CDC looks at data on use and overdoses involving a variety of drugs, including cocaine, psychostimulants with abuse potential (e.g., methamphetamine, amphetamines, and prescription stimulants), and marijuana. There are also an increasing number of studies available on using drugs in combination with each other, referred to as polysubstance use.
- Powerful stimulant for the nervous system
- Illegal drug
- Highly addictive drug that can be snorted, smoked, or dissolved and injected into a vein
Cocaine is a type of stimulant that was involved in nearly 1 in 5 overdose deaths in 2019. Over 5 million Americans reported current cocaine use in 2020, which is almost 2% of the population.20
Cocaine-involved overdose death rates in the United States decreased from 2006-2012 but began increasing again in 2012. From 2018-2019, drug overdose deaths involving cocaine increased by nearly 9%, with almost 16,000 Americans dying in 2019 from an overdose involving cocaine. Non-Hispanic black persons experienced the highest death rate for overdoses involving cocaine in 2019.19
- Include illegal drugs such as methamphetamine or ecstasy
- Also include prescription stimulants for conditions such as attention deficit hyperactivity disorder (ADHD) or depression
- Most of these drugs can be misused and are considered addictive
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. Approximately 5 million Americans misused prescription stimulants in 2020, which is approximately 1.8% of the U.S. population aged 12 years and older.20 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 psychostimulants have been increasing since 2010. More than 16,000 Americans died from an overdose involving psychostimulants with abuse potential in 2019, which was a 28% increase from the previous year. Nearly 23% of all drug overdose deaths in 2019 involved psychostimulants. From 2016-2017, among racial/ethnic groups, non-Hispanic white persons had the greatest percent increase in the death rate for overdoses involving psychostimulants, while from 2018-2019, the largest absolute rate change in psychostimulant-involved overdoses was in American Indian/Alaska Native (AI/AN) populations.19 AI/AN also experienced the highest death rate for overdoses involving psychostimulants in 2019.19
- Highly addictive central nervous system psychostimulant
- Man-made drug that can be smoked, snorted, injected, or orally ingested
Methamphetamine is a highly addictive central nervous system stimulant.3 It is also categorized as a psychostimulant. Methamphetamine is commonly referred to as meth, ice, speed, and crystal, among many other terms.4 In addition to risking becoming addicted to methamphetamine, people who use methamphetamine long-term may experience a range of negative health outcomes, including damage to the heart and brain, anxiety, confusion, insomnia, mood disturbances, and violent behavior.5 In recent years, methamphetamine-involved overdoses have been increasing in the United States across many demographic groups.19
In 2020, 2.5 million Americans aged 12 or older reported having used methamphetamine in the past year.20 From 2015-2018, an estimated 1.6 million U.S. adults aged ≥18 years, on average, reported past-year methamphetamine use.8 Among adults who used methamphetamine during this time:
- 53% met diagnostic criteria for methamphetamine use disorder. Less than 1 in 3 of those with methamphetamine use disorder received substance use treatment in the past year.
- 3% reported injecting methamphetamine in the past year.
- Co-occurring substance use and mental illness were common.
Identifying characteristics associated with past-year methamphetamine use provides insights into populations to prioritize for prevention and response efforts. Adults with limited income, those on Medicaid, people who are uninsured, those with lower education status, males, middle-aged adults, and people who live in rural areas are at increased risk for methamphetamine use.8 These data show the importance of recovery support services, such as vocational training and placement, and linkage to social service providers.
Nearly 85% of overdose deaths involved illicitly manufactured fentanyls, heroin, cocaine, or methamphetamine (alone or in combination) during January–June 2019.9 Over 50% of psychostimulant-related overdose deaths involved opioids in 2018.10 Learn more about polysubstance use.
Treatment for Methamphetamine Use Has Been on the Rise
Methamphetamine use among people who were admitted to drug-related treatment has been increasing. For more information, see SAMHSA’s Treatment for Stimulant Use Disorders, or call 1-800-662-HELP (4357).
Learn more about methamphetamine use:
- Know the Risks of Meth (SAMHSA)
- Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders: Counselor’s Treatment Manual
- Methamphetamine | National Institute on Drug Abuse (NIDA)
- Drug Facts: Methamphetamine | NIDA
- Patterns and Characteristics of Methamphetamine Use Among Adults — United States, 2015–2018
- Exposure to more than one drug, with or without the person’s knowledge
- Opioid-involved overdose often occurs in combination with exposure to other opioids and/or other non-opioid substances
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; IMF and cocaine; IMF and methamphetamine; and prescription or illicit opioids and benzodiazepines.13
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% involved another drug or alcohol, such as: another opioid, heroin, cocaine, prescription opioids, benzodiazepines, alcohol, psychostimulants, and antidepressants.13
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 in 2016.13
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.13 Approximately one-third of psychostimulant-involved deaths also involved synthetic opioids in 2019.19
An animal tranquilizer called xylazine is increasingly being found in the US illicit drug supply and linked to overdose deaths.20 Xylazine can be life threatening and is especially dangerous when combined with opioids like fentanyl.
