Relative and absolute rates of opioid-involved overdoses increased among persons living in both urban (13.6%; 16.9) and rural counties (10.1%; 6.1), as did rates of amphetamine-involved overdoses (21.7%; 1.3, urban and 20.8%; 1.9, rural). Number and age-adjusted ratesa of cocaine and psychostimulant overdose deaths with synthetic opioids other than methadone and heroin, by sex, age, Census region and level of urbanization—United States, 2016 and 2017. NEDS transitioned from using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes to International Classification of Diseases, 10th revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) on 1 October 2015. For non-fatal drug overdoses, ICD-9-CM codes were used to classify drug overdoses for 2006–14 and the first three quarters of 2015. These included codes for cocaine, amphetamine, other psychostimulants and opioids (Supporting information, Table S1).
Quick start for using the final data page
Fourth, hospital participation in NSSP varied across years; thus, results might be related to changes in hospital participation. Fifth, NSSP coverage is not necessarily uniform across or within all states, leading to different levels of coverage by region. Finally, analyses of overdoses stratified by race and ethnicity were not conducted because these data were not available in approximately one third and one half of visits, respectively. The Midwest experienced the only decline in relative and absolute rate for benzodiazepine-involved overdoses (−11.2%; −1.5).
Implications for Public Health Practice
- Opioids were substantially co-involved with cocaine, amphetamine, and benzodiazepine overdoses in 2019; 23.6%, 17.1%, and 18.7% of cocaine-, amphetamine-, and benzodiazepine-involved overdoses, respectively, involved opioids.
- For every overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll.3 OUD and overdose deaths continue to be a major public health concern in the United States, but they are preventable.
- The U.S. drug overdose epidemic continues to cause substantial morbidity and mortality.
- Prevention activities help educate and support individuals, families, and communities and are critical for maintaining both individual and community health.
Rates of psychostimulant-involved deaths without any opioid involvement increased from 2008 to 2017, and rates without synthetic opioid involvement increased from 2008 to 2017 (Figure 2). These findings have important programmatic implications regarding the evolving U.S. overdose epidemic. Syndromic surveillance is a critical data source for identifying overdose spikes and clusters to inform deployment of public health and public safety resources.
Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential — United States, 2003–2017
Additionally, we support the Drug-Free Communities (DFC) Program, which is the nation’s leading effort to support communities working to prevent youth substance use. The DFC program has been a central component of our nation’s youth substance use prevention strategy, and it provides funding and support to community coalitions to prevent and reduce youth substance use. DFC coalitions are uniquely situated to leverage historical knowledge and the unique needs and assets in their communities to address youth substance use by requiring comprehensive prevention planning with an emphasis on community level change.
Promising prevention strategies
The Injury Center is at the forefront of tracking the complex and changing nature of the drug overdose epidemic and implementing proven prevention strategies. For every overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll.3 OUD and overdose deaths continue to be a major public health concern in the United States, but they are preventable. ¶ Drug overdose deaths, as defined, that involve any opioid (T40.0-T40.4, and T40.6) and synthetic opioids other than methadone (T40.4). ¶ Drug overdose deaths, as defined, that involve any opioid (T40.0–T40.4 and T40.6) and synthetic opioids other than methadone (T40.4). The Prevention for States program includes evaluation of awarded states’ program activities to monitor performance, demonstrate effectiveness, and capture success stories.
Opioid use disorder and overdoses are preventable
Cocaine-involved death rates without any opioid decreased from 2006 to 2012 and then increased from 2012 to 2017, whereas cocaine-involved death rates without synthetic opioids increased from 2003 to 2006, decreased from 2006 to 2010, and then increased from 2010 to 2017 (Figure 1). From 2018 to 2019, overall relative and absolute rates increased for suspected nonfatal overdoses involving opioids (9.7%; 12.9 per 100,000 ED visits), cocaine (11.0%; 0.7), and amphetamines (18.3%; 1.3); rates decreased for overdoses involving benzodiazepines (−3.0%; −0.5) (Table 1). Relative and absolute rates for overdoses involving opioids increased from 2018 to 2019 among both females (7.1%; 6.0) and males (10.7%; 20.9), as well as all age groups. Cocaine- and amphetamine-involved overdose rates also increased among females (8.5%; 0.3 and 13.1%; 0.6, respectively) and males (12.4%; 1.1 and 20.5%; 2.2, respectively). Relative and absolute rate increases in amphetamine-involved overdoses occurred in all age groups except persons aged 15–24 years; relative and absolute rates of cocaine-involved overdoses increased only among persons aged 35–44 and ≥55 years.
