ANNUAL 

SURVEILLANCE 

REPORT OF 

DRUG-RELATED 

RISKS AND 

OUTCOMES 

UNITED STATES, 2019 

 

 

 

 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

ACKNOWLEDGEMENTS
 

This Surveillance Report was prepared by staff from the National 

Center for Injury Prevention and Control (NCIPC), Centers for Disease 

Control and Prevention (CDC), U.S. Department of Health and Human 

Services, Atlanta, Georgia. 

Contributors to this report include: Douglas R. Roehler, PhD, MPH1, 

Brooke E. Hoots, PhD, MSPH1, Emily O. Olsen, PhD, MSPH1, Mbabazi 

Kariisa, PhD1, Nana Otoo Wilson, PhD, MPH, MSc1, Rose A. Rudd, 

MSPH1, Desiree Mustaquim, MPH1, Likang Xu, MD, MS2, Lyna Schieber, 

MD, DPhil1

1

Division of Overdose Prevention (DOP), National Center for Injury 

Prevention and Control (NCIPC), CDC 

2

Division of Analysis, Research, and Practice Integration (DARPI), 

National Center for Injury Prevention and Control (NCIPC), CDC 

Corresponding author: Douglas R. Roehler, droehler@cdc.gov 

The authors would like to acknowledge Dr. Alana Vivolo-Kantor and 

Dr. Puja Seth for their contributions to the content development and 

reviews of this report. Thanks to Dr. Lawrence Scholl, Dr. Amy Board, 

and Mr. Herschel Smith for their editorial and scientific review of 

the report. The authors would also like to acknowledge the NCIPC 

communications team for supporting the development of this report 

and accompanying slide deck. 

This report is based on data collected from multiple sources and is 

updated annually. Data on opioid prescriptions filled were obtained 

from IQVIATM Xponent and the Total Patient Tracker (TPT). Data 

on drug use, misuse, substance use disorder, and treatment were 

obtained from the Substance Abuse and Mental Health Services 

Administration’s (SAMHSA) 2017 and 2018 National Survey on Drug 

Use and Health (NSDUH). Data on nonfatal overdose hospitalizations 

and emergency department (ED) visits were obtained from the 

Healthcare Cost and Utilization Project’s (HCUP) National Inpatient 

Sample (NIS) and Nationwide Emergency Department Sample (NEDS) 

2016 surveys, which are sponsored by the Agency for Healthcare 

Research and Quality. Data on mortality were obtained from the 

National Vital Statistics System’s (NVSS) 2017 mortality files through 

CDC WONDER (Wide-ranging Online Data for Epidemiology Research). 

The report is accessible online at: https://www.cdc.gov/ 

drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf. 

Disclaimer 

The findings and conclusions in 

this report are those of the authors 

and do not necessarily represent 

the views of the Centers for Disease 

Control and Prevention. 

All materials in this report is in the 

public domain and may be used 

and copied without permission but 

requires citation. 

Suggested Citation 

Centers for Disease Control 

and Prevention. 2019 Annual 

Surveillance Report of Drug-Related 

Risks and Outcomes — United 

States Surveillance Special Report. 

Centers for Disease Control and 

Prevention, U.S. Department 

of Health and Human Services. 

Published November 1, 2019. 

Accessed [date] from https://www. 

cdc.gov/drugoverdose/pdf/ 

pubs/2019-cdc-drug-surveillancereport.pdf. 

2 
 

 

TABLE OF CONTENTS
 

7 EXECUTIVE SUMMARY 

11 NOTABLE REPORT CHANGES FROM 2018 TO 2019 

13 RESULTS OF THE 2019 SURVEILLANCE REPORT 

13 Opioid Prescribing 

16 Drug Use, Misuse, Substance Use Disorder, and Treatment 

26 Nonfatal Overdose Hospitalizations and Emergency

Department (ED) Visits 

34 Drug Overdose Mortality 

40 Limitations 

41 CDC’s Opioid Overdose Surveillance and Prevention Efforts 

45 TECHNICAL NOTES 

56 REFERENCES 

58 TABLES 

59 TABLE 1A National estimates of total number and percentage of persons who had at least one 

prescription filled for an opioid, by age and sex — United States, 2018 

60 TABLE 1B Total number and rate of opioid prescriptions and morphine milligram equivalents 

(MME) dispensed per 100 persons annually — United States, 2018 

61 TABLE 1C Rates of opioid prescriptions filled per 100 persons by type, dosage, and state— United 

States, 2018 

62 TABLE 1D Trend analyses of opioid prescriptions filled and morphine milligram equivalents (MME) 

dispensed— United States, 2006-2018 
63 TABLE 2A	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past 

month, persons 12+ years old, numbers in thousands — United States, 2017 

67 TABLE 2B	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past year, 

persons 12+ years old, numbers in thousands — United States, 2017 

71 TABLE 2C	 Self-reported prevalence of any prescription drug use (including misuse) in the past 

year, persons 12+ years old, by drug type, numbers in thousands — United States, 2017 

72 TABLE 2D	 Self-reported prevalence of past year initiation of illicit drug use and prescription drug 

misuse, persons 12+ years old, by drug type, numbers in thousands — United States, 2017 

73 TABLE 2E	 Self-reported prevalence of substance use disorder for specific substances in the past 

year, persons 12+ years old, numbers in thousands — United States, 2017 

74 TABLE 2F	 Prevalence of self-reported treatment for illicit drug use and prescription drug misuse 

in the past year, persons 12+ years old, by demographic characteristics, numbers in 

thousands — United States, 2017 

75 TABLE 2G	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past 

month, persons 12+ years old, numbers in thousands — United States, 2018 

79 TABLE 2H	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past year, 

persons 12+ years old, numbers in thousands — United States, 2018 

83 TABLE 2I	 Self-reported prevalence of any prescription drug use (including misuse) in the past 

year, persons 12+ years old, by drug type, numbers in thousands — United States, 2018 

84 TABLE 2J	 Self-reported prevalence of past year initiation of illicit drug use and prescription drug 

misuse, persons 12+ years old, by drug type, numbers in thousands — United States, 2018 

85 TABLE 2K	 Self-reported prevalence of substance use disorder for specific substances in the past 

year, persons 12+ years old, numbers in thousands — United States, 2018 

86 TABLE 2L	 Prevalence of self-reported treatment for illicit drug use and prescription drug misuse 

in the past year, persons 12+ years old, by demographic characteristics, numbers in 

thousands — United States, 2018 

87 TABLE 3A	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated hospitalizations by selected substances, all intents — United States, 2016 

89 TABLE 3B	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated hospitalizations by selected substances, unintentional and undetermined 

intents — United States, 2016 

91 TABLE 3C	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated emergency department visits by selected substances, all intents — United 

States, 2016 

93 TABLE 3D	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated emergency department visits by selected substances, unintentional and 

undetermined intents — United States, 2016 

95 TABLE 3E	 Estimated number and percentage of drug poisoning-related hospitalization and 

emergency department visits by primary payer, all intents — United States, 2016 

97 TABLE 3F	 Estimated number and percentage of drug poisoning-related hospitalization and 

emergency department visits by primary payer, unintentional and undetermined 

intents — United States, 2016 

99 TABLE 4A	 Number and age-adjusted rates per 100,000 population of overall drug overdose 

deaths and drug overdose deaths involving any type of opioid, by sex, age group, race/ 

ethnicity, census region, urbanization, and intent — United States, 2017 
101 TABLE 4B	 Number and age-adjusted rates per 100,000 population of drug overdose deaths
 

involving selected opioids by sex, age group, race/ethnicity, census region,
 

urbanization, and intent — United States, 2017
 

103 TABLE 4C	 Number and age-adjusted rates per 100,000 population of drug overdose deaths
 

involving cocaine and other psychostimulants with abuse potential by sex, age group,
 

race/ethnicity, census region, urbanization, and intent — United States, 2017
 

105 FIGURES 

106 FIGURE 1A	 Rates for overall annual opioid prescriptions filled per 100 persons and for
 

high-dosage prescriptions (≥ 90 morphine milligram equivalents [MME]/day) —
 

United States, 2006-2018
 

107 FIGURE 1B	 Rates for overall annual opioid prescriptions filled per 100 persons by days of
 

supply per prescription — United States, 2006-2018
 

108 FIGURE 1C	 Average daily morphine milligram equivalents (MME) per opioid prescription
 

dispensed — United States, 2006-2018
 

109 FIGURE 1D	 Average days of supply per opioid prescription filled — United States, 2006-2018
 

110 FIGURE 2A	 Age-adjusted rates per 100,000 population of drug overdose deaths and drug
 

overdose deaths involving any opioid for all intents and for unintentional intent
 

by year — United States, 1999-2017
 

111 FIGURE 2B	 Age-adjusted rates per 100,000 population of drug overdose deaths by drug or
 

drug class and year — United States, 1999-2017
 

112 FIGURE 2C	 Rates per 100,000 population of drug overdose deaths by drug or drug class and
 

age category — United States, 2017
 

113 FIGURE 2D	 Age-adjusted rates per 100,000 population of drug overdose deaths by state —
 

United States, 2017
 

114 SUPPLEMENTAL TABLES 

115 SUPPLEMENTAL TABLE 1A 

Opioid prescriptions filled and morphine milligram equivalents (MME) dispensed—
 

United States, 2006-2018
 

116 SUPPLEMENTAL TABLE 2A 


Estimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-related
 

hospitalizations by selected substances, all intents — United States, 2016
 

118 SUPPLEMENTAL TABLE 2B
 

Estimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-related
 

hospitalizations by selected substances, unintentional and undetermined intents —
 

United States, 2016
 

120 SUPPLEMENTAL TABLE 2C 

Estimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-related 

emergency department visits by selected substances, all intents — United States, 2016 
122 SUPPLEMENTAL TABLE 2D 

Estimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-related 

emergency department visits by selected substances, unintentional and undetermined 

intents — United States, 2016 

124 SUPPLEMENTAL TABLE 3A 

Trend analyses of age-adjusted rates per 100,000 population of drug overdose deaths 

by drug or drug class—United States, 1999-2017 

125 SUPPLEMENTAL DATA SUPPORTING FIGURE 2A 

Age-adjusted rates per 100,000 population of drug overdose deaths and drug overdose 

deaths involving any opioid for all intents and for unintentional intent by year — United 

States, 1999-2017 

126 SUPPLEMENTAL DATA SUPPORTING FIGURE 2B 

Age-adjusted rates per 100,000 population of drug overdose deaths by drug or drug 

class and year — United States, 1999-2017 

127 SUPPLEMENTAL DATA SUPPORTING FIGURE 2C 

Rates per 100,000 population of drug overdose deaths by drug or drug class and age 

category — United States, 2017 

129 SUPPLEMENTAL DATA SUPPORTING FIGURE 2D 

Age-adjusted rates per 100,000 population of drug overdose deaths by state — United 

States, 2017 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

EXECUTIVE SUMMARY
 

The Current Drug Overdose Epidemic in the United States
 

Over 700,000 people died in the United States from drug overdoses between 1999 and 2017, with 70,237 

deaths in 2017 alone.1 Of these 70,237 deaths, 67.8% involved an opioid.1 The age-adjusted drug overdose 

death rate has significantly increased from 6.0 (1999) to 21.7 (2017) deaths per 100,000 population.2

However, as of September 2019, provisional mortality estimates through February 2019 suggest slight 

decreases in drug overdose deaths since 2017 in the United States.3

The observed increase in opioid overdose deaths can be outlined in three distinct waves. In the 1990s, 

deaths involving prescription opioids began increasing (Wave 1).4 In 2010, dramatic increases from heroininvolved deaths occurred (Wave 2).5

 Finally, since 2013, deaths involving synthetic opioids other than 

methadone (e.g., illicitly manufactured fentanyl) have risen at an unprecedented rate (Wave 3).6-8 From 2016 

to 2017 alone, synthetic opioid-involved overdose deaths increased by 45.2%.1

 More recently, we have seen 

increases in overdose deaths involving cocaine (largely with opioids) and psychostimulants with abuse 

potential (both with and without opioids).9

This is the third annual drug surveillance report summarizing the latest data at the national level for 

opioid prescribing patterns, drug use, nonfatal overdoses, and fatal overdoses related to the current 

drug overdose epidemic in the United States. This report is intended to serve as a resource for 1) people 

charged with addressing this ongoing national crisis, 2) members of the public who want to stay 

informed about the most recently available data, and 3) people who are interested in learning about 

the current drug overdose landscape and developing innovative and evidence-based solutions to 

address this crisis. 

