NCHS Data Brief ■ No. 356 ■ January 2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Drug Overdose Deaths in the United States, 1999–2018

Holly Hedegaard, M.D., Arialdi M. Miniño, M.P.H., and Margaret Warner, Ph.D.

Key findings

Data from the National 

Vital Statistics System, 

Mortality

● In 2018, there were 67,367 

drug overdose deaths in the 

United States, a 4.1% decline 

from 2017 (70,237 deaths). 

● The age-adjusted rate of 

drug overdose deaths in 2018 

(20.7 per 100,000) was 4.6% 

lower than in 2017 (21.7). 

● For 14 states and the District 

of Columbia, the drug overdose 

death rate was lower in 2018 

than in 2017. 

● The rate of drug overdose 

deaths involving synthetic 

opioids other than methadone 

(drugs such as fentanyl, 

fentanyl analogs, and tramadol) 

increased by 10%, from 9.0 in 

2017 to 9.9 in 2018. 

● From 2012 through 2018, the 

rate of drug overdose deaths 

involving cocaine more than 

tripled (from 1.4 to 4.5) and 

the rate for deaths involving 

psychostimulants with abuse 

potential (drugs such as 

methamphetamine) increased 

nearly 5-fold (from 0.8 to 3.9). 

Deaths from drug overdose continue to contribute to mortality in the 

United States (1–5). This report uses the most recent data from the National 

Vital Statistics System (NVSS) to update trends in drug overdose deaths for 

all drugs and for specific drugs and drug types, and to identify changes in 

rates by state from 2017 to 2018. 

In 2018, the age-adjusted rate of drug overdose deaths in the 

United States was 4.6% lower than the rate in 2017. 

● In 2018, there were 67,367 drug overdose deaths in the United States 

(Figure 1), 4.1% fewer deaths than in 2017 (70,237).

● The rate in 2018 (20.7) was 4.6% lower than the rate in 2017 (21.7).

● The age-adjusted rate of drug overdose deaths increased from 6.1 per 

100,000 standard population in 1999 to 21.7 in 2017. The rate increased 

1

Significant increasing trend from 1999 through 2016 with different rates of change over time, p < 0.05. Rate in 2018 was 

significantly lower than in 2017.

2

Rates for males were significantly higher than rates for females for all years, p < 0.05. 3

Significant increasing trend from 1999 through 2018 with different rates of change over time, p < 0.05. Rate in 2018 was 

significantly lower than in 2017. 

NOTES: Deaths are classified using the International Classification of Diseases, 10th Revision. Drug-poisoning (overdose) deaths 

are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. The number of drug overdose 

deaths in 2018 was 67,367. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#1.

SOURCE: NCHS, National Vital Statistics System, Mortality. 

Figure 1. Age-adjusted drug overdose death rates, by sex: United States, 1999–2018

 

 

 

 

 

 

 

 

 

 

 

 

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NCHS Data Brief ■ No. 356 ■ January 2020

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on average by 10% per year from 1999 through 2006, by 2% per year from 2006 through 

2013, and by 14% per year from 2013 through 2016.

● For each year, rates were higher for males than females. For males, the rate increased from 

8.2 in 1999 to 29.1 in 2017, then decreased to 27.9 in 2018. For females, the rate increased 

from 3.9 in 1999 to 14.4 in 2017, then decreased to 13.6 in 2018. 

For 14 states and the District of Columbia, the age-adjusted rate of drug 

overdose deaths in 2018 was lower than in 2017. 

● The drug overdose death rate was lower in 2018 than in 2017 for 15 jurisdictions: Alaska, 

the District of Columbia, Florida, Georgia, Indiana, Iowa, Kentucky, Maine, Minnesota, 

New York, North Carolina, Ohio, Pennsylvania, West Virginia, and Wisconsin (Figure 2).

● The drug overdose death rate was higher in 2018 than in 2017 for 5 states: California, 

Delaware, Missouri, New Jersey, and South Carolina. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2. Change in age-adjusted drug overdose death rates, by state: United States, 2017 and 2018

NOTES: Deaths are classified using the International Classification of Diseases, 10th Revision. Drug-poisoning (overdose) deaths are identified using underlying 

cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#2.

