CDC also looks at data on the use of and overdoses involving other types of legal and illegal drugs like cocaine, methamphetamine, amphetamines, prescription stimulants, and marijuana. There is also increasing research on using drugs in combination with each other, referred to as polysubstance use.
Psychostimulants with abuse potential include both illicit drugs, such as methamphetamine and ecstasy, as well as prescription stimulants. Prescription stimulants, which are drugs used to treat conditions such as attention deficit hyperactivity disorder (ADHD) or depression, can also be misused. Around 6 million Americans misused prescription stimulants in 2016, which is approximately two percent of the U.S. population aged 12 years and older.1 Cocaine is also a psychostimulant; however, estimates of cocaine use and the number of deaths involving cocaine are usually calculated separately from other psychostimulants with abuse potential.
More than 7,500 Americans died from an overdose involving psychostimulants with abuse potential in 2016. The rate of overdose deaths involving psychostimulants increased by 33.3% from 2015.2
The highest rates of overdose deaths from psychostimulants with abuse potential were found primarily in smaller towns and in Midwestern and western states, where 14 of 31 states (with good to excellent reporting) had significant increases in death rates. Of those 31 states, Nevada, New Mexico, and Oklahoma had the highest rates of overdose deaths involving psychostimulants with abuse potential. The highest rates of deaths involving psychostimulants with abuse potential, by demographic group, were among males aged 25 to 44 years and non-Hispanic American Indian/Alaska Natives.2
Cocaine is a type of psychostimulant that has been involved in many overdose deaths. Almost 5 million Americans reported current cocaine use in 2016, which is almost 2 percent of the population. The percentage of people currently using cocaine has shown little change since 2007.1
However, drug overdose death rates involving cocaine increased 52 percent in 2016, with more than 10,000 Americans dying from an overdose involving cocaine. This increase in the overdose death rate was second only to the increase seen in deaths involving synthetic opioids (other than methadone), such as illicitly manufactured fentanyl (IMF).2 IMF is likely driving the increases in deaths involving cocaine, as there is a lack of awareness of the potency or even knowledge of fentanyl contamination.3
Washington D.C., Rhode Island, and Ohio had the highest rates of overdose deaths involving cocaine, but a total of 16 states (with good to excellent reporting of drugs on death certificates) had significant increases from 2015 to 2016 in overdose deaths involving cocaine. Counties with large cities (large central and fringe metro areas) experienced the largest absolute rate increases in deaths involving cocaine. 2
Marijuana, which can also be called weed, pot, dope, or cannabis, is the dried flowers and leaves of the cannabis plant. It contains mind-altering (i.e., psychoactive) compounds like tetrahydrocannabinol, or THC, as well as other active compounds like cannabidiol, or CBD, that are not mind-altering.
Like any other drug, marijuana’s effects on a person depend on a number of factors, including the person’s previous experience with the drug or other drugs, biology (i.e., a person’s genetics), gender, how the drug is taken, and how potent it is.
In 2016, around 24 million Americans aged 12 or older, or 9% percent of the population, were current users of marijuana.2 Marijuana use disorder occurs when recurrent use of marijuana causes clinically significant impairment, including health problems; persistent or increasing use; and failure to meet major responsibilities at work, school, or home. In 2016, around 4 million people, or 1.5% percent of the population, had had a marijuana use disorder in the past year. The 2016 percentage of the population aged 12 or older with a marijuana use disorder was lower than the percentages in most years between 2002 and 2010 and was similar to the percentages in 2011 to 2015.4
For more data and information on Marijuana visit the CDC Marijuana and Public Health webpage.
Polysubstance drug use is a dangerous trend of taking drugs, like heroin, with other substances, like marijuana, cocaine, alcohol, and prescription opioids. This growing issue also means that an opioid overdose often includes the use of more than one drug at once.