This report presents information on four types of outcomes from four different data sources: 

1	 Opioid prescribing, 2006-2018, from IQVIATM. 

– This section includes estimates of the total number of opioid prescriptions filled in the United States 

from retail pharmacies. 

2	 Drug use, misuse, substance use disorder, drug initiation, and treatment, 2017 and 2018, from the 

National Survey on Drug Use and Health (NSDUH), a survey administered by the Substance Abuse and 

Mental Health Services Administration (SAMHSA). 

– This section includes estimates of self-reported use of prescription pain relievers, tranquilizers, 

stimulants, and sedatives in the past month and past year. In addition to prescription use, this section 

includes self-reported use of marijuana, opioids (heroin use and prescription pain reliever misuse), 

heroin, cocaine, and methamphetamine in the past month and past year. This section also includes 

self-reported substance use initiation, disorder, and treatment. 

7 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

3	 Nonfatal overdose hospitalizations and emergency department (ED) visits, 2016, from the Healthcare 

Cost and Utilization Project (HCUP), a product of the Agency for Healthcare Research and Quality (AHRQ). 

– This section includes nonfatal emergency department visits and hospitalizations from poisonings 

or overdoses stemming from the following: all drugs, all opioids, heroin, methadone, other specified 

opioids, cocaine, and methamphetamine. 

4	 Drug overdose mortality, 1999-2017, from the National Vital Statistics System (NVSS) Mortality 

Component, maintained by the National Center for Health Statistics (NCHS) at the Centers for Disease 

Control and Prevention (CDC). 

– This section includes fatalities from drug overdose as the underlying cause of death for the following 

drugs: heroin, natural/semisynthetic opioids (e.g., hydrocodone, oxycodone), methadone, synthetic 

opioids other than methadone (e.g., fentanyl, tramadol), any opioids, cocaine, and psychostimulants 

with abuse potential (e.g., methamphetamine, dextroamphetamine). 

Opioid Prescribing 

The rate of opioid prescriptions filled decreased by 29.0% from 2006 to 2018. In 2006, 72.4 opioid 

prescriptions per 100 persons were filled, and this rate increased annually by 1.9% from 2006 to 2012 (81.2 

opioid prescriptions per 100 persons), then decreased by 5.2% annually from 2012 to 2016. Starting in 

2016, this rate fell more sharply and decreased by 12.4% annually from 2016 to 2018. In 2018, 51.4 opioid 

prescriptions per 100 persons were filled. 

In 2018, 15.0% of the U.S. population filled one or more opioid prescriptions. In 2018, 12.8% of males and 

17.2% of females filled at least one prescription for an opioid. 

Between 2006 and 2018, the annual rate for filling high dosage opioid prescriptions (≥ 90 morphine 

milligram equivalents [MME]/day) decreased from 11.5 to 3.9 prescriptions per 100 persons, an overall 

relative reduction of 66.1%. 

Drug Use, Misuse, and Substance Use Disorder, and Treatment 

In 2018, over 53 million people aged 12 years and older in the United States, or 19.4% of people aged 12 

years and older, reported use of illicit drugs or misuse of prescription drugs in the past year. This estimate 

includes use of marijuana, heroin, cocaine (including crack), methamphetamines, hallucinogens, inhalants, 

and the misuse of prescription drugs. Among people aged 12 years and older in the United States, the 

estimated prevalence of illicit drug use in the past year was 15.9% for marijuana, 0.3% for heroin, 2.0% for 

cocaine, and 0.7% for methamphetamines. Given the small reported estimated prevalence and burden for 

hallucinogens and inhalant use, these estimates are not individually reported in this surveillance report but 

are included in the total estimates. Estimated prevalence of prescription drug misuse by drug type in the 

past year was 3.6% for prescription pain, 1.9% for prescription stimulants, 2.1% for prescription tranquilizers, 

0.4% for prescription sedatives, and 2.0% for prescription benzodiazepines. Reported prevalence of opioid 

misuse (i.e., heroin use or prescription pain reliever misuse) in the past year was 3.7%. 

In 2018, nearly 2.1 million people in the United States reported that they had received treatment in the past 

year to reduce or stop illicit drug use, including prescription drug misuse, or for medical problems associated 

with illicit drug use. 

Nonfatal Overdose Hospitalizations and Emergency Department (ED) Visits 

An estimated 326,200 hospitalizations for nonfatal drug poisonings, all intents (including unintentional, 

undetermined intent, and those attributed to intentional self-harm and assault), occurred in 2016, with an 

age-adjusted rate of 98.1 hospitalizations per 100,000 population. Age-adjusted rates of hospitalizations per 

100,000 population by drug type for all intents were 26.6 for all opioid poisonings, 7.0 for heroin poisonings, 

8 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

1.6 for methadone poisonings, 18.4 for other opioid poisonings, 6.1 for cocaine poisonings, and 5.7 for 

methamphetamine poisonings. 

An estimated 577,794 ED visits occurred for all nonfatal drug-related poisonings, all intents, in the United 

States in 2016, with an age-adjusted rate of 183.2 visits per 100,000 population. Age-adjusted rates of ED 

visits per 100,000 population by drug type for all intents were 62.0 for all opioid poisonings, 39.1 for heroin 

poisonings, 1.0 for methadone poisonings, 22.1 for other opioids poisonings, 2.7 for cocaine poisonings, and 

5.3 for methamphetamine poisonings. 

By region, the West had the highest rates of both hospitalizations and ED visits among all intents for 

methamphetamine-related poisonings. 

Drug Overdose Mortality 

A total of 70,237 drug overdose deaths occurred in 2017: an age-adjusted rate of 21.7 per 100,000 persons. 

Prescription and/or illicit opioids were involved in 67.8% (47,600) of these deaths. Among opioid-involved 

deaths, the category synthetic opioids other than methadone (a category that includes illicitly manufactured 

fentanyl) was the most common (28,466 deaths). The prescription opioids category, which includes natural 

and semi-synthetic opioids (e.g., oxycodone and hydrocodone) and methadone, was the second most 

common with 17,029 deaths. Heroin was involved in 15,482 deaths. Natural and semi-synthetic opioids were 

involved in 14,495 deaths, and methadone was involved in 3,194 deaths. Cocaine was involved in 13,942 

deaths, and 10,333 persons died from drug overdoses involving psychostimulants with abuse potential (e.g., 

methamphetamine). Some deaths involved more than one type of drug; these deaths were included in the 

counts and rates for each drug category. Therefore, categories are not mutually exclusive. 

The rapid increase in deaths involving heroin that began in 2010 plateaued from 2015 to 2017, with 

nonsignificant changes in rates between those years. Rates for deaths involving synthetic opioids other than 

methadone continued to increase sharply as they have since 2013, with rates increasing an average of 69.8% 

annually from 2013 to 2017. Deaths involving cocaine have increased sharply since 2014, increasing on 

average by 37.6% annually from 2014 to 2017. Deaths involving psychostimulants with abuse potential have 

increased sharply since 2012, with an average of 30.1% annually from 2012 to 2017. While rates of deaths 

involving prescription opioids increased sharply from 1999 to 2006, rates from 2006 to 2017 increased only 

by an annual average change of 2.0%. 

This report presents the most recent final mortality data that are currently available. CDC’s National Center 

for Health Statistics releases provisional monthly data on drug overdose deaths. The provisional estimates 

can be found at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm 

Limitations 

This report has important limitations. With the use of four independent data sources, terminology and 

definitions varied across datasets. Further, the most recent year of available data was not consistent across 

datasets. Collectively, comparability of data across datasets in this report is limited. In addition, this report 

does not quantify polysubstance use (i.e., the consumption of more than one drug over a defined period, 

simultaneously or at different times, for either therapeutic purposes or misuse) or overdose. However, this 

report does not exclude overdoses where multiple substances were involved. For a detailed description of 

the data sources, definitions, and restrictions, please refer to the technical notes and footnotes. 

9 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

Conclusions
 

The data from these four sources suggest the following conclusions: 

•	 Rates of opioid prescriptions filled in 2018 continued to decrease, following the trend that began in 

2012. 

•	 In 2018, among persons aged 12 years and older, 19.4% reported any illicit drug use or prescription 

drug misuse, 15.9% reported use of marijuana, 3.7% reported opioid misuse, 3.6% reported misuse 

of prescription pain relievers, 2.1% reported misuse of prescription tranquilizers, 2.0% reported use 

of cocaine, 2.0% reported misuse of prescription benzodiazepines, and 1.9% reported misuse of 

prescription stimulants. Misuse of prescription sedatives, heroin, and methamphetamine were each 

less than 1.0%. 

•	 In 2018, 25.9% of persons meeting the criteria for substance use disorder accessed treatment. 

•	 Among all hospitalizations and all emergency department visits for methamphetamine poisonings, the 

West region consistently experienced the highest rates of suspected methamphetamine poisonings. 

•	 The rate of drug overdose deaths increased significantly from 1999 to 2017. 

•	 There were only small increases in prescription opioid-involved deaths from 2006 to 2017, and rates in 

heroin-involved deaths were stable from 2015 to 2017. 

•	 Deaths rates involving synthetic opioids other than methadone, cocaine, and psychostimulants with 

abuse potential all increased from 2016 through 2017. 

10 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

NOTABLE REPORT CHANGES 

FROM 2018 TO 2019 

Opioid Prescribing 

Starting with 2017 data, IQVIATM changed the frame of measurement from number of prescriptions 

“dispensed to bin” to number of prescriptions “sold to the patient.”To do this, IQVIATM eliminated the 

effects of voided and reversed prescriptions (prescriptions that were never received by the patient). This 

change resulted in a 1.9% downward shift in prescriptions filled for 2017 and 2018, and this modification is 

represented in the data presented in this report. When analyzing trends using IQVIATM data, we compared 

data with and without this modification and found no significant differences in our findings. Additionally, 

this report includes additional subcategories for opioid prescription dosages (i.e., < 3 days, ≥ 3 and < 7 days) 

based on days’ supply recommendations in the CDC Guideline for Prescribing Opioids for Chronic Pain— 

United States, 2016.10 The Guideline recommends prescribing opioids at the lowest effective dose and that in 

most cases of acute pain not related to trauma or surgery, a supply of 3 or fewer days will be sufficient and 

more than 7 days will rarely be needed. 

Drug Use, Misuse, Substance Use Disorder, Drug Initiation, and Treatment 

Due to the timing of the release of the 2018 National Survey on Drug Use and Health (NSDUH), we 

included both 2017 and 2018 data in this report. In SAMHSA’s published reports of 2018 NSDUH results, the 

26-34 and ≥ 26 age groups were not included for some tables, and new age categories were added. Those 

changes are reflected in this report. Additionally, in SAMHSA’s published reports of 2018 NSDUH results, 

self-report misuse of prescription benzodiazepines in the past year was included; therefore, these data are 

included in this report for 2018. 

The 2017 National Survey on Drug Use and Health (NSDUH) slightly altered question wording 

surrounding the use and misuse of prescription psychotherapeutics compared to the 2016 NSDUH. For 

the 2017 NSDUH, text was added to the questions about misuse of “any other” prescription pain reliever, 

stimulant, or sedative to remind respondents not to include over-the-counter medications (e.g., Tylenol®, 

Dexatrim®, Sominex®). 

Nonfatal Overdose Hospitalizations and Emergency Departments (ED) Visits 

Information on medically attended, nonfatal overdose hospitalization and ED visit rates was obtained from 

the most recently available year of the Healthcare Cost and Utilization Project (HCUP) data. In this report, 

we present HCUP data from 2016. HCUP data sources transitioned from using International Classification 

of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes to International Classification of 

Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) on October 1, 2015 

(the beginning of fiscal year 2016). In the 2018 surveillance report, we presented both ICD-9-CM and ICD-10­

CM/PCM data, but for this report, we have only ICD-10-CM/PCS codes available in HCUP. Additionally, due to 

changes in the way drug poisoning intent was coded from ICD-9-CM to ICD-10-CM/PCS, this report presents 

data for all intents as well as for unintentional and undetermined intents separately. Due to the differences 

in the definitions used between the two reports, numbers and rates should not be compared between the 

2018 and 2019 surveillance reports. 

