Provisional Drug Overdose Death Counts for Specific Drugs

This data visualization presents counts of provisional drug overdose deaths by selected drugs and U.S. Department of Health and Human Services (HHS) public health regions, based on provisional mortality data from the National Vital Statistics System. This visualization is limited to drug overdose deaths with an underlying cause of death assigned to International Statistical Classification of Diseases, 10th Revision (ICD-10) code numbers X40-X44 (unintentional), X60-X64 (suicide), X85 (homicide), or Y10-Y14 (undetermined intent). Specific drugs were identified using methods for searching literal text from death certificates. Geographic patterns in drug overdose deaths involving specific drugs are presented using the ten HHS public health regions (see Technical Notes). 

Figure 1 allows users to examine trends in provisional drug overdose death counts by selected drug type over time nationally and according to specific region. Figure 2 allows users to examine trends in overdose death counts across regions according to specific drug type.

The provisional data in these figures are based on a current flow of mortality data and include reported 12 month-ending provisional counts of drug overdose deaths by jurisdiction of occurrence and specified drug. Provisional drug overdose death counts presented on this page are for “12-month ending periods,” defined as the number of deaths occurring in the 12-month period ending in the month indicated. For example, the 12-month ending period in June 2022 would include deaths occurring from July 1, 2021, through June 30, 2022. Evaluation of trends over time should compare estimates from year to year (June 2021 and June 2022), rather than month to month, to avoid overlapping time periods. It is important to note that the data represent counts of deaths, and not mortality ratios or rates, which are the standard measure used to compare groups, and therefore should not be used to determine populations at disproportionate risk of drug overdose death.

Provisional data presented on this page will be updated on a biannual basis as additional records are received. Previously released estimates are revised to include data and record updates received since the previous release. As a result, the reliability of estimates for a 12-month period ending with a specific month will improve with each biannual release and estimates for previous time periods may change with the addition of updated data. More than one drug can be reported on a death certificate; consequently, the resulting death counts do not form discrete, mutually exclusive categories.

Provisional counts include deaths among U.S. residents in the United States and are shown as of the date specified and may not include all deaths that occurred during a given time period.

Notes: Counts between 1-9 are suppressed in accordance with NCHS confidentiality standards. Reported provisional counts are the number of deaths occurring within the 50 states and the District of Columbia among U.S. residents received and processed for the 12-month period indicated. Drug overdose deaths are identified using ICD-10 underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Deaths may involve other drugs in addition to the referent (listed) drug. Deaths involving more than one drug (for example, a death involving both fentanyl and cocaine) are included in both totals.  Regions are the U.S. Department of Health and Human Services public health regions: Region 1 (CT, MA, ME, NH, RI, and VT), Region 2 (NJ and NY), Region 3 (DC, DE, MD, PA, VA, and WV), Region 4 (AL, FL, GA, KY, MS, NC, SC, and TN), Region 5 (IL, IN, MI, MN, OH, and WI), Region 6 (AR, LA, NM, OK, and TX), Region 7 (IA, KS, MO, and NE), Region 8 (CO, MT, ND, SD, UT, and WY), Region 9 (AZ, CA, HI, and NV), and Region 10 (AK, ID, OR, and WA).

Technical Notes

Nature and source of data

Death certificate records (mortality data) from the National Vital Statistics System (NVSS) are held in a live dynamic database and considered provisional until the data have been processed, reviewed, verified, and publicly released by National Center for Health Statistics as a final, static data set. Jurisdictions may continue to send updated death certificate information after the data year is considered final; these updates are not reflected in annual final mortality data files and official summary reports. The final data set also does not include literal text data, or information provided by those filling out the death certificate about the circumstances of death. As noted, this dynamic database may include updates to death certificate data received after the closeout of the data years, and death counts may differ from other published sources.

The ten HHS regions, excluding U.S. territories, presented on this page are:

• Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
• Region 2: New Jersey and New York
• Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia
• Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee
• Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
• Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
• Region 7: Iowa, Kansas, Missouri, and Nebraska
• Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming
• Region 9: Arizona, California, Hawaii, and Nevada
• Region 10: Alaska, Idaho, Oregon, and Washington

Drugs involved in drug overdose deaths were extracted from the death certificate literal text: the causes of death from Part I of the death certificate, significant conditions contributing to the death from Part II of the death certificate, and a description of how the injury occurred.  Drug overdose deaths involving the specific drugs presented in Figures 1 and 2 were identified from these text fields using the method described below.

Identifying drug overdose deaths involving specific drugs

Mortality statistics are compiled in accordance with World Health Organization (WHO) regulations specifying that WHO member nations classify and code causes of death with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) (1). ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on use of the classification. Causes of death for data presented on this page were coded according to ICD guidelines described in annual issues of Part 2a of the NCHS Instruction Manual (2).

This report includes decedents who resided and died in the United States and had an underlying cause of death of drug overdose. Drug overdose deaths are identified using underlying cause-of-death codes from the 10th Revision of ICD (ICD–10): X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined intent).