Opioids were substantially co-involved with cocaine, amphetamine, and benzodiazepine overdoses in 2019; 23.6%, 17.1%, and 18.7% of cocaine-, amphetamine-, and benzodiazepine-involved overdoses, respectively, involved opioids. During 2003–2017, rates for all psychostimulant-involved deaths increased from 2010 to 2017. Death rates involving psychostimulants and any opioid increased from 2003 to 2010, followed by sharper increases from 2010 to 2015 and from 2015 to 2017. Death rates involving psychostimulants and synthetic opioids increased from 2010 to 2015, followed by a sharper increase from 2015 to 2017 (Figure 2).
The Centers for Disease Control and Prevention (CDC) awarded $279 million to 49 states, the District of Columbia, and 40 local health departments to help stop overdoses within their communities. The resources come from two new Overdose Data to Action (OD2A) funding opportunities and fill a longstanding gap in funding for local communities by specifically supporting city, county, and territorial health departments. Census region is coded by state of the facility where emergency department visits occurred. Prevention activities help educate and support individuals, families, and communities and are critical for maintaining both individual and community health.
Second, PA PDMP data cannot account for drugs used illicitly by persons for whom they were not prescribed, and many stimulants contributing to overdose and death are used illicitly with few or no approved prescription applications (e.g., cocaine, methamphetamine, and 3,4-methylenedioxymethamphetamine) (1). Finally, data from the PA PDMP do not contain information stimulant overdose drug overdose cdc injury center on the condition for which the drug is prescribed and represent controlled substance prescriptions filled, which might not reflect actual use. Learn lessons from the field about the diagnosis and treatment of overdoses and withdrawal involving medetomidine mixed with opioids.
Continued increases in stimulant-involved deaths require expanded surveillance and comprehensive, evidence-based public health and public safety interventions. In 2017, a total of 967,615 nonfatal drug overdoses were treated in U.S. emergency departments (EDs); polydrug ED-treated overdoses increased from 2017 to 2018. ED visits for psychostimulant overdose without an opioid also increased from 2015 to 2016. The West has historically had higher methamphetamine use rates 17, and experienced particularly large increases in ED visits for psychostimulant overdose from 2015 to 2016. This is probably attributable to a shift in production of methamphetamine by Mexican cartels in recent years after a decline in US domestic production following laws limiting access to methamphetamine precursors, pseudoephedrine, phenylpropanolamine and ephedrine 18,19.
- In contrast to mortality data, cocaine overdose ED visits without an opioid decreased 13.6% from 2015 to 2016.
- The resources come from two new Overdose Data to Action (OD2A) funding opportunities and fill a longstanding gap in funding for local communities by specifically supporting city, county, and territorial health departments.
- 49.9%, and 34.6% of suspected unintentional and undetermined intent drug overdoses among persons aged 15–24, 25–34, 35–54, and ≥55 years, respectively.
- Rates also increased among both sexes, most age groups, all regions and all urbanization levels except for non-core counties.
Therefore, stimulants with opioid ED visit estimates may underestimate their actual values, and the without opioid categories may be overestimated. In 2017, there were drug overdose deaths and more than two-thirds involved an opioid 1. Fatal overdoses involving stimulants (cocaine and other psychostimulants, primarily methamphetamine) have been increasing during the past few years. From 2016 to 2017, deaths involving cocaine and psychostimulants increased 34.4 and 33.3%, respectively 1. During 2003–2017, rates for all cocaine-involved deaths peaked initially in 2006, decreased during 2006–2012, and increased again during 2012–2017. Rates of overdose deaths involving cocaine and any opioid increased from 2013 to 2017, and those involving cocaine and synthetic opioids increased from 2012 to 2017 (Figure 1).
Fourth, within-group differences in proportions in stimulant co-involved deaths tended to be small. Finally, this analysis was exploratory, with no guiding hypotheses; therefore, these findings should be considered hypothesis-generating and warrant confirmation. A total of 69,893 synthetic opioid-involved overdose deaths among U.S. residents aged 15–64 years were identified, 53.6% of which also involved either psychostimulants or cocaine (Table). The occupation and industry groups with highest percentages of synthetic opioid overdoses involving either psychostimulants or cocaine (excluding those labeled “other”) were farming, fishing, and forestry (57.5%) and mining (55.9%). Those with the lowest percentages of such overdoses were healthcare practitioners and technical (46.7%) occupations and utilities industries (43.4%). Death rates involving cocaine and synthetic opioids and cocaine and heroin increased from 2016 to 2017 (76.9 and 9.1%, respectively) (Table 3).