11 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Drug Overdose Mortality 

The mortality table from previous Surveillance Reports (“Number and age-adjusted rates of drug overdose 

deaths involving selected drugs by sex, age group, race/ethnicity, census region, urbanization, and intent — 

United States“) has now been split into three tables for easier viewing: Table 4a: Number and age-adjusted 

rates per 100,000 population of overall drug overdose deaths and drug overdose deaths involving any type 

of opioid, by sex, age group, race/ethnicity, census region, urbanization, and intent — United States; Table 

4b: Number and age-adjusted rates per 100,000 population of drug overdose deaths involving selected 

opioids by sex, age group, race/ethnicity, census region, urbanization, and intent — United States; and Table 

4c: Number and age-adjusted rates per 100,000 population of drug overdose deaths involving cocaine and 

other psychostimulants with abuse potential by sex, age group, race/ethnicity, census region, urbanization, 

and intent — United States. In addition, a supplemental table was added detailing the trend analyses for drug 

overdose deaths between 1999 and 2017: Supplemental Table 3a. Trend analyses of age-adjusted rates per 

100,000 population of drug overdose deaths by drug or drug class—United States, 1999-2017. 

12 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

RESULTS OF THE 2019 

SURVEILLANCE REPORT 

Opioid Prescribing 

This section includes estimates of the total number of opioid prescriptions filled in the United States from 

retail pharmacies based on the data available to CDC. Data on estimates of opioid prescriptions filled from 

IQVIATM are presented for the following outcomes: 

•	 National estimates of total number and percentage of persons who had at least one prescription filled 

for an opioid by age and sex — United States, 2018 (Table 1a) 

•	 Total number and rate of opioid prescriptions and morphine milligram equivalents (MME) dispensed per 

100 persons annually — United States, 2018 (Table 1b) 

•	 Rates of opioid prescriptions filled per 100 persons by type, dosage, and state— United States, 2018 

(Table 1c) 

•	 Trend analyses of opioid prescriptions filled — United States, 2006-2018 (Table 1d) 

•	 Rates for overall annual opioid prescriptions filled per 100 persons and for high-dosage prescriptions (≥

90 morphine milligram equivalents [MME]/day) — United States, 2006-2018 (Figure 1a) 

•	 Rates for overall annual opioid prescriptions filled per 100 persons by days of supply per prescription — 

United States, 2006-2018 (Figure 1b) 

•	 Average daily morphine milligram equivalents (MME) per opioid prescription dispensed — United 

States, 2006-2018 (Figure 1c) 

•	 Average days of supply per opioid prescription filled — United States, 2006-2018 (Figure 1d) 

All prescription fill rates are presented per 100 persons. For more detailed information, including definitions, 

please refer to the table footnotes and technical notes. 

Annual estimates of prescription fill rates for all opioids, high-dosage opioids (≥ 90 MME) dispensed, and 

days of supply per prescription in the United States during 2006-2018 are reported in Supplemental Table 1. 

Person-level opioid prescribing, United States, 2018 (Table 1a) 

•	 A total of 49,515,948 persons, or 15.0% of the population, filled at least one prescription for an opioid. 

•	 12.8% of males and 17.2% of females filled at least one prescription for an opioid in 2018. 

•	 Person-level prescribing was highest among older age groups, with 25.0% of persons aged 65 years and 

older, 23.9% of persons aged 55-64 years, and 20.4% of persons aged 45-54 years having filled at least 

one prescription for an opioid. 

Opioid prescription fill rates and dosages, United States, 2018 (Table 1b) 

•	 168,158,611 opioid prescriptions were filled at retail pharmacies; the total opioid prescription fill rate 

was 51.4 prescriptions per 100 persons. One opioid prescription was written for every 1.95 persons. This 

calculation was not adjusted for insurance status. 

•	 Among the 15% of persons had at least one prescription filled per year, each patient received on 

average 3.4 prescriptions per year. 

13 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

•	 The long-acting or extended-release (LA/ER) opioid (i.e., slower-acting medications with a longer 

duration of pain-relieving action) prescription dispense rate was 4.5 per 100 persons. 

•	 The prescription fill rate for < 30 days of supply per prescription was 29.4 per 100 persons; for ≥ 30 days 

of supply, the rate was 22.0 per 100 persons; for < 3 days of supply, the rate was 8.2 per 100 persons; 

for ≥ 3 and < 7 days of supply, the rate was 10.0 per 100 persons in 2018; and for < 7 days of supply, the 

rate was 18.2 per 100 persons. 

•	 The average number of opioid prescriptions filled per patient who filled an opioid prescription was 3.4, 

and the average number of days of supply per prescription was 18.4. 

•	 The total dosage or amount of opioid prescriptions dispensed in 2018 was 138,900,570,581 morphine 

milligram equivalents (MME). 

•	 The average dosage per prescription dispensed was 828.1 MME, and the average daily dosage per 

prescription filled was 42.9 MME. 

Opioid prescription fill rates and dosages by state, 2018 (Table 1c) 

•	 Opioid prescription fill rates ranged from 25.0 prescriptions per 100 persons in the District of Columbia 

to 97.5 per 100 persons in Alabama. 

– States with the highest opioid prescription fill rates were Alabama (97.5), Arkansas (93.5), Tennessee 

(81.8), Kentucky (79.5), and Louisiana (79.4). 

– States with the lowest opioid prescription fill rates were the District of Columbia (25.0), Hawaii (33.4), 

New York (34.0), California (35.1), and Massachusetts (35.3). 

•	 LA/ER opioid prescription fill rate ranged from 1.6 prescriptions per 100 persons in the District of 

Columbia to 10.1 per 100 persons in Delaware. 

– States with the highest LA/ER opioid prescription fill rates were Delaware (10.1), Oklahoma (7.4), 

Tennessee (7.0), Vermont (7.0), New Hampshire (7.0), and Alabama (6.9). 

– States with the lowest LA/ER opioid prescription fill rates were the District of Columbia (1.6), Texas (2.8), 

Illinois (2.9), California (3.0), and Minnesota (3.4). 

•	 High-dosage opioid prescription fill rates (≥ 90 MME/day) ranged from 1.1 prescriptions per 100 persons 

in the District of Columbia to 7.8 in Delaware. 

– States with the highest high-dosage opioid prescription fill rates were Delaware (7.8), Alaska (6.8), 

Vermont (6.8), Utah (6.7), and New Hampshire (6.4). 

– States with the lowest high-dosage opioid prescription fill rates were the District of Columbia (1.1), 

Texas (2.0), Illinois (2.2), North Dakota (2.3), and Minnesota (2.3). 

Trends in Opioid Prescription Fill Rates and Dosages, 2006–2018 

All opioids (Table 1d and Figure 1a) 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 72.4 to 51.4 per 

100 persons for all opioids, an overall relative reduction of 29.0% (Supplemental Table 1a). The prescription 

fill rate for all opioids initially increased annually from 2006 to 2012 by 1.9% (95% confidence limits [CL]: 0.9, 

2.9), decreased annually from 2012 to 2016 by 5.2% (95% CL: -7.9, -2.5), and continued to decrease annually 

by 12.4% (95% CL: -17.3, -7.2) from 2016 to 2018. 

High-dosage opioids (≥ 90 MME/day) (Table 1d and Figure 1a) 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 11.5 to 3.9 for highdosage opioids, an overall relative reduction of 66.4% (Supplemental Table 1a). The change in high-dosage 

opioid prescription fill rate was not significant between 2006 and 2009 (annual percent change [APC]: -0.5, 

95% CL: -10.5, 10.5), and then decreased annually by 8.9% (95% CL: -12.1, -5.6) from 2009 to 2016 and then 

change was not significant between 2016 and 2018 (APC: -18.5, 95% CL: -34.0, 0.7). 

14 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Annual prescription fill rate per 100 persons by days of supply per opioid prescription (≥ 30 days, < 30 days, 

< 3 days, and ≥ 3 and < 7 days) 

≥ 30 days of supply (Table 1d, Figure 1b, and Supplemental Table 1a)
 

Between 2006 and 2018, the annual prescription fill rate per 100 persons increased from 17.6 to 22.0 for
 

prescriptions with ≥ 30 days of supply, an overall relative increase of 25.0%. The annual prescription fill rate
 

increased annually by 10.3% (95% CL: 8.5, 12.1) from 2006 to 2010 and by 1.9% (95% CL: 0.2, 3.5) from 2010
 

to 2015, and then decreased annually by 8.4% (95% CL: -10.7, -6.0) from 2015 to 2018.
 

< 30 days of supply (Table 1d, Figure 1b, and Supplemental Table 1a)
 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 54.7 to 29.4 for
 

prescriptions with < 30 days of supply, an overall relative reduction of 46.3%. The annual prescription fill rate
 

did not significantly change between 2006 and 2012 (APC: -0.5, 95% CL: -1.6, 0.5), decreased annually by
 

7.6% (95% CL: -10.4, -4.7) from 2012 to 2016, and further decreased 13.7% (95% CL: -18.8, -8.3) annually from
 

2016 to 2018.
 

< 3 days of supply (Table 1d, Figure 1b, and Supplemental Table 1a)
 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 16.2 to 8.2 for
 

prescriptions with < 3 days of supply, an overall relative reduction of 49.4%. The annual prescription fill rate
 

decreased annually by 2.4% (95% CL: -3.0, -1.7) from 2006 to 2012, further decreased annually by 8.2% (95%
 

CL: -9.9, -6.4) from 2012 to 2016, and continued to decrease by 10.5% (95% CL: -13.8, -7.1) annually from 2016 

to 2018. 

< 7 days of supply (Table 1d, Figure 1b, and Supplemental Table 1a) 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 35.3 to 18.2 for 

prescriptions with < 7 days of supply, an overall relative reduction of 48.6%. The annual prescription fill rate 

did not change significantly between 2006 and 2010 (APC: -1.1, 95% CL: -2.8, 0.7), decreased annually by 

5.3% (95% CL: -7.9, -2.5) from 2010 to 2014, and further decreased 10.0% (95% CL: -11.6, -8.4) annually from 

2014 to 2018. 

≥ 3 and < 7 days of supply (Table 1d, Figure 1b, and Supplemental Table 1a) 

Between 2006 and 2018, the annual prescription fill rate per 100 persons decreased from 19.1 to 10.0 for 

prescriptions with ≥ 3 and < 7 days of supply, an overall relative reduction of 47.7%. The annual prescription 

fill rate did not change significantly between 2006 and 2010 (APC: -0.6, 95% CL: -2.3, 1.1), decreased annually 

by 5.3% (95% CL: -7.9, -2.6) from 2010 to 2014, and further decreased 10.2% (95% CL: -11.8, -8.6) annually 

from 2014 to 2018. 

Average daily dosage (MME/day) per prescription dispensed (Table 1d, Figure 1d, and Supplemental Table 1a) 

Between 2006 and 2018, the average daily MME per prescription dispensed decreased from 59.7 to 42.9 for 

all opioids, an overall relative reduction of 28.1%. The MME per prescription dispensed rate did not change 

significantly between 2006 and 2010 (APC: -1.1, 95% CL: -2.3, 0.2), decreased annually by 4.3% (95% CL: -8.2, 

-0.2) from 2010 to 2013, and further decreased 2.7% (95% CL: -3.6, -1.8) annually from 2013 to 2018. 

Average days of supply per prescription filled (Table 1d, Figure 1c, and Supplemental Table 1a) 

Between 2006 and 2018, average days of supply per prescription filled increased from 13.3 to 18.4 days, an 

overall relative increase of 37.6%. The rate increased annually by 4.0% (95% CL: 3.5, 4.4) from 2006 to 2010, 

by 2.6% (95% CL: 2.3, 2.8) from 2010 to 2016, and was not significant between 2016 and 2018 (APC: 0.7, 

95% CL: -0.5, 2.0). 

15 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

Drug Use, Misuse, Substance Use Disorder, 

Drug Initiation, and Treatment 

This section includes estimates of self-reported use of prescription pain relievers, tranquilizers, stimulants, 

and sedatives in the past month and past year for both 2017 and 2018. In addition to prescription use, this 

section includes self-reported use of marijuana, opioids (heroin use and prescription pain reliever misuse), 

heroin, cocaine, and methamphetamine in the past month and past year. This section also includes selfreported substance use initiation, disorder, and treatment. Illicit drug use includes the use of marijuana, 

cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Prescription drug misuse 

includes the misuse of prescription pain relievers, tranquilizers, stimulants, sedatives, and benzodiazepines. 

