Understanding the Epidemic

The number of drug overdose deaths decreased by 4% from 2017 to 2018, but the number of drug overdose deaths was still four times higher in 2018 than in 1999.¹  Nearly 70% of the 67,367 deaths in 2018 involved an opioid. From 2017 to 2018, there were significant changes in opioid-involved death rates:

• Opioid-involved death rates decreased by 2%.
• Prescription opioid-involved death rates decreased by 13.5%.
• Heroin-involved death rates decreased by 4%.
• Synthetic opioid-involved death rates (excluding methadone) increased by 10%.²

Three Waves of Opioid Overdose Deaths

From 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids.¹

This rise in opioid overdose deaths can be outlined in three distinct waves.

1. The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.³
2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.⁴
3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.^5,6,7 The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.⁸

Many opioid-involved overdose deaths also include other drugs.^9.10

Combatting the Opioid Overdose Epidemic

CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, respond to overdoses, and provide care to those in their communities. Overdose Data to Action (OD2A) is a 3-year cooperative agreement through which CDC funds health departments in 47 states, Washington DC, two territories, and 16 cities and counties for surveillance and prevention efforts. These efforts include timelier tracking of nonfatal and fatal drug overdoses, improving toxicology to better track polysubstance-involved deaths, enhancing linkage to care for people with opioid use disorder and risk for opioid overdose, improving prescription drug monitoring programs, implementing health systems interventions, partnering with public safety, and implementing other innovative surveillance and prevention activities.

CDC’s work focuses on:

• Monitoring trends to better understand and respond to the epidemic.
• Advancing research by collecting and analyzing data on opioid-related overdoses and improving data quality to better identify areas that need assistance and to evaluate prevention efforts.
• Building state, local and tribal capacity by equipping states with resources, improving data collection, and supporting use of evidence-based strategies. Overdose Data to Action (OD2A) is a cooperative agreement that aims to increase the timeliness and comprehensives of data and to use those data to inform public health response and prevention activities.
• Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.
• Partnering with public safety officials and community organizations, including law enforcement, to address the growing illicit opioid problem.
• Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids.

Collaboration is essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better coordinate efforts to prevent opioid overdoses and deaths.

Read more about CDC’s role in the opioid overdose epidemic.

References

1. 1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.
   2. Wilson N, Kariisa M, Seth P, et al. Drug and Opioid-Involved Overdose Deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2020;69:290-297.
   3. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR MorbMortal Wkly Rep. 2011 Nov 4; 60(43):1487-1492.
   4. Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A. Increases in heroin overdose deaths—28 states, 2010 to 2012. MMWR MorbMortal Wkly Rep. 2014 Oct 3; 63(39):849.
   5. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013–2014. MMWR MorbMortal Wkly Rep. 2016; 65:837–43.
   6. O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006–2015. MMWR MorbMortal Wkly Rep. 2017; 66:897–903.
   7. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700—10 states, July–December 2016. MMWR Morb Mortal Wkly Rep. 2017; 66:1197–202.
   8. Drug Enforcement Administration. 2019 National Drug Threat Assessment. Drug Enforcement Administration Strategic Intelligence Section, U.S. Department of Justice. Published December 2019. Accessed March 17, 2020 from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdfpdf iconexternal icon
   9. Gladden M, O’Donnell J, Mattson C, Seth P. Changes in Opioid-Involved Overdose Deaths by Opioid Type and Presence of Benzodiazepines, Cocaine, and Methamphetamine – 25 States, July-December 2017 to January-June 2018. MMWR Morb Mortal Wkly Rep 2019:68(34);737-744.
   10. Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths involving Cocaine and Psychostimulants with Abuse Potential – United States, 2003-2017. MMWR Morb Mortal Wkly Rep 2019:68(17);41-43.