Understanding the Opioid Overdose Epidemic

What to know

  • The number of opioid-related deaths has been rising continuously since 1999.
  • Three distinct waves of increases are related to different types of opioids throughout the last 25 years.
  • Increasing communities' support, capacity, and education may help turn the tide and prevent overdose deaths.

Opioid-related deaths are rising

Drug overdose deaths

  • The number of people who died from a drug overdose in 2021 was over six times the number in 1999.
  • The number of drug overdose deaths did not significantly change from 2021 to 2022.
  • Over 75% of the nearly 107,000 drug overdose deaths in 2022 involved an opioid.


  • Opioid-involved death rates decreased by 12.5%.
  • Prescription opioid-involved death rates remained the same.
  • Heroin-involved death rates decreased nearly 36%.
  • Synthetic opioid-involved death rates (excluding methadone) increased over 4%.1

Three waves of opioid overdose deaths

Line infographic showing 3 waves of opioid overdose deaths from 1999-2021.
This rise in opioid overdose deaths is shown in three distinct waves.

From 1999-2021, nearly 645,000 people died from an overdose involving any opioid, including prescription and illicit opioids.2

This rise in opioid overdose deaths can be outlined in three distinct waves.

First wave

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 1999.3

Second wave

The second wave began in 2010, with rapid increases in overdose deaths involving heroin.4

Third wave

The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illegally made fentanyl. 567The market for illegally made fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.8

Many opioid-involved overdose deaths also include other drugs. 910

Confronting the opioid overdose epidemic

CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, respond to overdoses, and provide care to those in their communities.

224 people died each day from an opioid overdose in 2022.
Hundreds of people died each day from an opioid overdose in 2021.

What CDC's work focuses on

Overdose Data to Action

Overdose Data to Action (OD2A) is a cooperative agreement that provides funding to 90 health departments under two distinct OD2A programs (State and Local) to reduce drug overdoses and the impact of related harms. This cooperative agreement supports jurisdictions in implementing prevention activities and in collecting accurate, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to enhance programmatic and surveillance efforts. OD2A focuses on understanding and tracking the complex and changing nature of the drug overdose crisis by seamlessly integrating data and prevention strategies.

Collaboration helps save lives

Collaboration is essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better coordinate efforts to prevent opioid overdoses and deaths.

Related pages

  1. Spencer MR, Garnett MF, Miniño AM. Drug Overdose Deaths in the United Sates, 2002-2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024.
  2. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.