Benzodiazepines can be prescribed as a tranquilizer or sedative. Regardless of whether specific 

benzodiazepines were reported as tranquilizers or sedatives, these responses were included in the 

aggregate measures of misuse of benzodiazepines 

Self-reported data for persons in the United States aged 12 years and older are presented from the 2017 and 

2018 National Survey on Drug Use and Health (NSDUH): 

•	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past month, persons 12+ 

years old, numbers in thousands — United States, 2017 (Table 2a) 

•	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past year, persons 12+ 

years old, numbers in thousands — United States, 2017 (Table 2b) 

•	 Self-reported prevalence of any prescription drug use (including misuse) in the past year, persons 12+ 

years old, by drug type, numbers in thousands — United States, 2017 (Table 2c) 

•	 Self-reported prevalence of past year initiation of illicit drug use and prescription drug misuse, persons 

12+ years old, by drug type, numbers in thousands — United States, 2017 (Table 2d) 

•	 Self-reported prevalence of substance use disorder for specific substances in the past year, persons 12+ 

years old, numbers in thousands — United States, 2017 (Table 2e) 

•	 Prevalence of self-reported treatment for illicit drug use and prescription drug misuse in the past year, 

persons 12+ years old, by demographic characteristics, numbers in thousands — United States, 2017 

(Table 2f) 

•	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past month, persons 12+ 

years old, numbers in thousands — United States, 2018 (Table 2g) 

•	 Self-reported prevalence of illicit drug use and prescription drug misuse in the past year, persons 12+ 

years old, numbers in thousands — United States, 2018 (Table 2h) 

•	 Self-reported prevalence of any prescription drug use (including misuse) in the past year, persons 12+ 

years old, by drug type, numbers in thousands — United States, 2018 (Table 2i) 

•	 Self-reported prevalence of past year initiation of illicit drug use and prescription drug misuse, persons 

12+ years old, by drug type, numbers in thousands — United States, 2018 (Table 2j) 

•	 Self-reported prevalence of substance use disorder for specific substances in the past year, persons 12+ 

years old, numbers in thousands — United States, 2018 (Table 2k) 

•	 Prevalence of self-reported treatment for illicit drug use and prescription drug misuse in the past year, 

persons 12+ years old, by demographic characteristics, numbers in thousands — United States, 2018 

(Table 2l) 

For more detailed information, please refer to the table footnotes and the technical notes. 

16 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

Illicit Drug Use and Prescription Drug Misuse 

Estimated prevalence of past year use of illicit drugs includes use of marijuana, cocaine (including crack), 

heroin, hallucinogens, inhalants, or methamphetamine. Prescription drug misuse includes misuse of 

prescription psychotherapeutics (i.e., prescription pain relievers, stimulants, sedatives, tranquilizers, and 

benzodiazepines). Use of “marijuana” was specifically asked in the survey instead of use of “cannabis,” 

therefore we use the term “marijuana” in this section, and “cannabis” elsewhere. In SAMHSA’s published 

report of 2018 data, different age categorizations were included in comparison to the 2017 data. Therefore, 

some age categorizations differed between the 2017 and 2018 data tables, and in the text below, some age 

categorizations may not reflect the age categorizations in Table 2h. 

•	 During 2017, an estimated 51,795,000 persons, or 19.0% of persons aged 12 years and older, reported 

use of illicit drugs or misuse of prescription drugs in the past year. (Table 2b). 

– By gender, prevalence was 22.0% among males and 16.2% among females. 

– By age, prevalence was highest among persons aged 18-25 years (39.4%) and persons aged 26-34 

years (28.7%). 

– By race/ethnicity, prevalence ranged from 9.5% among non-Hispanic Asians to 29.3% among nonHispanic American Indians or Alaska Natives. 

– By U.S. census region of residence, prevalence ranged from 16.6% in the South to 23.4% in the West. 

– By county type and urbanization, prevalence ranged from 14.2% of persons in non-metropolitan, 

completely rural counties to 19.9% of persons in large metropolitan counties. 

•	 During 2018, an estimated 53,182,000 persons, or 19.4% of persons aged 12 years and older, reported 

use of illicit drugs or misuse of prescription drugs in the past year (Table 2h). 

– By gender, prevalence was 22.0% among males and 17.0% among females. 

– By age, prevalence was highest among persons aged 18-25 years (38.7%) and persons aged 26-29 

years (34.3%). 

– By race/ethnicity, prevalence ranged from 11.2% among non-Hispanic Asians to 28.5% among nonHispanic American Indians or Alaska Natives. 

– By U.S. census region of residence, prevalence ranged from 16.7% in the South to 23.7% in the West. 

– By county type and urbanization, prevalence ranged from 12.5% of persons in non-metropolitan, 

completely rural counties to 20.2% of persons in large metropolitan counties. 

Opioids 

Prevalence of opioid use includes use of heroin and misuse of prescription pain relievers (e.g., oxycodone, 

hydrocodone). Estimates are provided for the prevalence of past year opioid misuse (includes heroin use and 

prescription pain reliever misuse) and substance use disorder. Estimates are provided for the prevalence of 

past year use and misuse, initiation, and substance use disorder for heroin and prescription pain relievers. 

•	 In 2017, an estimated 11,401,000, or 4.2% of persons aged 12 years and older, reported opioid misuse in 

the past year (Table 2b). 

– By gender, reported opioid misuse was 4.7% among males and 3.7% among females. 

– By age, reported opioid misuse was highest among persons aged 18–25 years (7.3%) and persons 

aged 26-34 years (6.2%). 

– By race/ethnicity, reported opioid misuse ranged from 1.9% among non-Hispanic Asians to 6.1% 

among non-Hispanic American Indians or Alaska Natives. 

– By U.S. census region of residence, reported opioid misuse ranged from 3.8% in the Northeast to 4.4% 

in the Midwest and West. 

– By county type and urbanization, reported opioid misuse ranged from 3.9% in non-metropolitan, 

urbanized counties to 4.5% in small metropolitan counties. 

•	 In 2017, an estimated 2,110,000, or 0.8% of persons aged 12 years and older, reported opioid use 

disorder in the past year (Table 2e). 

•	 In 2018, an estimated 10,250,000, or 3.7% of persons aged 12 years and older, reported opioid misuse 

17 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

in the past year (Table 2h). 

– By gender, reported opioid misuse was 4.0% among males and 3.5% among females. 

– By age, reported opioid misuse was highest among persons aged 30–34 years (5.9%) and persons 

aged 18-25 years (5.6%). 

– By race/ethnicity, reported opioid misuse ranged from 1.4% among non-Hispanic Asians to 8.4% 

among non-Hispanic Native Hawaiian or other Pacific Islander. 

– By U.S. census region of residence, reported opioid misuse ranged from 3.1% in the Northeast to 4.0% 

in the South and West. 

– By county type and urbanization, reported opioid misuse ranged from 3.5% in large metropolitan 

counties to 4.1% in small metropolitan counties. 

•	 In 2018, an estimated 2,028,000, or 0.7% of persons aged 12 years and older, reported opioid use 

disorder involving opioid misuse in the past year (Table 2k). 

Heroin 

•	 In 2017, an estimated 886,000, or 0.3% of persons aged 12 years and older, reported heroin use in the 

past year (Table 2b). 

– By gender, reported heroin use was 0.5% among males and 0.2% among females. 

– By age, reported heroin use was highest among persons aged 26–34 years (0.8%) and persons aged 

18-25 years and 35-39 years (both 0.6%). 

– By race/ethnicity, reported heroin use ranged from <0.05% among non-Hispanic Native Hawaiians or 

Other Pacific Islanders to 0.7% among non-Hispanic American Indians or Alaska Natives. 

– By U.S. census region of residence, reported heroin use ranged from 0.2% in the West to 0.5% in the 

Northeast. 

– By county type and urbanization, reported heroin use ranged from 0.1% in non-metropolitan,
 

completely rural counties to 0.4% in small metropolitan counties.
 

•	 In 2017, an estimated 81,000 persons, or < 0.05% of persons aged 12 years and older, reported initiation 

of heroin in the past year (Table 2d). 

•	 In 2017, an estimated 652,000 persons, or 0.2% of persons aged 12 years and older, reported a substance 

use disorder in the past year involving heroin (Table 2e). 

•	 In 2018, an estimated 808,000, or 0.3% of persons aged 12 years and older, reported heroin use in the 

past year (Table 2h). 

– By gender, reported heroin use was 0.4% among males and 0.2% among females. 

– By age, reported heroin use was highest among persons aged 26-34 years (0.6%) and persons aged 

18-25 years and 35-39 years (both 0.5%). 

– By race/ethnicity, reported heroin use ranged from <0.05% among non-Hispanic Asians to 0.4% 

among non-Hispanic Blacks. 

– By U.S. census region of residence, reported heroin use ranged from 0.2% in the South to 0.5% in 

the Northeast. 

– By county type and urbanization, reported heroin use ranged from <0.05% in non-metropolitan, 

completely rural counties to 0.3% in all other classifications of counties. 

•	 In 2018, an estimated 117,000 persons, or < 0.05% of persons aged 12 years and older, reported initiation 

of heroin in the past year (Table 2j). 

•	 In 2018, an estimated 526,000 persons, or 0.2% of persons aged 12 years and older, reported a substance 

use disorder in the past year involving heroin (Table 2k). 

Prescription pain relievers (e.g., oxycodone, hydrocodone) 

•	 In 2017, an estimated 11,077,000, or 4.1% of persons aged 12 years and older, reported misuse of 

prescription pain relievers in the past year (Table 2b). 

– By gender, reported misuse of prescription pain relievers was 4.6% among males and 3.6% among 

18 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

females. 

– By age, reported misuse of prescription pain relievers was highest among persons aged 18–25 years 

(7.2%) and persons aged 26-34 years (6.0%). 

– By race/ethnicity, reported misuse of prescription pain relievers ranged from 1.8% among nonHispanic Asians to 5.7% among non-Hispanic American Indians or Alaska Natives. 

– By U.S. census region of residence, reported misuse of prescription pain relievers ranged from 3.6% in 

the Northeast to 4.4% in the West. 

– By county type and urbanization, reported misuse of prescription pain relievers ranged from 3.9% in 

both large metropolitan and non-metropolitan, urbanized counties to 4.3% in both small metropolitan 

and non-metropolitan, completely rural counties. 

•	 In 2017, an estimated 2,010,000, or 0.7% of persons aged 12 years and older, reported initiation of 

prescription pain reliever misuse in the past year (Table 2d). 

•	 In 2017, an estimated 1,678,000, or 0.6% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving misuse of prescription pain relievers (Table 2e). 

•	 In 2018, an estimated 9,948,000, or 3.6% of persons aged 12 years and older, reported misuse of 

prescription pain relievers in the past year (Table 2h). 

– By gender, reported misuse of prescription pain relievers was 3.9% among males and 3.4% among 

females. 

– By age, reported misuse of prescription pain relievers was highest among persons aged 30-34 years 

(5.6%) and persons aged 18–25 years (5.5%). 

– By race/ethnicity, reported misuse of prescription pain relievers ranged from 1.4% among nonHispanic Asians to 8.4% among non-Hispanic Native Hawaiian or other Pacific Islander. 

– By U.S. census region of residence, reported misuse of prescription pain relievers ranged from 2.9% in 

the Northeast to 3.9% in the South and the West. 

– By county type and urbanization, reported misuse of prescription pain relievers ranged from 3.4% in 

large metropolitan counties to 4.0% in small metropolitan counties. 

•	 In 2018, an estimated 1,908,000, or 0.7% of persons aged 12 years and older, reported initiation of 

prescription pain reliever misuse in the past year (Table 2j). 

•	 In 2018, an estimated 1,694,000, or 0.6% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving misuse of prescription pain relievers (Table 2k). 

Stimulants 

Estimated prevalence includes use of cocaine and methamphetamine and misuse of prescription 

stimulants. Estimates are provided for the prevalence of past year use and misuse, initiation, and substance 

use disorder for these three types of stimulants. 

Cocaine 

•	 In 2017, an estimated 5,943,000, or 2.2% of persons aged 12 years and older, reported cocaine use in the 

past year (Table 2b). 

– By gender, reported cocaine use was 3.0% among males and 1.4% among females. 

– By age, reported cocaine use was highest among persons aged 18–25 years (6.2%) and persons aged 

26-34 years (4.5%). 

– By race/ethnicity, reported cocaine use ranged from 0.9% among non-Hispanic Asians to 3.6% among 

non-Hispanic American Indians or Alaskan Natives. 

– By U.S. census region of residence, reported cocaine use ranged from 1.9% in the South to 2.6% in 

the West. 

– By county type and urbanization, reported cocaine use ranged from 1.0% in non-metropolitan, 

completely rural counties to 2.4% in large metropolitan counties. 

•	 In 2017, an estimated 1,037,000, or 0.4% of persons aged 12 years and older, reported initiation of 

19 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

cocaine use in the past year (Table 2d). 

•	 In 2017, an estimated 966,000, or 0.4% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving cocaine (Table 2e). 

•	 In 2018, an estimated 5,529,000, or 2.0% of persons aged 12 years and older, reported cocaine use in the 

past year (Table 2h). 

– By gender, reported cocaine use was 2.6% among males and 1.5% among females. 

– By age, reported cocaine use was highest among persons aged 26–29 years (6.0%) and persons aged 

18-25 years (5.8%). 

– By race/ethnicity, reported cocaine use ranged from 1.4% among non-Hispanic Asians to 2.1% among 

non-Hispanic Whites. 

– By U.S. census region of residence, reported cocaine use ranged from 1.6% in the South to 2.7% in 

the West. 

– By county type and urbanization, reported cocaine use ranged from 0.7% in non-metropolitan, 

completely rural counties to 2.3% in large metropolitan counties. 

•	 In 2018, an estimated 874,000 or 0.3% of persons aged 12 years and older, reported initiation of cocaine 

use in the past year (Table 2j). 

•	 In 2018, an estimated 977,000 or 0.4% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving cocaine (Table 2k). 

Methamphetamine 

•	 In 2017, an estimated 1,633,000, or 0.6% of persons aged 12 years and older, reported 

methamphetamine use in the past year (Table 2b). 

– By gender, reported methamphetamine use was 0.8% among males and 0.4% among females. 

– By age, reported methamphetamine use was highest among persons aged 35–39 years (1.2%), and 

persons aged 18-25 years and 26-34 years (1.1% in both). 

– By race/ethnicity, reported methamphetamine use ranged from 0.1% among non-Hispanic Asians to 

4.3% among non-Hispanic American Indians or Alaskan Natives. 

– By U.S. census region of residence, reported methamphetamine use ranged from 0.2% in the
 

Northeast to 0.9% in the West.
 

– By county type and urbanization, reported methamphetamine use ranged from 0.4% in large 

metropolitan to 1.1% in both non-metropolitan, less urbanized and non-metropolitan, completely 

rural counties. 

•	 In 2017, an estimated 195,000, or 0.1% of persons aged 12 years and older, reported initiation of 

methamphetamine use in the past year (Table 2d). 

•	 In 2017, an estimated 964,000, or 0.4% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving methamphetamines (Table 2e). 

•	 In 2018, an estimated 1,867,000, or 0.7% of persons aged 12 years and older, reported 

methamphetamine use in the past year (Table 2h). 

– By gender, reported methamphetamine use was 0.8% among males and 0.5% among females. 

– By age, reported methamphetamine use was highest among persons aged 30–34 years (1.6%), and 

persons aged 26-29 years (1.2%), and 35-39 years (1.1%). 

– By race/ethnicity, reported methamphetamine use ranged from 0.2% among non-Hispanic Asians and 

among non-Hispanic Blacks to 2.4% among non-Hispanic American Indians or Alaskan Natives. 

– By U.S. census region of residence, reported methamphetamine use ranged from 0.3% in the
 

Northeast to 1.1% in the West.
 

– By county type and urbanization, reported methamphetamine use ranged from 0.6% in large
 

metropolitan to 1.0% in non-metropolitan, less urbanized counties.
 

•	 In 2018, an estimated 205,000, or 0.1% of persons aged 12 years and older, reported initiation of 

20 
 

 

Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019 

methamphetamine use in the past year (Table 2j). 

•	 In 2018, an estimated 1,051,000, or 0.4% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving methamphetamines (Table 2k). 

Prescription Stimulants 

•	 In 2017, an estimated 5,839,000, or 2.1% of persons aged 12 years and older, reported misuse of 

prescription stimulants in the past year (Table 2b). 

– By gender, reported misuse of prescription stimulants was 2.6% among males and 1.7%
 

among females.
 

– By age, reported misuse of prescription stimulants was highest among persons aged 18-25 years 

(7.4%) and persons aged 26-34 years (4.1%). 

– By race/ethnicity, reported misuse of prescription stimulants ranged from 0.8% among non-Hispanic 

Blacks to 2.6% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription stimulants ranged from 1.8% in 

the West to 2.8% in the Midwest. 

– By county type and urbanization, reported misuse of prescription stimulants ranged from 1.4% in 

non-metropolitan, less urbanized counties to 2.3% in large metropolitan counties. 

•	 In 2017, an estimated 1,192,000, or 0.4% of persons aged 12 years and older, reported initiation of 

prescription stimulant misuse in the past year (Table 2d). 

•	 In 2017, an estimated 572,000, or 0.2% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription stimulants (Table 2e). 

•	 In 2018, an estimated 5,109,000, or 1.9% of persons aged 12 years and older, reported misuse of 

prescription stimulants in the past year (Table 2h). 

– By gender, reported misuse of prescription stimulants was 2.1% among males and 1.6% among 

females. 

– By age, reported misuse of prescription stimulants was highest among persons aged 18-25 years 

(6.5%), followed by persons aged 26-29 years (4.4%) and persons aged 30-34 years (3.4%). 

– By race/ethnicity, reported misuse of prescription stimulants ranged from 0.9% among non-Hispanic 

Blacks to 2.2% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription stimulants ranged from 1.6% in the 

South to 2.2% in the Northeast. 

– By county type and urbanization, reported misuse of prescription stimulants ranged from 0.9% in nonmetropolitan, completely rural counties to 2.0% in small metropolitan counties. 

•	 In 2018, an estimated 1,001,000, or 0.4% of persons aged 12 years and older, reported initiation of 

prescription stimulant misuse in the past year (Table 2j). 

•	 In 2018, an estimated 561,000, or 0.2% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription stimulants (Table 2k). 

Other Drugs 

Estimated prevalence for use of other drugs includes marijuana use and misuse of prescription tranquilizers, 

sedatives, and benzodiazepines. Estimates are provided for the prevalence of past year use and misuse, 

initiation, and substance use disorder for these three types of drug classes. 

Marijuana 

•	 In 2017, an estimated 40,935,000, or 15% of persons aged 12 years and older, reported use of marijuana 

in the past year (Table 2b). 

– By gender, reported marijuana use was 17.8% among males and 12.5% among females. 

– By age, reported use of marijuana was highest among persons aged 18-25 years (34.9%) and persons 

21 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

aged 26-34 years (23.4%). 

– By race/ethnicity, reported use of marijuana ranged from 6.9% among non-Hispanic Asians to 24.3% 

among non-Hispanic American Indian or Alaska Natives. 

– By U.S. census region of residence, reported use of marijuana ranged from 12.7% in the South to 19.2% 

in the West. 

– By county type and urbanization, reported use of marijuana ranged from 10.0% in non-metropolitan, 

completely rural counties to 15.9% in large metropolitan counties. 

•	 In 2017, an estimated 3,033,000, or 1.1% of persons aged 12 years and older, reported initiation of 

marijuana in the past year (Table 2d). 

•	 In 2017, an estimated 4,057,000, or 1.5% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving marijuana (Table 2e). 

•	 In 2018, an estimated 43,486,000, or 15.9% of persons aged 12 years and older, reported use of 

marijuana in the past year (Table 2h). 

– By gender, reported marijuana use was 18.5% among males and 13.4% among females. 

– By age, reported use of marijuana was highest among persons aged 18-25 years (34.8%) and persons 

aged 26-34 years (29.6%). 

– By race/ethnicity, reported use of marijuana ranged from 8.9% among non-Hispanic Asians to 23.0% 

among non-Hispanic American Indian or Alaska Natives. 

– By U.S. census region of residence, reported use of marijuana ranged from 13.0% in the South to 20.2% 

in the West. 

– By county type and urbanization, reported use of marijuana ranged from 9.5% in non-metropolitan, 

completely rural counties to 16.8% in large metropolitan counties. 

•	 In 2018, an estimated 3,061,000, or 1.1% of persons aged 12 years and older, reported initiation of 

marijuana in the past year (Table 2j). 

•	 In 2018, an estimated 4,421,000, or 1.6% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving marijuana (Table 2k). 

Prescription Tranquilizers 

•	 In 2017, an estimated 5,944,000, or 2.2% of persons aged 12 years and older, reported misuse of 

prescription tranquilizers in the past year (Table 2b). 

– By gender, reported misuse of prescription tranquilizers was 2.3% among males and 2.1% among females. 

– By age, reported misuse of prescription tranquilizers was highest among persons aged 18-25 years 

(5.5%) and persons aged 26–34 years (3.4%). 

– By race/ethnicity, reported misuse of prescription tranquilizers ranged from 0.7% among non-Hispanic 

Asians to 2.6% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription tranquilizers ranged from 1.9% in 

the West to 2.4% in the Midwest. 

– By county type and urbanization, reported misuse of prescription tranquilizers ranged from 1.9% in 

both non-metropolitan, completely rural and non-metropolitan, urbanized counties to 2.2% in both 

large metropolitan and small metropolitan counties. 

•	 In 2017, an estimated 1,446,000, or 0.5% of persons aged 12 years and older, reported initiation of 

prescription tranquilizer misuse in the past year (Table 2d). 

•	 In 2017, an estimated 739,000, or 0.3% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription tranquilizers (Table 2e). 

•	 In 2018, an estimated 5,742,000, or 2.1% of persons aged 12 years and older, reported misuse of 

prescription tranquilizers in the past year (Table 2h). 

– By gender, reported misuse of prescription tranquilizers was 2.2% among males and 2.0%
 

among females.
 

– By age, reported misuse of prescription tranquilizers was highest among persons aged 18-25 years 

22 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

(4.6%), followed by persons aged 26–29 years (3.9%) and persons aged 30- 34 years (3.3%). 

– By race/ethnicity, reported misuse of prescription tranquilizers ranged from 0.7% among non-Hispanic 

Asians to 2.4% among both non-Hispanic whites and non-Hispanic American Indian or Alaska Natives. 

– By U.S. census region of residence, reported misuse of prescription tranquilizers was nearly uniform, 

with 2.1% in the South, West, and Northeast and 2.2% in the Midwest. 

– By county type and urbanization, reported misuse of prescription tranquilizers ranged from 0.8% in 

non-metropolitan, completely rural counties to 2.3% in large metropolitan counties. 

•	 In 2018, an estimated 1,210,000, or 0.4% of persons aged 12 years and older, reported initiation of 

prescription tranquilizer misuse in the past year (Table 2j). 

•	 In 2018, an estimated 673,000, or 0.2% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription tranquilizers (Table 2k). 

Prescription Sedatives 

•	 In 2017, an estimated 1,351,000, or 0.5% of persons aged 12 years and older, reported misuse of 

prescription sedatives in the past year (Table 2b). 

– By gender, reported misuse of prescription sedatives was 0.5% among males and 0.5% among females. 

– By age, reported misuse of prescription sedatives was highest among persons aged 50-54 years (1.0%) 

and persons aged 55-59 years and 60-64 years (both 0.7%). 

– By race/ethnicity, reported misuse of prescription sedatives ranged from 0.1% among non-Hispanic 

Asians to 0.6% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription sedatives ranged from 0.4% in the 

Northeast and Midwest to 0.6% in the West. 

– By county type and urbanization, reported misuse of prescription sedatives ranged from 0.3% in nonmetropolitan, urbanized counties to 0.9% in non-metropolitan, completely rural counties. 

•	 In 2017, an estimated 271,000, or 0.1% of persons aged 12 years and older, reported initiation of 

prescription sedative misuse in the past year (Table 2d). 

•	 In 2017, an estimated 198,000, or 0.1% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription sedatives (Table 2e). 

•	 In 2018, an estimated 1,084,000, or 0.4% of persons aged 12 years and older, reported misuse of 

prescription sedatives in the past year (Table 2h). 

– By gender, reported misuse of prescription sedatives was 0.5% among males and 0.3% among females. 

– By age group, reported misuse of prescription sedatives was highest at 0.6% among persons aged 18­

25, 26-29, 30-34, and 35-39 years. 

– By race/ethnicity, reported misuse of prescription sedatives ranged from 0.1% among both non-Hispanic 

Blacks and non-Hispanic Asians to 0.9% among non-Hispanic American Indian or Alaska Natives. 

– By U.S. census region of residence, reported misuse of prescription sedatives ranged from 0.3% in the 

South to 0.5% in the West. 

– By county type and urbanization, reported misuse of prescription sedatives ranged from 0.3% in small 

metropolitan counties to 0.6% in non-metropolitan, urbanized counties. 

•	 In 2018, an estimated 251,000, or 0.1% of persons aged 12 years and older, reported initiation of 

prescription sedative misuse in the past year (Table 2j). 

•	 In 2018, an estimated 113,000, or <0.05% of persons aged 12 years and older, reported a substance use 

disorder in the past year involving prescription sedatives (Table 2k). 

Prescription Benzodiazepines 

•	 In 2017, an estimated 5,674,000, or 2.1% of persons aged 12 years and older, reported misuse of 

prescription benzodiazepines in the past year (Table 2b). 

– By gender, reported misuse of prescription benzodiazepines was 2.2% among males and 2.0%
 

among females.
 

– By age, reported misuse of prescription benzodiazepines was highest among persons aged 18-25 

23 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

years (5.3%) and 35-39 years (2.0%). 

– By race/ethnicity, reported misuse of prescription benzodiazepines ranged from 0.7% among nonHispanic Asians to 2.5% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription benzodiazepines ranged from 1.7% 

in the West to 2.3% in the Midwest. 

– By county type and urbanization, reported misuse of prescription benzodiazepines ranged from 

1.7% in non-metropolitan, completely rural counties to 2.1% in large metropolitan counties, small 

metropolitan counties, and non-metropolitan less urbanized counties. 

•	 In 2018, an estimated 5,438,000, or 2.0% of persons aged 12 years and older, reported misuse of 

prescription benzodiazepines in the past year (Table 2h). 

– By gender, reported misuse of prescription benzodiazepines was 2.1% among males and 1.9%
 

among females.
 

– By age, reported misuse of prescription benzodiazepines was highest among persons aged 18-25 

years (4.5%) and 26-29 years (3.7%). 

– By race/ethnicity, reported misuse of prescription benzodiazepines ranged from 0.7% among nonHispanic Asians to 2.3% among non-Hispanic Whites. 

– By U.S. census region of residence, reported misuse of prescription benzodiazepines ranged from 1.9% 

in the South to 2.0% in the Midwest, Northeast, and West. 

– By county type and urbanization, reported misuse of prescription benzodiazepines ranged from 0.8% 

in non-metropolitan, completely rural counties to 2.2% in large metropolitan counties. 

Illicit and Prescription Drug Treatment (Table 2f and 2l)
 

Illicit and prescription drug treatment refers to treatment received to reduce or stop illicit drug use or
 

prescription drug misuse, or for medical problems associated with illicit drug use or prescription drug misuse in
 

the past year. 


Any location 

•	 In 2017, 2,448,000 persons, or 0.9% of persons aged 12 years and older, reported that they had received 

illicit or prescription drug treatment in the past year at any location, such as a hospital (inpatient), 

rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s 

office, self-help group, or a prison or jail. 

– By gender, 1.2% of males and 0.6% of females reported illicit or prescription drug treatment in the past year. 

– By age, 1.3% of persons aged 18-25 years reported illicit or prescription drug treatment in the past year. 

•	 In 2018, 2,097,000 persons, or 0.8% of persons aged 12 years and older, reported that they had received 

illicit or prescription drug treatment in the past year at any location, such as a hospital (inpatient), 

rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s 

office, self-help group, or a prison or jail. 

– By gender, 0.9% of males and 0.6% of females reported illicit or prescription drug treatment in the past year. 

– By age, 0.9% of persons aged 18-25 years reported illicit or prescription drug treatment in the past year. 

Specialty facility 

•	 In 2017, 1,674,000 persons, or 0.6% of persons aged 12 years and older, reported that they had received 

illicit or prescription drug treatment in the past year at a specialty facility, which includes a hospital 

(inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center. 

– By gender, 0.8% of males and 0.5% of females reported illicit or prescription drug treatment at a 

specialty facility in the past year. 

– By age, 0.9% of persons aged 18-25 years reported illicit or prescription drug treatment at a specialty 

24 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

facility in the past year. 

•	 In 2018, 1,392,000 persons, or 0.5% of persons aged 12 years and older, reported that they had received 

illicit or prescription drug treatment in the past year at a specialty facility, which includes a hospital 

(inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center. 

– By gender, 0.6% of males and 0.4% of females reported illicit or prescription drug treatment at a 

specialty facility in the past year. 

– By age, 0.6% of persons aged 18-25 years reported illicit or prescription drug treatment at a specialty 

facility in the past year. 

25 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Nonfatal Overdose Hospitalizations and 

Emergency Department (ED) Visits 

This section includes nonfatal emergency department (ED) visits and hospitalizations from poisonings or 

overdoses stemming from all drugs, opioids, and stimulants. Information on other drug poisoning-related 

hospitalizations and ED visits (e.g., antidepressants, benzodiazepines, cannabis, etc.) is available from the 

Healthcare Cost and Utilization Project (HCUP), but not presented in the 2019 surveillance report. Data on 

nonfatal, drug-related poisonings for all persons in the United States are presented from 2016 data HCUP: 

•	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoning-related 

hospitalizations by selected substances, all intents — United States, 2016 (Table 3a) 

•	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoning-related 

hospitalizations by selected substances, unintentional and undetermined intents — United States, 2016 

(Table 3b) 

•	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoning-related 

emergency department visits by selected substances, all intents — United States, 2016 (Table 3c) 

•	 Estimated numbers and age-adjusted rates per 100,000 population of drug poisoning-related 

emergency department visits by selected substances, unintentional and undetermined intents — United 

States, 2016 (Table 3d) 

•	 Estimated number and percentage of drug poisoning-related hospitalization and emergency 

department visits by primary payer, all intents — United States, 2016 (Table 3e) 

•	 Estimated number and percentage of drug poisoning-related hospitalization and emergency 

department visits by primary payer, unintentional and undetermined intent — United States, 2016 

(Table 3f) 

The categories of drugs and drug classes in the tables are not mutually exclusive, because poisoning-related 

hospitalizations and ED visits may involve more than one type of drug, and all diagnosis codes (i.e., not just 

the primary diagnosis code) were searched for drug-related poisonings. All rates are per 100,000 persons and 

are age-adjusted, except the rates by age group. For more detailed information, including definitions, please 

refer to the table footnotes and the technical notes. 

Rates of hospitalizations (Supplemental Tables 2a and 2b) and ED visits (Supplemental Tables 2c 

and 2d) due to nonfatal, drug-related overdoses for 2016 that are not age-adjusted are presented in the 

Supplemental Tables. 

All Drugs 

Hospitalizations, all intents 

•	 In 2016, an estimated 326,200 hospitalizations occurred for all drug-related poisonings of all intents in 

the United States; the age-adjusted rate was 98.1 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 89.3 among males and 106.8 among females. 

– By age, rates were highest among persons aged 45-54 years (135.6) and persons aged 55-64 years 

(129.7). 

•	 By region, hospitalization rates for all drug-related poisonings of all intents ranged from 79.1 in the West 

to 113.0 in the Midwest (Table 3a). 

•	 By urbanization, hospitalization rates for all drug-related poisonings of all intents ranged from 90.2 in 

large fringe metropolitan counties to 113.4 in small metropolitan counties (Table 3a). 

26 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Hospitalizations, unintentional and undetermined intents 

•	 In 2016, an estimated 193,150 hospitalizations occurred for all drug-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 56.2 hospitalizations per 

100,000 population (Table 3b). 

– By sex, the rate was 58.9 among males and 53.2 among females. 

– By age, rates were highest among persons aged 55–64 years (93.7) and persons aged ≥ 65 years (91.6). 

•	 By region, hospitalization rates for all drug-related poisonings of unintentional and undetermined intent 

ranged from 46.2 in the West to 60.5 in the South (Table 3b). 

•	 By urbanization, hospitalization rates for all drug-related poisonings of unintentional and undetermined 

intent ranged from 50.3 in noncore counties to 59.5 in medium metropolitan counties (Table 3b). 

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 577,794 ED visits occurred for all drug-related poisonings of all intents in the 

United States; the age-adjusted rate was 183.2 visits per 100,000 population (Table 3c). 

– By sex, the rate was 184.2 among males and 182.4 among females. 

– By age, rates were highest among persons aged 20–24 years (304.5) and persons aged 15-19 years (299.4). 

•	 By region, ED visit rates for all drug-related poisonings of all intents ranged from 156.0 in the West to 

228.6 in the Midwest (Table 3c). 

•	 By urbanization, ED visit rates for all drug-related poisonings of all intents ranged from 159.7 in large 

central metropolitan counties to 225.2 in micropolitan counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 435,983 ED visits occurred for all drug-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 137.2 visits per 100,000 

population (Table 3d). 

– By sex, the rate was 154.1 among males and 120.0 among females. 

– By age, rates were highest among persons aged 25-34 years (238.1) and persons aged 20-24 years (219.3). 

•	 By region, ED visit rates for all drug-related poisonings of unintentional and undetermined intent 

ranged from 103.8 in the West to 170.8 in the Midwest (Table 3d). 

•	 By urbanization, ED visit rates for all drug-related poisonings of unintentional and undetermined 

intent ranged from 116.0 in large central metropolitan counties to 161.6 in micropolitan counties 

(Table 3d). 

Opioids 

All Opioids 

Hospitalizations, all intents 

•	 In 2016, an estimated 91,840 hospitalizations occurred for opioid-related poisonings of all intents in the 

United States; the age-adjusted rate was 26.6 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 26.7 among males and 26.3 among females. 

– By age, rates were highest among persons aged 55-64 years (48.7) and persons aged 45-54 years (40.0). 

•	 By region, hospitalization rates for opioid-related poisonings of all intents ranged from 21.3 in the West to 

30.0 in the Midwest (Table 3a). 

•	 By urbanization, hospitalization rates for opioid-related poisonings of all intents ranged from 22.8 in 

noncore counties to 29.9 in medium metropolitan counties (Table 3a). 

27 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Hospitalizations, unintentional, and undetermined intents 

•	 In 2016, an estimated 73,650 hospitalizations occurred for opioid-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 21.1 hospitalizations per 

100,000 population (Table 3b). 

– By sex, the rate was 22.0 among males and 19.9 among females. 

– By age, rates were highest among persons aged 55-64 years (41.3) and persons aged ≥ 65 years (31.6). 

•	 By region, hospitalization rates for opioid-related poisonings of unintentional and undetermined intent 

ranged from 16.9 in the West to 23.1 in the Midwest (Table 3b). 

•	 By urbanization, hospitalization rates for opioid-related poisonings of unintentional and undetermined 

intent ranged from 17.7 in noncore counties to 23.1 in medium metropolitan counties (Table 3b). 

Emergency department visits, all intents 

•	 In 2016, an estimated 197,970 ED visits occurred for opioid-related poisonings of all intents in the United 

States; the age-adjusted rate was 62.0 visits per 100,000 population (Table 3c). 

– By sex, the rate was 78.2 among males and 45.7 among females. 

– By age, rates were highest among persons aged 25–34 years (160.8) and persons aged 20–24 

years (131.1). 

•	 By region, ED visit rates for opioid-related poisonings of all intents ranged from 33.1 in the West to 89.8 in 

the Northeast (Table 3c). 

•	 By urbanization, ED visit rates for opioid-related poisonings of all intents ranged from 40.6 in noncore 

counties to 79.3 in medium metropolitan counties (Table 3c). 

Emergency department visits, unintentional and undetermined intents 

•	 In 2016, an estimated 183,147 ED visits occurred for opioid-related poisonings of unintentional 

and undetermined intents in the United States; the age-adjusted rate was 57.3 visits per 100,000 

population (Table 3d). 

