The Injury Center is working to advance overdose prevention in communities across the country. † Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdoses are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). More than 3 in 5 people who died from drug overdose had an identified opportunity for linkage to care or life-saving actions.
- View the At-a-Glance document below to see how CDC uses data and research to prevent drowning and save lives.
- Research can also assess the effectiveness of interventions that map onto the strategies within CDC’s broad framework.
- A higher proportion of stimulant overdose decedents without an opioid contributing to death (74.1%) filled opioid prescriptions compared with decedents whose deaths involved opioids without stimulants or both opioids and stimulants (67.7% and 63.9%, respectively).
- Third, potential racial misclassification might lead to underestimates for certain groups, primarily AI/AN and A/PI.§§§§ Finally, certain trend analyses were limited, given small numbers of deaths and the inability to calculate stable rates among some stimulant-opioid drug combinations before 2003.
- These hypothesis-generating findings warrant confirmation but point to a potential role for work-related substance use and overdose prevention interventions.
Overdose Deaths and the Involvement of Illicit Drugs
First, overdose case definitions relied on discharge diagnosis codes, which were missing in 20.3% of ED visits available in NSSP for the 29 states analyzed. Improvements in submission of discharge diagnosis codes might have influenced the changes observed. However, in all included states, visits with valid discharge diagnosis codes increased 5.3% from 2018 to 2019. Second, discharge diagnosis codes might be used inconsistently by hospitals and providers, which could result in misclassification. Third, comprehensive toxicology testing of patients experiencing overdose rarely occurs in overdose ED visits (10), which might have underestimated polydrug overdoses.
Data Source
It is important that community service providers and members of the public have access to information about stimulants to increase awareness of the risks stimulants may pose, how to identify a stimulant overdose, and what resources exist to provide further support or education. The OD2A funds will help states and communities respond more quickly, effectively, and equitably to prevent overdose death and injury. The ten evidence-based strategies highlighted below are actions that states and jurisdictions can take today to prevent overdoses tomorrow. Research can help identify risk and protective factors for overdose and related harms and inform the development of prevention and mitigation strategies, including those implemented through programmatic funding. Research can also assess the effectiveness of interventions that map onto the strategies within CDC’s broad framework.
Drowning prevention
- Overdose deaths involving both synthetic opioids and stimulants have increased sharply in recent years.
- Our mission is to monitor, prevent, reduce, and respond to overdose via a data-driven approach that is anchored to evidence-based and evidence-informed strategies.
- While heroin drug submissions in NFLIS increased from 2006 to 2015, they decreased from 2015 to 2017 13.
- † Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10).
- The rate of cocaine overdose ED visits without opioids decreased 13.6% from 2015 to 2016, from 6.9 to 5.9.
- Employers and other entities seeking to implement work-related substance use and overdose prevention programs might need to tailor their approaches based on potential in psychostimulant or cocaine use within a given occupation or industry.
However, among decedents whose last dispensation was a stimulant, the median interval was longer among those whose deaths involved opioids without stimulants (50.5 days) than among those whose deaths involved stimulants without opioids or both opioids and stimulants (24.0 days for both groups). Overdose Data to Action (OD2A) is a cooperative agreement that provides funding to 90 health departments under two distinct OD2A programs (State and LOCAL) to reduce drug overdoses and related harms. This cooperative agreement supports jurisdictions in implementing prevention activities and in collecting accurate, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to enhance programmatic and surveillance efforts. OD2A focuses on understanding and tracking the complex and changing nature of the drug overdose crisis by seamlessly integrating data and prevention strategies.
Although some persons who co-use opioids and stimulants have cited motivations related to functionality and alertness in the workplace, occupational patterns of co-use remain uninvestigated. The drug overdose crisis is constantly evolving and remains an important public health issue. From 2020 to 2024, 75% of overdose deaths among youth ages 10–19 involved illegally made fentanyl. In addition, the number of teens reporting poor mental health has increased in the past decade. In 2023, 40% of high school students stopped regular activities because of persistent feelings of sadness or hopelessness and one in five students seriously considered attempting suicide.
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Percentage of changes in age-adjusted non-fatal and fatal rates of cocaine and psychostimulant-involved drug overdose with and without opioids. Non-fatal drug overdoses from the Healthcare Cost and Utilization Project’s Nationwide Emergency Department Sample; drug overdose deaths from the National Vital Statistics System. Drug overdose remains a leading cause of injury-related death in the United States—in 2023, there were about 287 overdose deaths each day.
