug categories (e.g., the same death was included in counts of heroin deaths and in counts of cocaine deaths); therefore counts are not mutually exclusive. Only deaths with mention of at least two specific drugs (the referent drug and at least one concomitant drug) were included in the analysis. Alcohol, nicotine, and nondrug substances were not included in the analysis.
The percentage of drug overdose deaths mentioning at least one specific drug or substance increased from 73% of the deaths in 2011 to 85% of the deaths in 2016 (record-level data from the 2011–2016 National Vital Statistics System–Mortality files were linked to electronic files containing literal text information from death certificates).
The top 15 drugs were identified based on the number of drug overdose deaths per referent drug category. While the ranking changed from year to year, the top 10 drugs involved in overdose deaths remained consistent throughout the 6-year period. The top 10 drugs belonged to three drug classes: Opioids: fentanyl, heroin, hydrocodone, methadone, morphine, and oxycodone; Benzodiazepines: alprazolam and diazepam; and Stimulants: cocaine and methamphetamine.
Two in five overdose deaths involving cocaine also mentioned fentanyl. Nearly one-third of drug overdose deaths involving fentanyl also mentioned heroin (32%). More than one-third of the overdose deaths involving cocaine also mentioned heroin (34%). More than 20% of the overdose deaths involving methamphetamine also mentioned heroin.
In 2016, unintentional drug overdose deaths most frequently mentioned fentanyl, heroin, and cocaine, while suicides by drug overdose most frequently mentioned oxycodone, diphenhydramine, hydrocodone, and alprazolam. Methadone ranked in the top 10 for unintentional and undetermined intent deaths, but not among suicides by drug overdose. Quetiapine, tramadol, bupropion, and zolpidem ranked in the top 10 for suicides by drug overdose, but not for unintentional drug overdose deaths and overdose deaths of undetermined intent.
For the top 10 drugs involved in drug overdose deaths in 2016, the proportion of deaths involving both the referent drug and at least one other concomitant drug ranged from 50% for methamphetamine to 96% for alprazolam or diazepam. Approximately 70% of drug overdose deaths involving fentanyl or heroin (the top two drugs involved in drug overdose deaths in 2016) involved at least one other specific drug.
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