– By sex, the rate was 73.9 among males and 40.5 among females. 

– By age, rates were highest among persons aged 25–34 years (152.1) and persons aged 20–24 

years (121.8). 

•	 By region, ED visit rates for opioid-related poisonings of unintentional and undetermined intents ranged 

from 27.9 in the West to 86.4 in the Northeast (Table 3d). 

•	 By urbanization, ED visit rates for opioid-related poisonings of unintentional and undetermined intents 

ranged from 35.1 in noncore counties to 73.2 in medium metropolitan counties (Table 3d). 

Heroin 

Hospitalizations, all intents 

•	 In 2016, an estimated 22,360 hospitalizations occurred for heroin-related poisonings of all intents in the 

United States; the age-adjusted rate was 7.0 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 9.7 among males and 4.3 among females. 

– By age, rates were highest among persons aged 25-34 years (17.9) and persons aged 20-24 years (15.2). 

•	 By region, hospitalization rates for heroin-related poisonings of all intents ranged from 3.6 in the West to 

11.5 in the Northeast (Table 3a). 

•	 By urbanization, hospitalization rates for heroin-related poisonings of all intents ranged from 2.5 in 

noncore counties to 8.7 in large fringe metropolitan counties (Table 3a). 

Hospitalizations, unintentional and undetermined intents 

•	 In 2016, an estimated 19,325 hospitalizations occurred for heroin-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 6.0 hospitalizations per 100,000 

28 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

population (Table 3b). 

– By sex, the rate was 8.4 among males and 3.6 among females. 

– By age, rates were highest among persons aged 25-34 years (15.2) and persons aged 20-24 years 

(13.4). 

•	 By region, hospitalization rates for heroin-related poisonings of unintentional and undetermined intent 

ranged from 3.1 in the West to 10.0 in the Northeast (Table 3b). 

•	 By urbanization, hospitalization rates for heroin-related poisonings of unintentional and undetermined 

intent ranged from 2.3 in noncore counties to 7.5 in large fringe metropolitan counties (Table 3b). 

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 123,272 ED visits occurred for heroin-related poisonings of all intents in the 

United States; the age-adjusted rate was 39.1 visits per 100,000 population (Table 3c). 

– By sex, the rate was 53.3 among males and 24.9 among females. 

– By age, rates were highest among persons aged 25-34 years (119.0) and persons aged 20-24 years 

(96.5). 

•	 By region, ED visit rates for heroin-related poisonings of all intents ranged from 14.2 in the West to 64.7 

in the Northeast (Table 3c). 

•	 By urbanization, ED visit rates for heroin-related poisonings of all intents ranged from 17.7 in noncore 

counties to 52.8 in medium metropolitan counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 119,465 ED visits occurred for heroin-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 37.9 visits per 100,000 

population (Table 3d). 

– By sex, the rate was 51.6 among males and 24.1 among females. 

– By age, rates were highest among persons aged 25-34 years (115.5) and persons aged 20-24 years 

(93.4). 

•	 By region, ED visit rates for heroin-related poisonings of unintentional and undetermined intent 

ranged from 13.5 in the West to 63.1 in the Northeast (Table 3d). 

•	 By urbanization, ED visit rates for heroin-related poisonings of unintentional and undetermined 

intent ranged from 16.7 in noncore counties to 50.9 in medium metropolitan counties (Table 3d). 

Methadone 

Hospitalizations, all intents 

•	 In 2016, an estimated 5,675 hospitalizations occurred for methadone-related poisonings of all intents in 

the United States; the age-adjusted rate was 1.6 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 1.7 among males and 1.6 among females. 

– By age, rates were highest among persons aged 55-64 years (3.5) and persons aged 45-54 years (2.8). 

•	 By region, hospitalization rates for methadone-related poisonings of all intents ranged from 1.5 in the 

West to 2.0 in the Northeast (Table 3a). 

•	 By urbanization, hospitalization rates for methadone-related poisonings of all intents ranged from 1.3 in 

both large fringe metropolitan and micropolitan counties to 2.0 in noncore counties (Table 3a). 

Hospitalizations, unintentional and undetermined intents 

•	 In 2016, an estimated 4,810 hospitalizations occurred for methadone-related poisonings of 

unintentional and undetermined intent in the United States; the age-adjusted rate was 1.4 

hospitalizations per 100,000 population (Table 3b). 

– By sex, the rate was 1.5 among males and 1.2 among females. 

– By age, rates were highest among persons aged 55-64 years (3.0) and persons aged 45-54 years (2.4). 

29 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

•	 By region, hospitalization rates for methadone-related poisonings of unintentional and undetermined 

intent ranged from 1.3 in the Midwest, South, and West to 1.7 in the Northeast (Table 3b). 

•	 By urbanization, hospitalization rates for methadone-related poisonings of unintentional and 

undetermined intent ranged from 1.0 in micropolitan counties to 1.7 in large central metropolitan 

counties (Table 3b). 

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 3,434 ED visits occurred for methadone-related poisonings of all intents in the 

United States; the age-adjusted rate was 1.0 visits per 100,000 population (Table 3c). 

– By sex, the rate was 1.1 among males and 1.0 among females. 

– By age, rates were highest among persons aged 25-34 years (1.8) and persons aged 45-54 years (1.6). 

•	 By region, ED visit rates for methadone-related poisonings of all intents ranged from 0.9 in the Midwest 

to 1.3 in the West (Table 3c). 

•	 By urbanization, ED visit rates for methadone-related poisonings of all intents ranged from 0.7 in large 

fringe metropolitan counties to 1.2 in large central metropolitan and noncore counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 3,038 ED visits occurred for methadone-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 0.9 visits per 100,000 

population (Table 3d). 

– By sex, the rate was 1.0 among males and 0.8 among females. 

– By age, rates were highest among persons aged 25-34 years (1.6), persons aged 45-54 years (1.4), and 

persons aged 55-64 years (1.4). 

•	 By region, ED visit rates for methadone-related poisonings of unintentional and undetermined intent 

ranged from 0.8 in both the Midwest and South to 1.1 in the West (Table 3d). 

•	 By urbanization, ED visit rates for methadone-related poisonings of unintentional and undetermined 

intent ranged from 0.6 in large fringe metropolitan counties to 1.2 in large central metropolitan 

(Table 3d). 

Other Opioids (e.g., Unspecified Opioids, Opium) 

Hospitalizations, all intents 

•	 In 2016, an estimated 65,110 hospitalizations occurred for poisonings by other opioids of all intents in 

the United States; the age-adjusted rate was 18.4 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 15.8 among males and 20.7 among females. 

– By age, rates were highest among persons aged 55-64 years (40.0) and persons aged ≥ 65 years (32.3). 

•	 By region, hospitalization rates for poisonings by other opioids of all intents ranged from 15.4 in the 

Northeast to 20.8 in the South (Table 3a). 

•	 By urbanization, hospitalization rates for poisonings by other opioids of all intents ranged from 16.3 in 

large central metropolitan counties to 21.3 in medium metropolitan counties (Table 3a). 

Hospitalizations, unintentional and undetermined intents 

•	 In 2016, an estimated 50,515 hospitalizations occurred for poisonings by other opioids of 

unintentional and undetermined intent in the United States; the age-adjusted rate was 14.0 

hospitalizations per 100,000 population (Table 3b). 

– By sex, the rate was 12.6 among males and 15.2 among females. 

– By age, rates were highest among persons aged 55-64 years (33.5) and persons aged ≥ 65 years (29.1). 

•	 By region, hospitalization rates for poisonings by other opioids of unintentional and undetermined 

intent ranged from 11.9 in the Northeast to 16.1 in the South (Table 3b). 

30 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

•	 By urbanization, hospitalization rates for poisonings by other opioids of unintentional and 

undetermined intent ranged from 12.7 in large central metropolitan counties to 15.8 in medium 

metropolitan counties (Table 3b). 

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 72,065 ED visits occurred for poisonings by other opioids of all intents in the 

United States; the age-adjusted rate was 22.1 visits per 100,000 population (Table 3c). 

– By sex, the rate was 24.2 among males and 19.9 among females. 

– By age, rates were highest among persons aged 25-34 years (40.9) and persons aged 20-24 years (33.9). 

•	 By region, ED visit rates for poisonings by other opioids of all intents ranged from 17.7 in the West to 26.5 

in the Midwest (Table 3c). 

•	 By urbanization, ED visit rates for poisonings by other opioids of all intents ranged from 17.7 in large 

central metropolitan counties to 28.2 in micropolitan counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 61,318 ED visits occurred for poisonings by other opioids of unintentional 

and undetermined intents in the United States; the age-adjusted rate was 18.7 visits per 100,000 

population (Table 3d). 

– By sex, the rate was 21.7 among males and 15.6 among females. 

– By age, rates were highest among persons aged 25-34 years (35.9) and persons aged 20-24 years (27.7). 

•	 By region, ED visit rates for poisonings by other opioids of unintentional and undetermined intents 

ranged from 13.3 in the West to 22.7 in the Northeast (Table 3d). 

•	 By urbanization, ED visit rates for poisonings by other opioids of unintentional and undetermined intents 

ranged from 14.7 in large central metropolitan counties to 23.4 in micropolitan counties (Table 3d). 

Stimulants 

Cocaine 

Hospitalizations, all intents 

•	 In 2016, an estimated 20,090 hospitalizations occurred for cocaine-related poisonings of all intents in the 

United States; the age-adjusted rate was 6.1 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 8.2 among males and 4.1 among females. 

– By age, rates were highest among persons aged 45-54 years (13.1) and persons aged 55-64 years (9.9). 

•	 By region, hospitalization rates for cocaine-related poisonings of all intents ranged from 2.0 in the West to 

9.9 in the Northeast (Table 3a). 

•	 By urbanization, hospitalization rates for cocaine-related poisonings of all intents ranged from 2.6 in 

noncore counties to 8.6 in large central metropolitan counties (Table 3a). 

Hospitalizations, unintentional and undetermined intents 

•	 In 2016, an estimated 17,620 hospitalizations occurred for cocaine-related poisonings of unintentional 

and undetermined intent in the United States; the age-adjusted rate was 5.3 hospitalizations per 100,000 

population (Table 3b). 

– By sex, the rate was 7.3 among males and 3.4 among females. 

– By age, rates were highest among persons aged 45-54 years (11.7) and persons aged 55-64 years (9.2). 

•	 By region, hospitalization rates for cocaine-related poisonings of unintentional and undetermined intent 

ranged from 1.8 in the West to 8.8 in the Northeast (Table 3b). 

•	 By urbanization, hospitalization rates for cocaine-related poisonings of unintentional and undetermined 

intent ranged from 2.2 in noncore counties to 7.8 in large central metropolitan counties (Table 3b). 

31 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 8,617 ED visits occurred for cocaine-related poisonings of all intents in the United 

States; the age-adjusted rate was 2.7 visits per 100,000 population (Table 3c). 

– By sex, the rate was 3.6 among males and 1.9 among females. 

– By age, rates were highest among persons aged 25-34 years (6.3) and persons aged 20-24 years (5.4). 

•	 By region, ED visit rates for cocaine-related poisonings of all intents ranged from 1.5 in the West to 3.4 in 

the South (Table 3c). 

•	 By urbanization, ED visit rates for cocaine-related poisonings of all intents ranged from 1.7 in noncore 

counties to 3.6 in medium metropolitan counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 7,399 ED visits occurred for cocaine-related poisonings of unintentional and 

undetermined intent in the United States; the age-adjusted rate was 2.4 visits per 100,000 population 

(Table 3d). 

– By sex, the rate was 3.1 among males and 1.6 among females. 

– By age, rates were highest among persons aged 25-34 years (5.5) and persons aged 20-24 years (4.6). 

•	 By region, ED visit rates for cocaine-related poisonings of unintentional and undetermined intent ranged 

from 1.3 in the West to 3.0 in the Northeast (Table 3d). 

•	 By urbanization, ED visit rates for cocaine-related poisonings of unintentional and undetermined intent 

ranged from 1.3 in noncore counties to 3.0 in medium metropolitan counties (Table 3d). 