The presence of xylazine in drugs tested in labs increased in every region of the United States from 2020-2021, with the largest increase in the South.21 Studies from specific areas found similar increases. One study from 10 US cities showed xylazine was involved in less than 1% of drug overdose deaths in 2015 and in nearly 7% in 2020.22 In samples from eight syringe service programs in Maryland tested between 2021 and 2022, xylazine was found in almost 80% of drug samples that contained opioids.23 In Philadelphia, Pennsylvania, xylazine was found in 31% of heroin and/or fentanyl overdose deaths in 2019.24
- A synthetic (man-made) opioid 50x more potent than heroin and 100x more potent than morphine
- Prescribed in the form of transdermal patches, tablets, lozenges, or nasal sprays
- Can also be illegally made (illicitly manufactured fentanyl) and mixed into other drugs like heroin or cocaine, pressed into pills, co-used, or used alone
Fentanyl analogs are:
The risks of fentanyl contamination of illegal drugs are 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 a 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.15
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% of those who died from an opioid overdose tested positive for any fentanyl analog, and more than 11% tested positive for carfentanil.16
Beginning in 2013, there were significant increases in deaths involving synthetic opioids – particularly those involving IMF. Individuals using substances may not know if or 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.17, 18
The Drug Enforcement Administration’s (DEA) National Forensic Laboratory Information System (NFLIS) collects Fentanyl Encounters Data on drug chemistry analysis from drugs seized during law enforcement operations.
- Dried flowers and leaves of the cannabis plant
- Can also be called weed, pot, dope, or cannabis
- Contains mind-altering (or psychoactive) compounds
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.1 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 2015.14
For more data and information, visit Marijuana.
- 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.
- 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.
- Barr AM, Panenka WJ, MacEwan GW, et al. The need for speed: an update on methamphetamine addiction [PDF]. J Psychiatry Neurosci. 2006;31(5):301-313.
- Substance Abuse and Mental Health Services Administration. Tips for Teens. Methamphetamine: The Truth About Methamphetamine. https://store.samhsa.gov/product/Tips-for-Teens-The-Truth-About-Methamphetamine/PEP18-03. Accessed 15 December 2020.
- Substance Abuse and Mental Health Services Administration. Know the Risks of Meth. https://www.samhsa.gov/methhttps://www.samhsa.gov/meth. Accessed 15 December 2020.
- Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. Published 2018 Jan 4. doi:10.15585/mmwr.mm675152e1
- Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). 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, Compton WM, Mustaquim D. Patterns and Characteristics of Methamphetamine Use Among Adults — United States, 2015–2018. MMWR Morb Mortal Wkly Rep2020;69:317–323. DOI: http://dx.doi.org/10.15585/mmwr.mm6912a1
- O’Donnell J, Gladden RM, Mattson CL, Hunter CT, Davis NL. Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019. MMWR Morb Mortal Wkly Rep 2020;69:1189–1197. DOI: http://dx.doi.org/10.15585/mmwr.mm6935a1
- Jones CM, Bekheet F, Park JN, Alexander GC. (2020). The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms. Epidemiologic Reviews. https://doi.org/10.1093/epirev/mxaa011
- Jones CM, Olsen EO, O’Donnell J, Mustaquim D, 2020. Resurgent Methamphetamine Use at Treatment Admission in the United States, 2008–2017. American Journal of Public Health 110, 509_516, https://doi.org/10.2105/AJPH.2019.305527
- CDC Health Alert Network. Increase in Fatal Drug Overdoses Across the Unites States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic [HAN Archive – 00438]. https://emergency.cdc.gov/han/2020/han00438.asp. Accessed 21 December 2020.
- 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 Healthexternal 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/
- 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.
- Kariisa M, Seth P, Scholl L, Wilson N, Davis N. Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential among Racial and Ethnic Groups – United States, 2004-2019. Drug and Alcohol Dependence. 2021; 227. https://doi.org/10.1016/j.drugalcdep.2021.109001.
- Kariisa M, Patel P, Smith H, Bitting J. Notes from the field: xylazine detection and involvement in drug overdose deaths—United States, 2019. Morbidity and Mortality Weekly Report. 2021;70(37):1300.
- Drug Enforcement Administration. The growing threat of xylazine and its mixture with illicit drugs. 2022. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf
- Friedman J, Montero F, Bourgois P, et al. Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug and alcohol dependence. 2022;233:109380.
- Russell E, Sisco E, Thomson A, et al. Rapid Analysis of Drugs: A Pilot Surveillance System To Detect Changes in the Illicit Drug Supply To Guide Timely Harm Reduction Responses – Eight Syringe Services Programs, Maryland, November 2021-August 2022. MMWR Morb Mortal Wkly Rep. 2023;72(17):458-462. Published 2023 Apr 28. doi:10.15585/mmwr.mm7217a2
- Korn WR, Stone MD, Haviland KL, Toohey JM, Stickle DF. High prevalence of xylazine among fentanyl screen-positive urines from hospitalized patients, Philadelphia, 2021. Clinica Chimica Acta. 2021;521:151-154.
- Substance Abuse and Mental Health Services Administration. (2021). Results from the 2020 National Survey on Drug Use and Health: Detailed Tables: Prevalence Estimates, Standard Errors, and Sample Sizes. https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables