NCHS Data Brief ■ No. 166 ■ September 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Drug-poisoning Deaths Involving Opioid Analgesics:

United States, 1999–2011

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

Key findings

Data from the National 

Vital Statistics System, 

Mortality File

• The age-adjusted rate for

opioid-analgesic poisoning 

deaths nearly quadrupled from 

1.4 per 100,000 in 1999 to 5.4 

per 100,000 in 2011. 

• Although the opioidanalgesic poisoning death 

rates increased each year from 

1999 through 2011, the rate of 

increase has slowed since 2006. 

• Natural and semisynthetic

opioid analgesics, such as 

hydrocodone, morphine, and 

oxycodone, were involved in 

11,693 drug-poisoning deaths 

in 2011, up from 2,749 deaths 

in 1999. 

• Benzodiazepines were

involved in 31% of the opioidanalgesic poisoning deaths 

in 2011, up from 13% of the 

opioid-analgesic poisoning 

deaths in 1999.

• During the past decade,

adults aged 55–64 and 

non-Hispanic white persons 

experienced the greatest 

increase in the rates of opioidanalgesic poisoning deaths.

Poisoning is the leading cause of injury death in the United States (1). 

Drugs—both illicit and pharmaceutical—are the major cause of poisoning 

deaths, accounting for 90% of poisoning deaths in 2011. Misuse or abuse of 

prescription drugs, including opioid-analgesic pain relievers, is responsible 

for much of the recent increase in drug-poisoning deaths (2). This report 

highlights trends in drug-poisoning deaths involving opioid analgesics 

(referred to as opioid-analgesic poisoning deaths) and updates previous Data 

Briefs on this topic (1,3).

Keywords: overdose • prescription pain relievers • National Vital Statistics 

System Mortality File

Although the age-adjusted opioid-analgesic poisoning death 

rate nearly quadrupled from 1999 through 2011, the rate of 

increase has slowed since 2006.

NOTES: The number of drug-poisoning deaths in 2011 was 41,340, and the number of drug-poisoning deaths in 2011 involving 

opioid analgesics was 16,917. Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db166_table.pdf#1.

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

Year

Deaths per 100,000 population

Figure 1. Age-adjusted drug-poisoning and opioid-analgesic poisoning death rates: United States, 

1999–2011

0

2

4

6

8

10

12

14

Drug poisoning involving

opioid analgesics 

Drug poisoning

1999 2001 2003 2005 2007 2009 2011
NCHS Data Brief ■ No. 166 ■ September 2014

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In 2011, there were 41,340 deaths due to drug poisoning; 41% (16,917 deaths) of them involved 

opioid analgesics. From 1999 through 2011, the rate for opioid-analgesic poisoning deaths almost 

quadrupled from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011 (Figure 1). The death rate 

increased at a faster pace from 1999 through 2006 (18% increase each year) than from 2006 

through 2011 (3% increase each year). From 1999 through 2011, the age-adjusted death rates for 

drug poisoning from all types of drugs more than doubled from 6.1 per 100,000 in 1999 to 13.2 

per 100,000 in 2011.

Natural and semisynthetic opioid analgesics were involved in about 11,700 

drug-poisoning deaths in 2011, up from about 2,700 deaths in 1999.

About 70% of the opioid-analgesic poisoning deaths in 2011 involved natural and semisynthetic 

opioid analgesics such as hydrocodone, morphine, and oxycodone. The number of drug-poisoning 

deaths involving natural and semisynthetic opioid analgesics increased each year from 2,749 

deaths in 1999 to 11,693 deaths in 2011 (Figure 2). The number of drug-poisoning deaths 

involving synthetic opioid analgesics other than methadone, such as fentanyl, meperidine, and 

propoxyphene, increased from 730 deaths in 1999 to 2,666 deaths in 2011.

