NCHS Data Brief ■ No. 190 ■ March 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Drug-poisoning Deaths Involving Heroin:

United States, 2000–2013

Holly Hedegaard, M.D., M.S.P.H.; Li-Hui Chen, M.S., Ph.D.; and Margaret Warner, Ph.D.

Key findings

Data from the National 

Vital Statistics System 

(Mortality)

● From 2000 through 2013, 

the age-adjusted rate for drugpoisoning deaths involving 

heroin nearly quadrupled from 

0.7 deaths per 100,000 in 2000 

to 2.7 deaths per 100,000 in 

2013. Most of the increase 

occurred after 2010. 

● The number of drugpoisoning deaths involving 

heroin was nearly four times 

higher for men (6,525 deaths) 

than women (1,732 deaths) in 

2013.

● In 2000, non-Hispanic black 

persons aged 45–64 had the 

highest rate for drug-poisoning 

deaths involving heroin (2.0 

per 100,000). In 2013, nonHispanic white persons aged 

18–44 had the highest rate (7.0 

per 100,000). 

● From 2000 through 2013, 

the age-adjusted rate for drugpoisoning deaths involving 

heroin increased for all regions 

of the country, with the greatest 

increase seen in the Midwest.

Drug poisoning (overdose) is the number one cause of injury-related death 

in the United States, with 43,982 deaths occurring in 2013 (1). While much 

attention has been given to deaths involving opioid analgesics (2), in recent 

years there has been a steady increase in the number of drug-poisoning 

deaths involving heroin. A recent study using data from 28 states reported 

that the death rate for heroin overdose doubled from 2010 through 2012 (3). 

Using data from the National Vital Statistics System, this data brief provides 

a description of trends and demographics for heroin-related drug-poisoning 

deaths in the United States from 2000 through 2013.

Keywords: overdose • mortality • National Vital Statistics System

While the age-adjusted rate for drug-poisoning deaths 

involving opioid analgesics has leveled in recent years, 

the rate for deaths involving heroin has almost tripled 

since 2010.

Figure 1. Age-adjusted rates for drug-poisoning deaths, by type of drug: United States, 2000–2013

NOTES: The number of drug-poisoning deaths in 2013 was 43,982, the number of drug-poisoning deaths involving opioid 

analgesics was 16,235, and the number of drug-poisoning deaths involving heroin was 8,257. A small subset of 1,342 deaths 

involved both opioid analgesics and heroin. Deaths involving both opioid analgesics and heroin are included in both the rate of

deaths involving opioid analgesics and the rate of deaths involving heroin. Access data table for Figure 1 at: http://www.cdc.gov/

nchs/data/databriefs/db190_table.pdf#1.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality. Deaths per 100,000 population

Year

0

1

2

3

4

5

6

Opioid analgesics

Heroin

2000 2002 2004 2006 2008 2010 2012 2013
NCHS Data Brief ■ No. 190 ■ March 2015

■ 2  ■

From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths involving opioid 

analgesics was higher than the rate for drug-poisoning deaths involving heroin (Figure 1). The 

age-adjusted rate for opioid-analgesic poisoning deaths increased at a faster pace from 2000 

through 2006 (19% per year) than from 2006 through 2013 (2% per year). From 2010 through 

2013, the age-adjusted rate for opioid-analgesic poisoning deaths declined slightly from 5.4 to 5.1 

per 100,000. In contrast, the age-adjusted rate for drug-poisoning deaths involving heroin showed 

a different pattern with a slower pace of increase between 2000 and 2010 (6% per year) and a 

faster pace of increase from 2010 forward (37% per year). From 2010 through 2013, the ageadjusted rate for heroin-related drug-poisoning deaths nearly tripled from 1.0 per 100,000 in 2010 

to 2.7 per 100,000 in 2013.

In 2013, the number of drug-poisoning deaths involving heroin was nearly 

four times higher for men than women.

More men than women died from drug poisoning involving heroin (Figure 2). In 2013, the 

number of heroin-related drug-poisoning deaths for men (6,525 deaths) was nearly four times that 

for women (1,732 deaths). From 2010 through 2013, the age-adjusted rate increased from 1.6 to 

4.2 per 100,000 for men and from 0.4 to 1.2 per 100,000 for women. Number of deaths in thousands

Figure 2. Number of drug-poisoning deaths involving heroin, by sex: United States, 2000–2013

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db190_table.pdf#2. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

Year

0

1

2

3

4

5

6

7

2000 2002 2004 2006 2008 2010 2012 2013

Men

Women
NCHS Data Brief ■ No. 190 ■ March 2015

■ 3  ■

The rate for heroin-related drug-poisoning deaths was highest among 

adults aged 25–44 from 2000 through 2013.

Compared with adults aged 18–24 and 45–64, those aged 25–44 had the highest rate for drugpoisoning deaths involving heroin (Figure 3). From 2000 through 2010, the average annual 

increase in the rates was 10% for adults aged 18–24, 5% for those aged 25–44, and 4% for those 

aged 45–64. From 2010 through 2013, the death rate for adults aged 18–24 increased 2.3-fold 

from 1.7 to 3.9 per 100,000, for those aged 25–44 the rate increased 2.8-fold from 1.9 to 5.4, and 

for those aged 45–64 the rate increased 2.7-fold from 1.1 to 3.0. Deaths per 100,000 population

Figure 3. Rates for drug-poisoning deaths involving heroin, by selected age groups: United States, 2000–2013

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db190_table.pdf#3. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

Year

0

1

2

3

4

5

6

45–64

25–44

18–24

2000 2002 2004 2006 2008 2010 2012 2013
NCHS Data Brief ■ No. 190 ■ March 2015

■  4  ■

In 2000, non-Hispanic black persons aged 45–64 had the highest rate 

for drug-poisoning deaths involving heroin. In 2013, non-Hispanic white 

persons aged 18–44 had the highest rate.

In 2000, the highest rate for drug-poisoning deaths involving heroin was among non-Hispanic 

black persons aged 45–64 (2.0 per 100,000) (Figure 4). In contrast, in 2013, the rate was highest 

among non-Hispanic white persons aged 18–44 (7.0 per 100,000). From 2000 through 2013, rates 

increased for both age groups (18–44 and 45–64) and race and ethnicity groups (non-Hispanic 

white, non-Hispanic black, and Hispanic), with the largest increases seen among non-Hispanic 

white persons. Deaths per 100,000 population

Figure 4. Rates for drug-poisoning deaths involving heroin, by selected age and race and ethnicity groups: United States, 

2000 and 2013

Non-Hispanic white

 95% confidence interval.

NOTES: Deaths for Hispanic persons are underreported by about 5%. See "Deaths: Final Data for 2010.” Access data table for Figure 4 at: http://www.cdc.gov/

nchs/data/databriefs/db190_table.pdf#4. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

0

1

2

3

4

5

6

7

8 2000 2013

18–44 45–64 18–44 45–64 18–44 45–64

Non-Hispanic black Hispanic
NCHS Data Brief ■ No. 190 ■ March 2015

■  5  ■

From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths 

involving heroin increased for all regions of the country, with the greatest 

increase seen in the Midwest.

In 2000, age-adjusted rates for drug-poisoning deaths involving heroin were higher in the 

Northeast and West regions (0.9 per 100,000) (Figure 5). In contrast, in 2013, the Midwest and 

Northeast regions had higher rates (4.3 and 3.9 per 100,000, respectively). From 2000 through 

2013, the age-adjusted rate for heroin-related drug-poisoning deaths increased nearly 11-fold in 

the Midwest region (from 0.4 to 4.3 per 100,000), more than 4-fold in the Northeast region (from 

0.9 to 3.9), more than 3-fold in the South region (from 0.5 to 1.7), and doubled in the West region 

(from 0.9 to 1.8). Deaths per 100,000 population

Figure 5. Age-adjusted rates for drug-poisoning deaths involving heroin, by census region: United States, 2000, 2007, 

and 2013

 95% confidence interval.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db190_table.pdf#5. 

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

2000 2007 2013

0

1

2

3

4

5

Northeast Midwest South West

Summary

This report provides the latest national statistics on drug overdose deaths involving heroin, 

highlighting the substantial increase in death rates and the populations most at risk. From 2000 

through 2013, the age-adjusted rate for drug-poisoning deaths involving heroin nearly quadrupled 

from 0.7 per 100,000 in 2000 to 2.7 per 100,000 in 2013. During this 14-year period, the ageadjusted rate showed an average increase of 6% per year from 2000 through 2010, followed by a 

larger average increase of 37% per year from 2010 through 2013.
NCHS Data Brief ■ No. 190 ■ March 2015

■  6  ■

Identifying populations at high risk of heroin-related drug-poisoning death can help target 

prevention strategies. The number of heroin-related drug-poisoning deaths among men was nearly 

four times higher than among women. Since 2000, the rates for drug-poisoning death involving 

heroin have increased for all age and race and ethnicity groups, with adults aged 25–44 having the 

highest rate. Heroin-related drug-poisoning deaths increased for all regions of the country from 

2000 through 2013, with the greatest increase seen in the Midwest.