From 2010-2016, there were significant increases in overdose deaths involving synthetic opioids that also involved prescription opioids, heroin, and all other illicit or prescription drugs. Among synthetic opioid–related overdose deaths in 2016, almost 80 percent involved another drug or alcohol, like another opioid, heroin, cocaine, prescription opioids, benzodiazepines, alcohol, psychostimulants, and antidepressants.3
For example, synthetic opioids appear to be driving the recent increase in cocaine-related overdose deaths.3 The percentage of cocaine-related overdose deaths involving any opioid increased from 29.4% in 2000 to 63.0% in 2015, with heroin or synthetic opioids contributing to more than 81% of these deaths.5
Nearly all people who used heroin in 2013 also used one other drug, and most used at least three other drugs. Those with heroin use disorder are also more likely to misuse alcohol, marijuana, cocaine, and opioid pain medications.6
In 2016, among synthetic opioid–related overdose deaths, almost 80 percent involved another drug or alcohol. The most common other substances used in the overdose death were another opioid, heroin, cocaine, prescription opioids, benzodiazepines, alcohol, psychostimulants, and antidepressants.5
Fentanyl Contamination of Other Drugs is Increasing Overdose Risk
The risks of fentanyl contamination of illegal drugs is also a growing concern, as this can lead to an increase in overdose deaths among people who may or may not be aware that their drugs include this deadly additive, and among people who have not used opioids before, and thus are at greater risk for overdose.
Fentanyl is approximately 50 times as potent as heroin. Fentanyl and fentanyl analogs are being mixed into counterfeit opioid pills, heroin, cocaine, and methamphetamine. Illicitly-manufactured fentanyl (IMF), which is illegal, non-pharmaceutical fentanyl, is likely contributing to deaths involving these other substances.
People who only use non-opioid drugs are more likely to overdose if they are exposed to drugs mixed with opioids, including fentanyl. This fentanyl contamination of other drugs may contribute to increased risk for overdose as those misusing other drugs can be exposed to drug products that vary in potency, including some extremely strong products.
- In 10-state study, almost 57% of people who died from an overdose tested positive for fentanyl and fentanyl analogs also tested positive for cocaine, methamphetamine, or heroin.
- More than half of opioid overdose deaths in 10 states studied tested positive for fentanyl. Northeastern states and Missouri reported the highest percentage of opioid overdose deaths involving fentanyl, followed by Midwestern and Southern states.
- The detection of fentanyl analogs in >10% of opioid overdoses in four states raises the concern that fentanyl analogs are rapidly becoming part of illicit opioid markets in multiple states.7
There have been an alarming number of recent deaths involving fentanyl analogs in certain states. Carfentanil, which is the most potent fentanyl analog detected in the United States, is responsible for the largest number of these deaths. For example, during July 2016–June 2017, among 11,045 opioid overdose deaths examined in 10 states, more than 20% percent of those dying from an opioid overdose tested positive for any fentanyl analog, and more than 11 percent tested positive for carfentanil.8
Fentanyl analogs are drugs that have similar chemical structures to fentanyl, such as
Beginning in 2013, there were significant increases in deaths involving synthetic opioids – particularly those involving IMF. Individuals misusing substances may not know if and when substances may be contaminated with fentanyl, so they need to be aware of the risks. Good Samaritan Laws assist eyewitnesses or bystanders in seeking help if they witness an overdose, as these people know that they can safely call for help to ensure a rapid emergency response. Overdoses can be reversed with naloxone, either administered by bystanders or by first responders. However, a higher dose or multiple number of doses per overdose event may be required to revive a patient due to the high potency of drugs currently in the drug supply.9,10
The Drug Enforcement Administration’s (DEA) National Forensic Laboratory Information System (NFLIS) collects data on drug chemistry analysis from drugs seized during law enforcement operations. These data on fentanyl contamination can be found on the Fentanyl Encounters Data page.
- Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
- Seth P, Scholl L, Rudd RA, Bacon S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants — United States, 2015–2016. MMWR Morb Mortal Wkly Rep. March 2018. 67(12);349–358.
- Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA. 2018;319(17):1819-1821.
- Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
- Jones CM, Baldwin GT, Compton WM. Recent Increases in Cocaine-Related Overdose Deaths and the Role of Opioids. American Journal of Public Health, March 2017, Vol. 107, No. 3, pp. 430-432.
- Centers for Disease Control and Prevention. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
- O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700 — 10 states, July 1–December 31, 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202.
- O’Donnell J, Gladden RM, Mattson CL, Kariisa M. Notes from the Field: Overdose Deaths with Carfentanil and Other Fentanyl Analogs Detected – 10 States, July 2016-June 2017. MMWR Morb Mortal Wkly Rep. July 2018. 67(27);767–768
- Centers for Disease Control and Prevention. CDC Health Advisory: Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities. August 25, 2016. https://emergency.cdc.gov/han/han00395.asp
- Centers for Disease Control and Prevention. CDC Health Advisory: Rising Numbers of Deaths Involving Fentanyl and Fentanyl Analogs, Including Carfentanil, and Increased Usage and Mixing with Non-opioids. HAN Health Advisory, July 11, 2018.