SOURCE: NCHS, National Vital Statistics System, Mortality.
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● In 2018, the states with the highest age-adjusted drug overdose death rates were West 

Virginia (51.5 per 100,000 standard population), Delaware (43.8), Maryland (37.2), 

Pennsylvania (36.1), Ohio (35.9), and New Hampshire (35.8). 

● In 2018, the states with the lowest age-adjusted drug overdose death rates were Texas (10.4), 

North Dakota (10.2), Iowa (9.6), Nebraska (7.4), and South Dakota (6.9). 

The age-adjusted rate of drug overdose deaths involving synthetic opioids 

other than methadone increased by 10% from 2017 to 2018. 

● The age-adjusted rate of drug overdose deaths involving synthetic opioids other than 

methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased 

from 0.3 per 100,000 standard population in 1999 to 1.0 in 2013, 1.8 in 2014, 3.1 in 2015, 6.2 

in 2016, 9.0 in 2017, and 9.9 in 2018 (Figure 3). 

● The rate of drug overdose deaths involving heroin increased from 0.7 in 1999 to 1.0 in 2010, 

then increased to 4.9 in 2016 and 2017. The rate in 2018 (4.7) was lower than in 2017. 

● The rate of drug overdose deaths involving natural and semisynthetic opioids, which 

include drugs such as oxycodone and hydrocodone, increased from 1.0 in 1999 to 3.1 in 

2009, then increased to 4.4 in 2016 and 2017. The rate in 2018 (3.8) was lower than in 2017. 

● The rate of drug overdose deaths involving methadone increased from 0.3 in 1999 to 1.8 in 

2006 and 2007, then decreased to 1.0 in 2016 and 2017. The rate in 2018 (0.9) was lower than 

in 2017. 

1

Significant increasing trend from 1999 through 2006 and 2013 through 2018, with different rates of change over time, p < 0.05. 2

Significant increasing trend from 1999 through 2018, with different rates of change over time, p < 0.05. 3

Significant increasing trend from 2005 through 2015, with different rates of change over time, p < 0.05. 4

Significant increasing trend from 1999 through 2006, then significant decreasing trend from 2006 through 2018, with different rates of change over time, p < 0.05.

NOTES: Deaths are classified using the International Classification of Diseases, 10th Revision. Drug-poisoning (overdose) deaths are identified using underlying 

cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths involving selected drug categories are identified by specific 

multiple-cause-of-death codes: heroin, T40.1; natural and semisynthetic opioids, T40.2; methadone, T40.3; and synthetic opioids other than methadone, T40.4. 

Deaths involving more than one opioid category (e.g., a death involving both methadone and a natural or semisynthetic opioid) are counted in both categories. Deaths 

may involve multiple drugs. The percentage of drug overdose deaths that identified the specific drugs involved varied by year, with ranges of 75%–79% from 1999 

through 2013 and 81%–92% from 2014 through 2018. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#3.

SOURCE: NCHS, National Vital Statistics System, Mortality. 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3. Age-adjusted drug overdose death rates involving opioids, by type of opioid: United States, 1999–2018
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From 2012 through 2018, the age-adjusted rate of drug overdose deaths 

involving cocaine more than tripled, and the rate of deaths involving 

psychostimulants with abuse potential increased nearly 5-fold. 

● The age-adjusted rate of drug overdose deaths involving cocaine increased from 1.4 per 

100,000 standard population in 1999 to 2.5 in 2006, then decreased to 1.3 in 2010 and 1.5 

in 2011. From 2012 through 2018, the rate increased on average by 27% per year to a rate of 

4.5 in 2018 (Figure 4).

● The age-adjusted rate of drug overdose deaths involving psychostimulants with 

abuse potential, which include drugs such as methamphetamine, amphetamine, and 

methylphenidate, increased from 0.2 in 1999 to 0.8 in 2012. From 2012 through 2018, the 

rate increased on average by 30% per year to a rate of 3.9 in 2018. 