Specific drugs are identified as being involved in a drug overdose death when the drug or substance is mentioned in the literal text of the death certificate. The drugs or substances mentioned in literal text fields are assumed to be involved in the death unless contextual information indicates otherwise.

The data presented on this page use the Drugs Mentioned with Involvement (DMI) methodology to map search terms to a principal variant, which reflects a drug or drug group (3-8). Search terms include drug and pharmaceutical generic names, brand names, common usage or street names, abbreviations, metabolites, misspellings, and other variations.

Principal variants are linked to a unique ingredient identifier, which describes the substance’s molecular structure or descriptive information as generated by the Global Substance Registration System, maintained by the U.S. Food and Drug Administration. For example, terms such as COCAIEN, COCAINE CRACK, COCAINE HYDROCHLORIDE, and COCAINETOXICITY are all mapped to the principal variant COCAINE. Principal variants also are categorized according to whether they referred to a specific drug or substance (for example, oxycodone), class of drug or substances (for example, opioid), or nonspecific references (for example, words such as DRUG, MULTIDRUG, or POLYPHARMACY).

Referent drug groups serve as the unit of analysis for reporting drug overdose deaths of specific drugs. A referent drug group may include two or more principal variants reflecting a drug category. For example, the referent drug group fentanyl includes principal variants of fentanyl, which includes fentanyl analogs (for example, CARFENTANIL), precursors (for example, DEPROPIONYLFENTANYL), and metabolites (for example, NORFENTANYL) of fentanyl.

The methods to identify specific drugs involved in the death (DMI methodology) are routinely enhanced to better search the literal text from death certificates. The latest list of search terms found in the literal text of data presented in this visualization are provided in an accompanying file, available from: Drug Specific Terms [XLS – 44 KB]. More than one drug can be reported on a death certificate; consequently, the resulting death counts do not form discrete, mutually exclusive categories.

Limitations and other considerations

Counts of drug overdose deaths by specific drug are subject to change as additional search terms for drugs are identified. Therefore, findings from this report may differ from reports using final data or from provisional mortality data taken at a different time point. Further, determination of the source of the drugs or whether the drug was illegally manufactured cannot be determined from the literal text.

Methods based on literal text analysis are dependent on the quality and completeness of the information provided, which may vary by jurisdiction due to differences in reporting practices in systems that conduct death investigations and certify the cause and manner of unnatural and unexplained deaths (medicolegal death investigation systems) across the United States. Regional differences in the quality and completeness of death investigations and reporting must be considered when reviewing these findings.

Variations in the way drug overdose death are reported on death certificates, including the level of detail on the specific drugs involved, can impact comparability.

Source

National Center for Health Statistics, death certificate literal text data from the National Vital Statistics System as of March 7, 2024.

References

1. World Health Organization. International statistical classification of diseases and related health problems, 10^th 2008 ed. 2009.
2. National Vital Statistics System. Instructions for classifying the underlying cause of death. In: NCHS instruction manual: Part 2s. Published annually.
3. Trinidad JP, Warner M, Bastian BA, Miniño AM, Hedegaard H. Using literal text from the death certificate to enhance mortality statistics: Characterizing drug involvement in deaths. National Vital Statistics Reports; vol 65 no 9. Hyattsville, MD: National Center for Health Statistics. 2016. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_09.pdf
4. Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_09-508.pdf
5. Spencer MR, Warner M, Bastian BA, Trinidad JP, Hedegaard H. Drug overdose deaths involving fentanyl, 2011–2016. National Vital Statistics Reports; vol 68 no 3. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf
6. Hedegaard H, Bastian BA, Trinidad JP, Spencer MR, Warner M. Regional differences in the drugs most frequently involved in drug overdose deaths: United States, 2017. National Vital Statistics Reports; vol 68 no 12. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_12-508.pdf.
7. Spencer MR, Warner M, Cisewski JA, Miniño A, Dodds D, Perera J, Ahmad FB. Estimates of drug overdose deaths involving fentanyl, methamphetamine, cocaine, heroin, and oxycodone: United States, 2021. Vital Statistics Rapid Release; no 27. Hyattsville, MD: National Center for Health Statistics. May 2023. Available from: https://www.cdc.gov/nchs/data/vsrr/vsrr027.pdf
8. Spencer MR, Cisewski JA, Warner M, Garnett MF. Drug overdose deaths involving xylazine: United States, 2018–2021. Vital Statistics Rapid Release; no 30. Hyattsville, MD: National Center for Health Statistics. 2023. Available from: https://www.cdc.gov/nchs/data/vsrr/vsrr030.pdf

Suggested Citation

Ahmad FB, Cisewski JA, Garnett M, Warner M. Provisional drug overdose death counts by specific drugs. National Center for Health Statistics. 2024.

Acknowledgements

The interactive dashboard was designed by William Johnson. Bruce Goldberger contributed technical expertise in categorizing drugs and updating the DMI drug term database. David Dodds and Janaka Perera from the Information Services Branch of the NCHS Division of Vital Statistics (DVS) created the data file. DVS’s Data Acquisition and Evaluation Branch staff evaluated the quality of and acceptance procedures for the data files on which this report is based.