Opioid Data Analysis and Resources

CDC’s Injury Center looks at deaths and nonfatal overdoses for four categories of opioids:

  • Natural opioids (including morphine and codeine) and semi-synthetic opioids (drugs like oxycodone, hydrocodone, hydromorphone, and oxymorphone)
  • Methadone, a synthetic opioid
  • Synthetic opioids other than methadone (drugs like tramadol and fentanyl)
  • Heroin, an illicit (illegally made) opioid synthesized from morphine that can be a white or brown powder, or a black sticky substance.
Annual Surveillance Report
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The Second Annual Surveillance Report of Prescription and Illicit Drug-Related Risks and Outcomes pdf icon[PDF – 3 MB] covers latest data available on rates of opioid prescribing, substance use disorder, nonfatal hospitalizations and emergency department visits, and overdose deaths. A presentation is available pdf icon[PDF – 2 MB] that includes highlights of data, maps, tables, and charts from the report.

Nearly 450,000 people died from overdoses involving any opioid, including prescription and illicit opioids, from 1999-2018.1

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 1999.2
  2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.3
  3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.4,5,6 The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.7

Many opioid-involved overdose deaths also include other drugs.8,9

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Opioids were involved in nearly 47,000 deaths in 2018, which is nearly six times the number of opioid-involved overdose deaths in 1999.

The rate of drug overdose deaths involving opioids remains high, and CDC continues to track opioid overdose deaths.

The graph below shows rates of overdose deaths associated with three categories of opioids, as well as all opioids overall. Rates of deaths involving natural and semi-synthetic opioids and methadone are combined in one category called Commonly Prescribed Opioids.

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Opioid Overdose Deaths – United States, 2000-2016

Death Rates per 100,000 people

Year Any Opioid Synthetic opioid analgesics, excluding methadone    (e.g., fentanyl, tramadol)

 

Commonly Prescribed Opioids

(Natural & Semi-Synthetic Opioids and Methadone)

Heroin
2000 3.0 0.3 1.3 0.7
2001 3.3 0.3 1.7 0.6
2002 4.1 0.4 2.3 0.7
2003 4.5 0.5 2.6 0.7
2004 4.7 0.6 2.9 0.6
2005 5.1 0.6 3.2 0.7
2006 5.9 0.9 3.9 0.7
2007 6.1 0.7 4.2 0.8
2008 6.4 0.8 4.3 1.0
2009 6.6 1.0 4.4 1.1
2010 6.8 1.0 4.7 1.0
2011 7.3 0.8 4.9 1.4
2012 7.4 0.8 4.5 1.9
2013 7.9 1.0 4.4 2.7
2014 9.0 1.8 4.6 3.4
2015 10.4 3.1 4.7 4.1
2016 13.3 6.2 5.2 4.9
2017 14.9 9.0 5.2 4.9

NOTE:  Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdose deaths are identified using underlying cause of death codes X40-X44, X60-X64, X85, and Y10-Y14. The following multiple cause of death codes were used to identify specific drug types: T40.2 for natural and semi-synthetic opioid analgesics, T40.3 for methadone, T40.4 for synthetic opioid analgesics excluding methadone, T40.1 for heroin, and T40.0, T40.1, T40.2, T40.3, T40.4 or T40.6 for any opioid, and T40.2, T40.3 for prescription opioids. Approximately one-fifth of drug poisoning deaths lack information on the specific drugs involved. Some of these deaths may involve opioid analgesics or heroin. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.
SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

How the CDC Injury Center Calculates Opioid Overdoses

It is important to identify and classify which types of drugs are involved in an overdose, how often they are involved, and how that involvement changes over time. By understanding drug involvement, we can better identify appropriate prevention and response activities.

Historically, the approach to analyzing overdose death data used National Vital Statistics System mortality data (NVSS-M), with the combined categories of natural, semi-synthetic, and synthetic opioids (including methadone) used to report on overdose deaths involving prescription opioids.

In more recent years, the data have shown the increase in overdose deaths is being fueled by deaths involving synthetic opioids (other than methadone), likely illicitly manufactured fentanyl (IMF). This increase in deaths has been associated with increases in drug submissions (i.e., drug products tested by forensic labs) of IMF, but not in pharmaceutical fentanyl prescribing rates. 4,10,11,12  Thus, a large proportion of the increase in overdose deaths is presumably due to IMF and not prescription opioids.13 However, current information reported about overdose deaths in NVSS does not distinguish pharmaceutical fentanyl from IMF.

Given the surge in availability of IMF starting in 2013, the CDC Injury Center began analyzing synthetic opioids (other than methadone) separately from other prescription opioids for 2014 mortality data. This analysis provides a more detailed understanding of the increase in different categories of opioid deaths.

Using this approach, there were nearly 15,000 deaths involving this (more specific) category of prescription opioids in 2018, equivalent to about 41 deaths per day.12 This number is likely an undercount of deaths related to prescription opioids because it does not include deaths associated with pharmaceutical fentanyl, tramadol, and other synthetic opioids that are used as pain medications.

Drug overdose deaths can be hard to categorize. In 8% of drug overdose deaths in 2018, no specific drug was listed on the death certificate.12 In many deaths, multiple drugs are present, and it is difficult to identify which drug or drugs caused the death (for example, heroin or a prescription opioid, when both are present).3

Regardless of the method used to calculate the total numbers, prescription opioids continue to be involved in a significant proportion of drug overdose deaths, and the numbers are likely an underestimate of the true burden, given the large proportion of overdose deaths where the type of drug is not listed on the death certificate. The findings show three distinct but interconnected waves that are driving America’s opioid overdose epidemic: an increase in deaths from prescription opioid overdoses since the 1990s, an increase in heroin deaths starting in 2010, and a more recent surge in deaths from IMF, including fentanyl analogs.1,4

CDC uses a variety of data tools and resources to understand the scope of the drug overdose epidemic, both for overdose deaths and nonfatal overdoses treated in emergency departments or by emergency medical services.

  • Xponent: provides data from a sample of approximately 50,400 retail pharmacies, representing 90% of prescriptions in the United States.
  • SMART – US Edition: provides prescription level data across three unique channels: retail, mail service, and long-term care pharmacies.
  • SMART – US Regional Edition: provides the same information that is collected in the SMART – US Edition and adds geographic information (state and metropolitan statistical areas ).
  • SMART – Patient Insights Edition: provides information on a patient’s first-time use of a brand.
  • Total Patient Tracker: provides data on the total number of unique patients in the retail outpatient setting from United States retail pharmacies.
  • Prescriber Profiler: provides opioid prescribing data at the prescriber level for prescriptions dispensed from retail pharmacies.

References

  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. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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
  8. 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.
  9. 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.
  10. Centers for Disease Control and Prevention. CDC Health Advisory: Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. HAN Health Advisory. October 26, 2015.
  11. 2017 National Drug Threat Assessment. U.S. Department of Justice, Drug Enforcement Administration. October 2017.
  12. 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.
  13. Seth P, Rudd R, Noonan, R, Haegerich, T. Quantifying the Epidemic of Prescription Opioid Overdose Deathsexternal icon. American Journal of Public Health, March 2018;108(4):e1-e3.
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