Figure 2. Number of opioid-analgesic poisoning deaths, by opioid analgesic category: United States, 1999–2011

NOTES: Opioid analgesic categories are mutually exclusive. Deaths involving more than one opioid analgesic category (e.g., a death involving both methadone 

and a natural and semisynthetic opioid analgesic such as oxycodone) are counted in both categories. Access data table for Figure 2 at: http://www.cdc.gov/nchs/

data/databriefs/db166_table.pdf#2.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality File. Number of deaths in thousands

0

2

4

6

8

10

12

14

Synthetic opioid analgesics,

excluding methadone

Methadone

Natural and semisynthetic

opioid analgesics

Year

1999 2001 2003 2005 2007 2009 2011

The number of drug-poisoning deaths involving methadone, a synthetic opioid analgesic used 

to treat opioid dependency and pain, increased from 784 deaths in 1999 to 5,518 deaths in 2007; 

then it declined to 4,418 deaths in 2011. Methadone was involved in 26% of all opioid-analgesic 

poisoning deaths in 2011, compared with 38% of all opioid-analgesic poisoning deaths in 2007.
NCHS Data Brief ■ No. 166 ■ September 2014

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Benzodiazepines were involved in 31% of the opioid-analgesic poisoning 

deaths in 2011, up from 13% of such deaths in 1999. 

In 2011, 5,188 opioid-analgesic poisoning deaths also involved benzodiazepines (sedatives used 

to treat anxiety, insomnia, and seizures), up from 527 such deaths in 1999 (Figure 3). From 

2006 through 2011, the number of opioid-analgesic poisoning deaths involving benzodiazepines 

increased 14% on average each year, while the number of opioid-analgesic poisoning deaths not 

involving benzodiazepines did not change significantly. 

Figure 3. Number of opioid-analgesic poisoning deaths, by involvement of benzodiazepines: United States, 1999–2011

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db166_table.pdf#3.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality File. Number of deaths in thousands

Year

1999 2001 2003 2005 2007 2009 2011

0

2

4

6

8

10

12

14

Not involving benzodiazepines

Involving benzodiazepines
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From 1999 through 2011, adults aged 55–64 experienced the greatest 

increase in the opioid-analgesic poisoning death rate.

While the age groups 25–34, 35–44, and 45–54 have higher opioid-analgesic poisoning death 

rates than other age groups, the greatest increase in rates over the past decade was seen for 

persons aged 55–64 (Figure 4). The opioid-analgesic poisoning death rate for adults aged 55–64 

increased more than six-fold, from 1.0 per 100,000 in 1999 to 6.3 per 100,000 in 2011. Since 

2006, the opioid-analgesic poisoning death rate did not change significantly among those aged 

15–24. For all other age groups, the rate of increase slowed from 2006 through 2011. 

Figure 4. Opioid-analgesic poisoning death rates, by age group: United States, 1999–2011

NOTE: Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db166_table.pdf#4.

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

Year

1999 2001 2003 2005 2007 2009 2011

0

2

4

6

8

10

12

65 and over

55–64

45–54

35–44

25–34

15–24 
NCHS Data Brief ■ No. 166 ■ September 2014

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From 1999 through 2011, the age-adjusted opioid-analgesic poisoning 

death rate among non-Hispanic white persons more than quadrupled, while 

the rate for non-Hispanic black persons more than doubled.

In 2011, 14,637 non-Hispanic white persons, 904 non-Hispanic black persons, and 979 Hispanic 

persons died from drug poisoning involving opioid analgesics (Figure 5). The age-adjusted rate of 

opioid-analgesic poisoning deaths for non-Hispanic white persons increased 4.5 times, from 1.6 

per 100,000 in 1999 to 7.3 per 100,000 in 2011. The rates more than doubled for non-Hispanic 

black persons, from 0.9 per 100,000 in 1999 to 2.3 per 100,000 in 2011; they increased slightly 

for Hispanic persons, from 1.7 per 100,000 in 1999 to 2.0 per 100,000 in 2011. Since 2000, 

non-Hispanic white persons have had the highest rates among the three race and ethnicity groups. 

The disparity in rates between non-Hispanic white persons and the other two groups has widened 

in recent years. 

Figure 5. Age-adjusted opioid-analgesic poisoning death rates, by race and ethnicity: United States, 1999–2011

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

nchs/data/databriefs/db166_table.pdf#5.

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

Year

1999 2001 2003 2005 2007 2009 2011 0

2

4

6

8

Hispanic

Non-Hispanic black

Non-Hispanic white

Summary

From 1999 through 2011, the age-adjusted rate of drug-poisoning deaths more than doubled, and 

the rate of opioid-analgesic poisoning deaths almost quadrupled. However, the increase in rates 

seems to be slowing. For opioid-analgesic poisoning deaths, there was an 18% increase each year 

from 1999 through 2006 but only a 3% increase each year from 2006 through 2011. 

Deaths from opioid analgesics often involve other drugs. Benzodiazepines have been reported 

frequently in deaths involving opioid analgesics (4). Over the past decade, there has been an 
NCHS Data Brief ■ No. 166 ■ September 2014

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upward trend in the presence of benzodiazepines in opioid-analgesic poisoning deaths. In 1999, 

benzodiazepines were involved in 13% of the opioid-analgesic poisoning deaths; by 2011, 31% of 

the opioid-analgesic-related drug-poisoning deaths also involved benzodiazepines.

Identifying populations at high risk for opioid-analgesic poisoning death can help inform targeted 

prevention strategies. Similar to findings in a previous Data Brief (1), the demographic groups 

with the highest opioid-analgesic poisoning death rates in 2011 were adults aged 45–54 and nonHispanic white persons. Adults aged 55–64 and non-Hispanic white persons experienced a greater 

increase in rates compared with other groups.

Many prevention efforts have been initiated since the increasing trend in drug-poisoning 

deaths was reported in the late 1990s (5,6). This report provides updated statistics on deaths 

from all drug poisonings and opioid analgesics, and it identifies the populations at highest risk. 

These results provide useful information to evaluate current prevention efforts and assist the 

development of future prevention strategies.

Definitions

Drug-poisoning 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.

Opioid analgesics: Drugs that are usually prescribed to relieve pain and include: natural and 

semisynthetic opioid analgesics such as morphine, codeine, hydrocodone, and oxycodone; 

methadone, which is a synthetic opioid analgesic used to treat opioid dependence and pain; and 

other synthetic opioid analgesics (excluding methadone) such as fentanyl and meperidine. Opium 

and heroin are not included in this class of drugs.

Benzodiazepines: A class of drugs that depresses the central nervous system and are prescribed 

for their sedative-hypnotic, anti-anxiety, muscle relaxant, and anticonvulsant effects.

Data sources and methods

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

files (7). Deaths were classified using the International Classification of Diseases, 10th Revision

(ICD–10). Drug-poisoning deaths were defined as having ICD–10 underlying cause-of-death 

codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined 

intent) (8). Of the drug-poisoning deaths in 2011, 80% were unintentional, 13% were suicides, 

7% were of undetermined intent, and less than 1% were homicides. Among deaths with drug 

poisoning as the underlying cause, the type of drug(s) involved are indicated by the following 

ICD–10 codes: any opioid analgesic (T40.2, T40.3, or T40.4); natural and semisynthetic opioid 

analgesic (T40.2); methadone (T40.3); synthetic opioid analgesic, excluding methadone (T40.4); 

and benzodiazepines (T42.4). 

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

population (9). 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 (9). Trends in death rates and number of deaths were evaluated using the 

Joinpoint Regression Program (10).
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Several factors related to death investigation and reporting may affect measurement of death 

rates involving specific drugs. At autopsy, toxicological lab tests may be performed to determine 

the type of drugs present. The substances tested for and circumstances under which the tests are 

performed vary by jurisdiction. Measurement errors related to these factors are more likely to 

affect substance-specific death rates than the overall drug-poisoning death rate. In 2011, 25% 

of drug-poisoning deaths did not include information on the specific type of drug involved (i.e., 

drug-poisoning deaths with only an unspecified drug-related multiple cause-of-death code—

T50.9). These deaths could potentially involve opioid analgesics.

About the authors

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

Office of Analysis and Epidemiology, and Margaret Warner is with NCHS Division of Vital 

Statistics.

References

1. Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the

United States, 1980–2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health 

Statistics. 2011. 

2. Paulozzi LJ. Prescription drug overdoses: A review. J. Safety Res 43(4):283–9. 2012.

3. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics

in the United States, 1999–2006. NCHS data brief, no 22. Hyattsville, MD: National Center for 

Health Statistics. 2009. 

4. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010.

JAMA 309(7):657–9. 2013.

5. Hernandez SH, Nelson LS. Prescription drug abuse: Insight into the epidemic. Clin

Pharmacol Ther 88(3):307–17. 2010.

6. CDC. Policy impact: Prescription painkiller overdoses. Atlanta, GA. Available from:

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/. 

7. NCHS. Mortality multiple cause files. 2011. Available from: http://www.cdc.gov/nchs/data_

access/Vitalstatsonline.htm#Mortality_Multiple.

8. 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.

9. 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.

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

software]. 2010.
NCHS Data Brief ■ No. 166 ■ September 2014

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Suggested citation

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. 

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

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

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