CDC also looks at data on the use of and overdoses involving other types of legal and illegal drugs like cocaine, other psychostimulants with abuse potential (e.g., methamphetamine, amphetamines, prescription stimulants, and marijuana). There is also increasing research on using drugs in combination with each other, referred to as polysubstance use.
Cocaine is a type of psychostimulant that was involved in nearly 1 in 5 overdose deaths during 2017. Almost 5 million Americans reported current cocaine use in 2016, which is almost 2 percent of the population. This percentage has shown little change since 2007.1
Cocaine-involved overdose death rates in the United States decreased from 2006-2012 but began increasing again in 2012 In 2017, drug overdose deaths involving cocaine increased by more than 34 percent, with almost 14,000 Americans dying from an overdose involving cocaine. From 2016-2017, among racial/ethnic groups the largest relative rate and absolute rate changes for cocaine-involved overdoses were highest among non-Hispanic blacks.2 Non-Hispanic blacks also experienced the highest death rate for overdoses involving cocaine in 2017. 2
The largest rate increases in cocaine-involved overdose death rates were in the Midwest region from 2016-2017. Overall, the 2017 rate was highest in the Northeast region, however the highest death rates were in Washington D.C. and Ohio.2
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 stimulant drug; however, estimates of cocaine use and the number of deaths involving cocaine are usually calculated separately from other psychostimulants with abuse potential.
Rates of overdose deaths from all psychostimulants has been increasing since 2010. More than 10,000 Americans died from an overdose involving psychostimulants with abuse potential in 2017, which was a 37 percent increase from the previous year. From 2016-2017, among racial/ethnic groups, non-Hispanic whites had the greatest percent increase in the death rate for overdoses involving psychostimulants, while the largest absolute rate change in psychostimulant-involved overdoses was in American Indian / Alaska Native (AI/AN) populations.2 AI/AN also experienced the highest death rate for overdoses involving psychostimulants in 2017. 2
The highest rate increases of psychostimulant-related overdose deaths were in the Midwest region in 2017, while the overall rate was highest in the West. However, the highest overdose death rates were in West Virginia and Alaska.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 occurs with exposure to more than one drug, with or without the person’s knowledge. This growing issue also means that an opioid-involved overdose often occurs in combination with exposure to other opioids and/or other non-opioid substances. Some examples of polysubstance exposures found in combination in overdose deaths include: illicitly-manufactured fentanyl (IMF) and heroin; illicitly-manufactured fentanyl and cocaine; heroin and methamphetamine; and prescription or illicit opioids and benzodiazepines.3
From 2010-2016, there were significant increases in overdose deaths involving synthetic opioids that also involved prescription opioids, heroin, and other illicit or prescription drugs. Among synthetic opioid–involved 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
The overdose epidemic has grown increasingly complex by co-involvement of prescription and illicit drugs. For example, synthetic opioids (primarily IMF) were involved in 23.7% of deaths involving prescription opioids, 37.4% involving heroin, and 40.3% involving cocaine.3
Recent data indicate that the involvement of opioids in stimulant-involved deaths is increasing. Nearly three-quarters (72.7%) of cocaine-involved overdose deaths also involved an opioid in 2017.² Previous data have indicated that synthetic opioids, in particular, appear to be driving increases in cocaine-involved overdose deaths.3 Although increases in psychostimulant-involved deaths have occurred largely independent of opioids, co-involvement of opioids in psychostimulant involved deaths has increased more sharply from 2015-2017.² Approximately half (50.4%) of psychostimulant-involved deaths also involved opioids in 2017.²
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.6
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.7
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.8,9
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 2pdf icon. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.
- Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths involving Cocaine and Psychostimulants with Abuse Potential – United States, 2003-2017. Morb Mortal Wkly Rep. ePub. 3 May 2019.
- 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 Healthpdf iconexternal icon (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/external icon
- 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.