CDC: Drug Overdose Death Rates Involving Fentanyl Rose 279% between 2016 and 2021

Drug overdose death rates in the US involving fentanyl, methamphetamine, and cocaine increased from 2016 through 2021, according to researchers from the US Centers for Disease Control and Prevention (CDC).

The age-adjusted overdose death rate involving fentanyl increased by 279%, from 5.7 per 100 000 standard population in 2016 to 21.6 per 100 000 in 2021, reported Merianne Rose Spencer, MPH, epidemiologist, Division of Analysis and Epidemiology, National Center for Health Statistics, CDC, and colleagues in the May 2023 issue of Vital Statistics Rapid Release.

Rates of overdose deaths involving methamphetamine more than quadrupled, from 2.1 per 100 000 in 2016 to 9.6 per 100 000 in 2021, and those involving cocaine more than doubled, from 3.5 to 7.9, respectively. In contrast, the rate of drug overdose deaths involving oxycodone decreased 21%, from 1.9 in 2016 to 1.5 in 2021, and the rate of overdose deaths involving heroin decreased by 40.8%, from 4.9 to 2.9 per 100 000 standard population.

"Drug overdose deaths continue to be a significant public health burden in the United States, given the rise in rates over the past 2 decades," wrote researchers. "This report presents the trend in drug overdose deaths for the five most frequent opioids and stimulant drugs involved in deaths in the United States from 2016 through 2021."

Researchers analyzed literal text from the National Vital Statistics System mortality data for deaths occurring in the US among US residents. “Death certificate literal text is the written information provided by the medical certifier, usually a medical examiner or coroner for drug overdose deaths, that describes the causes, manner, and circumstances contributing to the death,” explained Spencer et al.

Investigators observed that in 2021, overdose death rates were higher among men than women, respectively, across all 5 of the drugs examined:

• Fentanyl: 31.3 vs 11.9 per 100 000
• Methamphetamine: 13.8 vs 5.4 per 100 000
• Cocaine: 11.3 vs 4.5 per 100 000
• Heroin: 4.2 vs 1.5 per 100 000
• Oxycodone: 1.7 vs 1.3 per 100 000

Variations were also seen among different age groups. In 2021, among adults aged 25-34 and 35-44 years, overdose death rates were highest for fentanyl (40.8 and 43.5, respectively), followed by methamphetamine (15.4 and 20.3) and cocaine (11.5 and 14.9). For persons aged 45-54 and 55-64 years, the rate of overdose deaths was similar for deaths involving fentanyl, cocaine, and methamphetamine, though were highest with fentanyl (32.7 and 24.8, respectively).

Among individuals aged 0-24 and ≥65 years, the rate of drug overdose deaths involving fentanyl was higher than other drug types, but it was "not significantly different," noted Spencer and colleagues.

In 2021, among non-Hispanic Black persons, the highest age-adjusted rate of drug overdose deaths involved fentanyl (31.3), followed by cocaine (20.6) and methamphetamine (7.0).

When researchers analyzed overdose death rates by race and ethnicity, they found that fentanyl was the number one drug tied to overdose deaths in 2021, with age-adjusted rates of 31.3 for non-Hispanic Black persons, 24.6 for non-Hispanic White persons, 33.1 for American Indian or Alaska Native people, and 2.3 for Asian individuals.

In addition, investigators noted geographic differences. In 2021, rates of drug overdose death that involved fentanyl were highest in 8 of the 10 US Department of Health and Human Services-designated public health regions compared with other drugs in the analysis. In the other 2 regions—Region 8 (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming) and Region 10 (Alaska, Idaho, Oregon, and Washington)—death rates involving fentanyl and methamphetamine "were similar," said investigators.

The regions in which overdose death rates involving fentanyl were highest were Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia), at 32.2 and 32.0 per 100 000, respectively.

Because authors analyzed the literal text of death certificates for the current study, they noted that “methods based on the literal text are dependent on the quality and completeness of the information provided, which may vary from jurisdiction to jurisdiction” due to differences in the ways deaths are reported.

“Interpretations of these findings should consider these limitations,” added Spencer and colleagues.