Figure 4. Age-adjusted drug overdose death rates involving stimulants, by type of stimulant: United States, 1999–2018

1

Significant increasing trend from 1999 through 2006, decreasing trend from 2006 through 2012, and increasing trend from 2012 through 2018 with different 

rates of change over time, p < 0.05. 2

Significant increasing trend from 1999 through 2005, 2008 through 2012, and 2012 through 2018 with different rates of change over time, p < 0.05. 

NOTES: Deaths are classified using the International Classification of Diseases, 10th Revision. Drug-poisoning (overdose) deaths are identified using 

underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug overdose deaths involving selected drug categories are identified by specific 

multiple-cause-of-death codes: cocaine, T40.5; and psychostimulants, T43.6. Deaths may involve multiple drugs. The percentage of drug overdose deaths 

that identified the specific drugs involved varied by year, with ranges of 75%–79% from 1999 through 2013 and 81%–92% from 2014 through 2018. Access 

data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#4.

SOURCE: NCHS, National Vital Statistics System, Mortality. 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 356 ■ January 2020

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Summary

This report updates statistics on deaths from drug overdoses in the United States, including 

information on trends since 1999 and changes in drug overdose death rates by state from 

2017 to 2018. 

Compared with 2017, the age-adjusted rate of drug overdose deaths declined in 2018, from 21.7 

per 100,000 standard population to 20.7. There was a decrease in the rate for both males and 

females (from 29.1 in 2017 to 27.9 in 2018 for males, and from 14.4 in 2017 to 13.6 in 2018 for 

females). Fifteen jurisdictions (Alaska, District of Columbia, Florida, Georgia, Indiana, Iowa, 

Kentucky, Maine, Minnesota, New York, North Carolina, Ohio, Pennsylvania, West Virginia, 

and Wisconsin) had a lower age-adjusted rate of drug overdose deaths in 2018 compared with 

2017, while five states (California, Delaware, Missouri, New Jersey, and South Carolina) had 

a higher rate in 2018 than in 2017. For all other states, the rates in 2017 and 2018 were not 

statistically different. 

By specific drug, the rate of drug overdose deaths involving synthetic opioids other than 

methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) continued to increase from 

9.0 in 2017 to 9.9 in 2018. The rates of drug overdose deaths involving heroin, natural and 

semisynthetic opioids, and methadone were lower in 2018 than in 2017 (from 4.9 in 2017 to 4.7 in 

2018 for heroin, from 4.4 in 2017 to 3.8 in 2018 for natural and semisynthetic opioids, and from 

1.0 in 2017 to 0.9 in 2018 for methadone). The rates of drug overdose deaths involving cocaine 

and involving psychostimulants with abuse potential (drugs such as methamphetamine) were 

higher in 2018 than in 2017 (from 4.3 in 2017 to 4.5 in 2018 for cocaine, and 3.2 in 2017 to 3.9 in 

2018 for psychostimulants with abuse potential). 

Definitions

Drug poisoning (overdose) deaths: Includes deaths resulting from unintentional or intentional 

overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug 

inadvertently. 

Natural and semisynthetic opioids: Includes drugs such as morphine, codeine, hydrocodone, and 

oxycodone. 

Synthetic opioids other than methadone: Includes drugs such as fentanyl, fentanyl analogs, and 

tramadol. 

Psychostimulants with abuse potential: Includes drugs such as methamphetamine, amphetamine, 

and methylphenidate. 
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Data source and methods

Estimates are based on the NVSS multiple-cause-of-death mortality files (6). Drug poisoning 

(overdose) deaths were identified using International Classification of Diseases, 10th Revision

(ICD–10) underlying-cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 

(homicide), or Y10–Y14 (undetermined intent). Of the drug overdose deaths in 2018, 87.4% 

were unintentional, 7.2% were suicides, 5.2% were of undetermined intent, and less than 1% 

were homicides. The type of drug(s) involved are indicated by ICD–10 multiple-cause-of-death 

codes: heroin (T40.1); natural and semisynthetic opioids (T40.2); methadone (T40.3); synthetic 

opioids other than methadone (T40.4); cocaine (T40.5); and psychostimulants with abuse 

potential (T43.6).