About Overdose Prevention
Rates of overdoses involving opioids, cocaine, and amphetamines increased 9.7%, 11.0%, and 18.3%, respectively, and the rate of benzodiazepine-involved overdoses decreased 3.0%. Overdoses co-involving opioids and amphetamines increased from 2018 to 2019, overall, in both sexes, and in most age groups. In 2019, 23.6%, 17.1%, and 18.7% of overdoses involving cocaine, amphetamine, and benzodiazepines, respectively, also involved opioids. Expanding overdose prevention, treatment, and response efforts is needed to reduce the number of drug and polydrug overdoses.
For overdose ED visits, comprehensive toxicological testing of biological samples from patients experiencing overdose rarely occurs 22, and may have led to misclassification of overdoses involving stimulants with and without opioids. As poisoning codes on ED medical records are influenced by patient self-report or observations by ED personnel 12, inclusion of opioid codes in combination with a stimulant code may be underestimated in ED data, especially in cases where patients use a stimulant unknowingly mixed with fentanyl 23,24. For overdose deaths, improvements in toxicological testing over time might account for some increases. In addition, the types of drugs involved in overdose deaths were not included on 15% of death certificates in 2016 and 12% in 2017, potentially leading to an underestimate of stimulant-involved overdose deaths.
Drug overdose deaths, as defined, that have psychostimulantswith abuse potential (T43.6) and do not have an opioid (T40.0, T40.1, T40.2, T40.3, T40.4 or T40.6) as a contributing cause. Stimulants include methamphetamine, cocaine, crack cocaine, and amphetamines, such as medications prescribed for the treatment of ADHD. Timely data help improve coordination and promote readiness among health departments, community members, healthcare providers, public health, law enforcement, and government agencies, for regional or multiple state overdose increases. Ways to prevent opioid overdose are to improve opioid prescribing, reduce exposure to opioids, prevent illegal opioid use and prescription opioid misuse, and treat opioid use disorder. There are strategies that can help prevent overdose and support the health and well-being of communities. § ICD-10 multiple cause of death code T43.6, poisoning by psychostimulants with abuse potential, includes poisoning by substances such as methamphetamine, amphetamine, methylphenidate, and MDMA and excludes poisoning by cocaine.
Psychostimulant (stimulant)-related overdose death rates have increased sharply in the United States since 2010, and in 2022, 32% of all U.S. overdose deaths involved stimulants. Comparing overdose deaths in 2022 with those in 2017, deaths involving opioids without stimulants decreased from 2,974 to 1,995, deaths involving stimulants without opioids increased from 300 to 549, and deaths involving both opioids and stimulants increased from 1,703 to 2,346. Irrespective of whether an opioid, stimulant, or both contributed to death, decedents filled more opioid (67.7%, 74.1%, and 63.9%, respectively) than stimulant (10.6%, 11.6%, and 13.4%, respectively) prescriptions preceding death. A higher proportion of stimulant overdose decedents without an opioid contributing to death (74.1%) filled opioid prescriptions compared with decedents whose deaths involved opioids without stimulants or both opioids and stimulants (67.7% and 63.9%, respectively). Opioid prescribing, rather than stimulant prescribing, might be an important potential risk factor for stimulant-related overdose death. In 2017, a total of 10,333 deaths involving psychostimulants occurred, representing 14.7% of drug overdose deaths and a 37.0% increase from 2016 (Table).
However, the increasing mortality resulting from stimulant use warrants further analysis, including a longer history of PA PDMP data, enhanced monitoring as new stimulant overdose drug overdose cdc injury center data become available, and investigation of risk factors outside of controlled substance prescribing. In addition, some persons who use opioids have reported that they also use stimulants to compensate for the effects of synthetic opioids (e.g., fentanyl), thereby improving alertness and their ability to function, and this polysubstance use also warrants further exploration (8). Occupations and industries with higher percentages of cocaine involvement were those often considered to be less physically strenuous. Occupations with the highest percentages of synthetic opioid-involved overdoses involving cocaine were healthcare support (34.2%); community and social services (33.5%); business and financial (31.6%); legal (31.5%); and protective services (30.5%). Deaths involving cocaine and opioids increased more than cocaine deaths without an opioid from 2016 to 2017, suggesting that the opioid overdose epidemic is contributing to recent increases in cocaine-involved deaths. Data from 2016 to 2017 on psychostimulant-involved deaths with and without opioids also point to increasing opioid involvement.
This also underscores the importance of naloxone access not onlyamong individuals knowingly using opioids, but also among individuals using other illicit drugs that might be contaminated with IMF 16. In 2017, among 70,237 drug overdose deaths that occurred in the United States, 13,942 (19.8%) involved cocaine, representing a 34.4% increase from 2016 (Table). Nearly three fourths (72.7%) of cocaine-involved deaths in 2017 also involved opioids.
