Heroin Overdose Data

In 2018, nearly 15,000 people died from a drug overdose involving heroin in the United States, a rate of almost 5 deaths for every 100,000 Americans. However, also in 2018, heroin-involved overdose death rates showed a decline, decreasing 4.1% from 2017 to 2018.1

  • Reductions occurred among males and females, persons aged 15–34 years, non-Hispanic whites, and in large central metro and large fringe metro areas.
  • Rates decreased in the Midwest and increased in the West.
  • Rates decreased in seven states and DC and increased in three states from 2017 to 2018. The largest relative decrease occurred in Kentucky (50.0%) while the largest absolute decrease occurred in DC (–7.1 per 100,000); the largest relative and absolute increase was in Tennessee (18.8%, 0.9 per 100,000). The highest heroin-involved death rate in 2018 was in Vermont (12.5 per 100,000).1
  • Reported heroin use in the past year also decreased from an estimated 886,000 people in 2017 to an estimated 808,000 people in 2018.2

Decreases in heroin-involved overdose deaths were seen in 2018, but the number of heroin-involved overdose deaths was still more than 7 times higher in 2018 than in 1999. Nearly a third of all opioid deaths involved heroin.3

2017-2018

  • 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. Rates are age-adjusted using the direct method and the 2000 U.S. standard population, except for age-specific crude rates. All rates are per 100,000 population.
  • Drug overdose deaths, as defined, have heroin (T40.1) as a contributing cause.
  • Analyses were limited to states meeting the following criteria: For states with very good to excellent reporting, ≥90% of drug overdose deaths mention at least one specific drug in 2017, with the change in drug overdose deaths mentioning of at least one specific drug differing by <10 percentage points between 2017 and 2018. States with good reporting had 80% to <90% of drug overdose deaths mention at least one specific drug in 2017, with the change in the percentage of drug overdose deaths mentioning at least one specific drug differing by <10 percentage points between 2017 and 2018. States included were also required to have stable rate estimates, i.e., based on ≥20 deaths, in at least two drug categories (i.e., opioids, prescription opioids, synthetic opioids other than methadone, and heroin).
  • Rate comparisons between states should not be made due to variations in reporting across states.

The figures below show the changes in age-adjusted death rates involving heroin by urbanization classification of residence from year to year.

  • Large central metro—Counties in metropolitan statistical areas of 1 million or more population that:
    • Contain the entire population of the largest principal city
    • Have their entire population contained in the largest principal city
    • Contain at least 250,000 inhabitants of any principal city
  • Large fringe metro—Counties of 1 million or more population that did not qualify as large central metro counties.
  • Medium metro—Counties of populations of 250,000 to 999,999.
  • Small metro—Counties of populations less than 250,000.
  • Micropolitan—Counties in micropolitan statistical areas that have a population of at least 10,000 but less than 50,000.
  • Noncore—Nonmetropolitan counties that did not qualify as micropolitan.

Categories of 2013 NCHS Urban-Rural Classification Scheme for Counties (https://www.cdc.gov/nchs/data_access/urban_rural.htm)

2018 heroin overdose dot plot

2016-2017

  • 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.
  • Rates shown are for the number of deaths per 100,000 population. Age-adjusted death rates were calculated using the direct method and the 2000 standard population.
  • Drug overdose deaths, as defined, have heroin (T40.1) as contributing causes.
  • Analyses were limited to states meeting the following criteria: For states with very good to excellent reporting, ≥90% of drug overdose deaths mention at least one specific drug in 2016, with the change in drug overdose deaths mentions of at least one specific drug differing by no more than 10 percentage points (pp) between 2016 and 2017. States with good reporting had 80% – <90% of drug overdose deaths mention of at least one specific drug in 2016, with the change in the percentage of drug overdose deaths mentioning at least one specific drug differing by no more than 10 percentage points between 2016 and 2017. States included also were required to have stable rate estimates, based on ≥20 deaths, in at least two drug categories (i.e., opioids, prescription opioids, synthetic opioids other than methadone, heroin).
  • Absolute rate change is the difference between 2016 and 2017 rates. Percent change is the absolute rate change divided by the 2016 rate, multiplied by 100. Statistically significant at p<0.05 level. Nonoverlapping confidence intervals based on the gamma method were used if the number of deaths was <100 in 2016 or 2017, and z-tests were used if the number of deaths was ≥100 in both 2016 and 2017. Note that the method of comparing confidence intervals is a conservative method for statistical significance; caution should be observed when interpreting a nonsignificant difference when the lower and upper limits being compared overlap only slightly.
  • Rate comparisons between states should not be made due to variations in reporting across states.
2015-2016 Overdose Map

Heroin Overdose Death Rates.  Age-adjusted deaths per 100,000 population for heroin from 2014 to 2015, by census region of residence. Northeast*: 3,461 deaths in 2015. 5.1 in 2014, 6.3 in 2015. Midwest*: 3,959 deaths in 2015, 2.4 in 2014, 3.2 in 2015. South*: 3,722 deaths in 2015, 2.4 in 2014, 3.2 in 2015. West*: 1,847 deaths in 2015, 2.2 in 2014, 2.4 in 2015. United States*: 12,989 deaths in 2015, 3.4 in 2014, 4.1 in 2015. SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://wonder.cdc.gov/. *Statistically significant at p<0.05 level.

References

  1. 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.
  2. CDC. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States Surveillance Special Report.pdf icon Centers for Disease Control and Prevention: U.S. Department of Health and Human Services. Published November 1, 2019.
  3. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.
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