Age-adjusted death rates were calculated using the direct method and adjusted to the 2000 U.S. 

standard population (7). Trends in age-adjusted death rates were evaluated using the Joinpoint 

Regression Program (Version 4.7.0.0) (8). Joinpoint software fitted weighted least-squares 

regression models to the rates on the log transform scale. Analyses were set to allow a maximum 

of three joinpoints across the period, a minimum of three observed time points from any given 

joinpoint to either end of the data, and a minimum of four observed time points between any 

two joinpoints. The permutation tests for model (number of joinpoints) significance were set 

at an overall alpha level of 0.05 (9). Differences between state estimates in 2017 and 2018 were 

evaluated using two-sided significance tests at the 0.01 level. Unless otherwise stated, differences 

in all other comparisons (e.g., age-adjusted rates for males compared with females) were 

statistically significant at the 0.05 level (7). 

Several factors related to death investigation and reporting may affect measurement of death 

rates involving specific drugs. At autopsy, the substances tested for and the circumstances under 

which the toxicology tests are performed vary by jurisdiction. This variability is more likely to 

affect substance-specific death rates than the overall drug overdose death rate. The percentage 

of drug overdose deaths that identified the specific drugs involved varied by year, ranging from 

75%–79% from 1999 through 2013 and from 81%–92% from 2014 through 2018. 

Additionally, drug overdose deaths may involve multiple drugs; therefore, a single death might be 

included in more than one category when describing the rate of drug overdose deaths involving 

specific drugs. For example, a death that involved both fentanyl and cocaine would be included 

in both the rate of drug overdose deaths involving synthetic opioids other than methadone and the 

rate of drug overdose deaths involving cocaine.

About the authors

Holly Hedegaard is with the National Center for Health Statistics (NCHS), Division of Analysis 

and Epidemiology. Arialdi Miniño and Margaret Warner are with NCHS, Division of Vital 

Statistics. 
NCHS Data Brief ■ No. 356 ■ January 2020

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References

1. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–

2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018. 

Available from: https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf. 

2. Ahmad FB, Rossen LM, Spencer MR, Warner M, Sutton P. Provisional drug overdose death 

counts. National Center for Health Statistics. 2018. Available from: https://www.cdc.gov/nchs/

nvss/vsrr/drug-overdose-data.htm. 

3. 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 68(17):388–95. 2019. Available from: https://www.cdc.gov/mmwr/volumes/68/wr/

mm6817a3.htm. 

4. 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 67(5152):1419–27. 2019. 

Available from: https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm. 

5. Hedegaard H, Chen LH, Warner M. Drug-poisoning deaths involving heroin: United States, 

2000–2013. NCHS Data Brief, no 190. Hyattsville, MD: National Center for Health Statistics. 

2015. Available from: https://www.cdc.gov/nchs/products/databriefs/db190.htm. 

6. National Center for Health Statistics. Public-use data files: Mortality multiple cause files. 

2018. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm#Mortality_

Multiple.

7. Murphy SL, Xu JQ, Kochanek KD. Deaths: Final data for 2010. National Vital Statistics 

Reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics. 2013. Available 

from: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.

8. National Cancer Institute. Joinpoint Regression Program (Version 4.7.0.0) [computer 

software]. 2019.

9. Ingram DD, Malec DJ, Makuc DM, Kruszon-Moran D, Gindi RM, Albert M, et al. National 

Center for Health Statistics guidelines for analysis of trends. National Center for Health Statistics. 

Vital Health Stat 2(179). 2018. Available from: https://www.cdc.gov/nchs/data/series/sr_02/

sr02_179.pdf.
NCHS Data Brief ■ No. 356 ■ January 2020

Keywords: opioids • heroin • cocaine • methamphetamine • National Vital 

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Suggested citation

Hedegaard H, Miniño AM, Warner M. 

Drug overdose deaths in the United States, 

1999–2018. NCHS Data Brief, no 356. 

Hyattsville, MD: National Center for Health 

Statistics. 2020.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Jennifer H. Madans, Ph.D., Acting Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Kevin C. Heslin, Ph.D., Associate Director for 

Science

Division of Vital Statistics

Steven Schwartz, Ph.D., Director

Hanyu Ni, Ph.D., M.P.H., Associate Director for 

Science