Data source and methods

Estimates are based on the National Vital Statistics System multiple cause-of-death mortality 

files (4). Deaths were classified using the International Classification of Diseases, Tenth Revision

(ICD–10). Drug-poisoning deaths were defined as having an ICD–10 underlying cause-ofdeath code of X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 

(undetermined intent) (5). Of the drug-poisoning deaths in 2013, 81% were unintentional, 12% 

were suicides, 6% were of undetermined intent, and less than 1% were homicides. Among deaths 

with drug poisoning as the underlying cause, the types of drugs involved are indicated by the 

ICD–10 multiple cause-of-death codes of T40.1 for heroin and T40.2, T40.3, or T40.4 for opioid 

analgesics.

Age-adjusted death rates were calculated using the direct method and the 2000 standard 

population (6). Data for Hispanic origin should be interpreted with caution. Studies comparing 

Hispanic origin on death certificates and on census surveys have shown inconsistent reporting 

on Hispanic ethnicity (6). Geographic regions were based on census definitions (7). Trends 

in death rates and number of deaths were evaluated using the Joinpoint Regression Program 

(8). Comparisons of rates among different groups were tested for statistical significance using 

methods described elsewhere (6); a statement that a given death rate is higher or lower than 

another rate indicates that the difference in the rates is statistically significant.

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

involving specific drugs. For example, toxicological tests to determine the types of drugs present 

may vary by jurisdiction (9). Measurement errors related to these factors are more likely to affect 

substance-specific death rates than the overall drug-poisoning death rate. In 2013, 22% of drugpoisoning deaths did not include information on the specific types of drugs involved. Some of 

these deaths could potentially involve heroin or opioid analgesics.

Metabolic breakdown of heroin into morphine in the body can make it difficult to distinguish 

between deaths from heroin and deaths from morphine based on the information on the death 

certificate. Some deaths reported to involve morphine could actually be deaths from heroin. This 

may result in an undercount of heroin-related deaths.

Drug-poisoning deaths may involve multiple drugs. Analysis shows that approximately 16% of 

the drug-poisoning deaths involving heroin also involve opioid analgesics. This percentage is 

relatively consistent across time, age groups, and race and ethnicity groups.

About the authors

Holly Hedegaard and Li-Hui Chen are with CDC’s National Center for Health Statistics (NCHS), 

Office of Analysis and Epidemiology; Margaret Warner is with NCHS Division of Vital Statistics.
NCHS Data Brief ■ No. 190 ■ March 2015

■  7  ■

References

1. Chen LH, Hedegaard H, Warner M. QuickStat: Rates of death from drug poisoning and 

drug poisoning involving opioid analgesics—United States, 1999–2013. MMWR 64(01):32. 

2015. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a10.htm?s_

cid=mm6401a10_e.

2. Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: 

United States, 1999–2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health 

Statistics. 2014. Available from: http://www.cdc.gov/nchs/data/databriefs/db166.pdf.

3. Rudd RA, Paulozzi LJ, Bauer MJ, et al. Increases in heroin overdose deaths—28 states, 2010 

to 2012. MMWR 63(39):849–54. 2014. Available from: http://www.cdc.gov/mmwr/preview/

mmwrhtml/mm6339a1.htm.

4. Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2013. NCHS data 

brief, no 178. Hyattsville, MD: National Center for Health Statistics. 2014. Available from: 

http://www.cdc.gov/nchs/data/databriefs/db178.pdf.

5. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. 

Hyattsville, MD: National Center for Health Statistics. 2008. Available from: http://www.cdc.gov/

nchs/data/misc/injury2007.pdf.

6. 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.

7. U.S. Census Bureau. Census regions and divisions of the United States. Available from: 

http://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf. 

8. National Cancer Institute. Joinpoint Regression Program (Version 3.4.3.) [computer 

software]. 2010.

9. Warner M, Paulozzi LJ, Nolte KB, Davis GG, Nelson LS. State variation in certifying manner 

of death and drugs involved in drug intoxication deaths. Acad Forensic Pathol 3(2):231–7. 2013.
NCHS Data Brief ■ No. 190 ■ March 2015

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

For more NCHS Data Briefs, visit:

http://www.cdc.gov/nchs/products/databriefs.htm.

Suggested citation

Hedegaard H, Chen LH, Warner M. Drugpoisoning deaths involving heroin: United 

States, 2000–2013. NCHS data brief, no 

190. Hyattsville, MD: National Center for 

Health Statistics. 2015.

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

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: http://www.cdc.gov/nchs

Online request form: http://www.cdc.gov/info

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2015–1209

CS254336