Methamphetamine 

Hospitalizations, all intents 

•	 In 2016, an estimated 17,725 hospitalizations occurred for methamphetamine-related poisonings of all 

intents in the United States; the rate was 5.7 hospitalizations per 100,000 population (Table 3a). 

– By sex, the rate was 7.2 among males and 4.1 among females. 

– By age, rates were highest among persons aged 25-34 years (11.6) and persons aged 35-44 years (9.9). 

•	 By region, hospitalization rates for methamphetamine-related poisonings of all intents ranged from 2.3 in 

the Northeast to 9.0 in the West (Table 3a). 

•	 By urbanization, hospitalization rates for methamphetamine-related poisonings of all intents ranged from 

4.0 in large fringe metropolitan counties to 7.9 in small metropolitan counties (Table 3a). 

Hospitalizations, unintentional and undetermined intent 

•	 In 2016, an estimated 14,005 hospitalizations occurred for methamphetamine-related poisonings of 

unintentional and undetermined intent in the United States; the rate was 4.4 hospitalizations per 100,000 

population (Table 3b). 

– By sex, the rate was 6.0 among males and 2.9 among females. 

– By age, rates were highest among persons aged 25-34 years (8.9) and persons aged 35-44 years (7.9). 

•	 By region, hospitalization rates for methamphetamine-related poisonings of unintentional and 

undetermined intent ranged from 1.6 in the Northeast to 7.8 in the West (Table 3b). 

•	 By urbanization, hospitalization rates for methamphetamine-related poisonings of unintentional and 

undetermined intent ranged from 3.0 in large fringe metropolitan counties to 6.0 in small metropolitan 

counties (Table 3b). 

Emergency department (ED) visits, all intents 

•	 In 2016, an estimated 16,341 ED visits occurred for methamphetamine-related poisonings of all intents 

in the United States; the age-adjusted rate was 5.3 visits per 100,000 population (Table 3c). 

32 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

– By sex, the rate was 6.7 among males and 4.0 among females. 

– By age, rates were highest among persons aged 25–34 years (11.7) and persons aged 20–24 

years (11.2). 

•	 By region, ED visit rates for methamphetamine-related poisonings of all intents ranged from 2.1 in the 

Northeast to 7.8 in the West (Table 3c). 

•	 By urbanization, ED visit rates for methamphetamine-related poisonings of all intents ranged from 3.3 in 

large fringe metropolitan counties to 8.7 in both micropolitan and noncore counties (Table 3c). 

Emergency department (ED) visits, unintentional and undetermined intents 

•	 In 2016, an estimated 13,131 ED visits occurred for methamphetamine-related poisonings of 

unintentional and undetermined intent in the United States; the age-adjusted rate was 4.3 visits per 

100,000 population (Table 3d). 

– By sex, the rate was 5.5 among males and 3.0 among females. 

– By age, rates were highest among persons aged 25-34 years (9.4) and persons aged 20-24 years (9.0). 

•	 By region, ED visit rates for methamphetamine-related poisonings of unintentional and undetermined 

intent ranged from 1.8 in the Northeast to 6.7 in the West (Table 3d). 

•	 By urbanization, ED visit rates for methamphetamine-related poisonings of unintentional and 

undetermined intent ranged from 2.6 in large fringe metropolitan counties to 7.1 in micropolitan 

counties (Table 3d). 

Primary Source of Payment for Medically Attended, Nonfatal Drug Overdose, 2016 

All intents (Table 3e) 

•	 32.5% of hospitalizations for all drug poisonings of all intents listed Medicaid as the primary source for 

payment, 29.7% listed Medicare, 23.7% listed private insurance, and 10.4% involved uninsured persons. 

•	 37.7% of ED visits for all drug poisonings of all intents listed Medicaid as the primary source for payment, 

26.5% listed private insurance, 17.6% involved uninsured persons, and 13.9% listed Medicare. 

Unintentional and undetermined intents (Table 3f) 

•	 37.8% of hospitalizations for all drug poisonings of unintentional and undetermined intent listed 

Medicare as the primary source for payment, 30.5% listed Medicaid, 18.5% listed private insurance, and 

10.1% involved uninsured persons. 

•	 38.0% of ED visits for all drug poisonings of unintentional and undetermined intent listed Medicaid as 

the primary source for payment, 23.7% listed private insurance, 18.7% involved uninsured persons, and 

15.4% listed Medicare. 

33 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Drug Overdose Mortality
 

This section includes fatalities from drug overdose as the underlying cause of death for the following drugs: 

heroin, natural/semisynthetic opioids (e.g., hydrocodone, oxycodone), methadone, synthetic opioids other than 

methadone (e.g., fentanyl, tramadol), any opioids, cocaine, and psychostimulants with abuse potential (e.g., 

methamphetamine, dextroamphetamine). Information on other drugs involved in overdose deaths is available 

within the National Vital Statistics System (NVSS), but not presented in the 2019 surveillance report. CDC’s 

National Center for Health Statistics releases more current provisional monthly data on drug overdose deaths. 

Given these are provisional counts, we do not include these data in this report. The provisional estimates can be 

found at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm 

Data on drug overdose deaths for all persons in the United States are presented from NVSS: 

•	 Number and age-adjusted rates per 100,000 population of overall drug overdose deaths and drug 

overdose deaths involving any type of opioid, by sex, age group, race/ethnicity, census region, 

urbanization, and intent — United States, 2017 (Table 4a) 

•	 Number and age-adjusted rates per 100,000 population of drug overdose deaths involving selected 

opioids by sex, age group, race/ethnicity, census region, urbanization, and intent — United States, 2017 

(Table 4b) 

•	 Number and age-adjusted rates per 100,000 population of drug overdose deaths involving cocaine 

and other psychostimulants with abuse potential by sex, age group, race/ethnicity, census region, 

urbanization, and intent — United States, 2017 (Table 4c) 

•	 Age-adjusted rates per 100,000 population of drug overdose deaths and drug overdose deaths involving 

any opioid for all intents and for unintentional intent by year — United States, 1999-2017 (Figure 2a) 

•	 Age-adjusted rates per 100,000 population of drug overdose deaths by drug or drug class and year — 

United States, 1999–2017 (Figure 2b) 

•	 Rates per 100,000 population of drug overdose deaths by drug or drug class and age category — United 

States, 2017 (Figure 2c) 

•	 Age-adjusted rates per 100,000 population of drug overdose deaths by state — United States, 2017 

(Figure 2d) 

Rates are calculated per 100,000 persons age-adjusted to the 2000 U.S. standard population using the 

vintage year population of the data year (excluding those for age group, which are not adjusted and are per 

100,000 persons). For more detailed information, including definitions, please refer to table footnotes and 

the technical notes. 

Data supporting Figures 2a-2d are presented in Supplemental Tables. 

All Drug Overdose Deaths (Table 4a) •	 In 2017, 70,237 persons in the United States died from drug overdoses; the age-adjusted rate was 21.7 

deaths per 100,000 persons. 

– By sex, the rate was 29.1 among males and 14.4 among females. 

– By age, rates were highest among persons aged 35-44 years (39.0), persons aged 25-34 years (38.4), 

and persons aged 45-54 years (37.7). 

– By race/ethnicity, rates ranged from 3.5 among non-Hispanic Asians/Pacific Islanders to 27.5 among 

non-Hispanic Whites. 

– By region, age-adjusted death rates from drug overdose ranged from 14.7 in the West to 29.8 in the 

Northeast. 

34 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

– By urbanization, age-adjusted death rates from drug overdose ranged from 18.2 in noncore counties 

to 24.1 in medium metropolitan counties. 

•	 In 2017, 61,311 persons in the United States died from unintentional drug overdoses; the age-adjusted 

rate was 19.1. A total of 3,687 persons died of drug overdoses of undetermined intent; the age-adjusted 

rate was 1.1 

Opioid-Involved Overdose Deaths (Table 4a) •	 In 2017, 47,600 persons in the United States died from drug overdoses involving opioids; the ageadjusted rate was 14.9 per 100,000. 

– By sex, the rate was 20.4 among males and 9.4 among females. 

– By age, rates were highest among persons aged 25-34 years (29.1) and persons aged 35-44 years (27.3). 

– By race/ethnicity, rates ranged from 1.6 among non-Hispanic Asians/Pacific Islanders to 19.4 among 

non-Hispanic Whites. 

– By region, age-adjusted death rates for drug overdoses involving opioids ranged from 8.0 in the West 

to 21.3 in the Northeast. 

– By urbanization, age-adjusted death rates for drug overdoses involving opioids ranged from 11.2 in 

noncore counties to 17.2 in large fringe metropolitan counties. 

•	 In 2017, 43,036 persons in the United States died from unintentional drug overdoses involving opioids; 

the age-adjusted rate was 13.5. A total of 2,586 persons died of drug overdoses of undetermined intent 

involving opioids; the age-adjusted rate was 0.8. 

Prescription opioid-involved overdose deaths (Table 4b) 

•	 In 2017, 17,029 persons in the United States died from drug overdoses involving prescription opioids 

(natural and semi-synthetic opioids [e.g., oxycodone and hydrocodone] and methadone); the ageadjusted rate was 5.2 per 100,000. 

– By sex, the rate was 6.1 among males and 4.2 among females. 

– By age, rates were highest among persons aged 45-54 years (10.0) and persons aged 35-44 years (9.1). 

– By race/ethnicity, rates ranged from 0.6 among non-Hispanic Asians/Pacific Islanders to 7.2 among 

non-Hispanic American Indians or Alaska Natives. 

– By region, age-adjusted death rates for drug overdoses involving prescription opioids ranged from 4.1 

in the West to 5.6 in the South. 

– By urbanization, age-adjusted death rates for drug overdoses involving prescription opioids ranged 

from 4.7 in large central metropolitan counties to 5.9 in medium metropolitan counties. 

•	 In 2017, 14,502 persons in the United States died from unintentional drug overdoses involving 

prescription opioids; the age-adjusted rate was 4.4. A total of 1,076 persons died of drug overdoses of 

undetermined intent involving prescription opioids; the age-adjusted rate was 0.3. 

Natural and semi-synthetic opioid-involved overdose deaths (Table 4b) 

•	 In 2017, 14,495 persons in the United States died from drug overdoses involving natural and semisynthetic opioids (e.g., oxycodone, hydrocodone, or morphine); the age-adjusted rate was 4.4 per 100,000. 

– By sex, the rate was 5.2 among males and 3.6 among females. 

– By age, rates were highest among persons aged 45-54 years (8.6) and persons aged 35-44 years (7.7). 

– By race/ethnicity, rates ranged from 0.5 among non-Hispanic Asians/Pacific Islanders to 5.9 among 

non-Hispanic Whites. 

– By region, age-adjusted death rates for drug overdoses involving natural and semi-synthetic opioids 

ranged from 3.5 in the West to 4.9 in the South. 

– By urbanization, age-adjusted death rates for drug overdoses involving natural and semi-synthetic 

opioids ranged from 3.8 in large central metropolitan counties to 5.0 in medium metropolitan counties 

and micropolitan counties. 

35 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

•	 In 2017, 12,255 persons in the United States died from unintentional drug overdoses involving natural 

and semi-synthetic opioids; the age-adjusted rate was 3.8. A total of 869 persons died of drug overdoses 

of undetermined intent involving natural and semi-synthetic opioids; the age-adjusted rate was 0.3. 

Methadone-involved overdose deaths (Table 4b) 

•	 In 2017, 3,194 persons in the United States died from drug overdoses involving methadone; the ageadjusted rate was 1.0 per 100,000. 

– By sex, the rate was 1.1 among males and 0.8 among females. 

– By age, rates were highest among persons aged 35-44 years (1.8) and persons aged 45-54 years (1.8). 

– By race/ethnicity, rates ranged from 0.5 among Hispanics to 1.8 among non-Hispanic American 

Indians/Alaskan Natives. 

– By region, age-adjusted death rates for drug overdoses involving methadone were 0.9 in the South 

and in the West, 1.0 in the Midwest and 1.2 in the Northeast. 

– By urbanization, age-adjusted death rates for drug overdoses involving methadone ranged from 0.8 in 

micropolitan counties to 1.1 in large central metropolitan counties. 

•	 In 2017, 2,831 persons in the United States died from unintentional drug overdoses involving 

methadone; the age-adjusted rate was 0.9. A total of 265 persons died of drug overdoses of 

undetermined intent involving methadone; the age-adjusted rate was 0.1. 

Heroin-involved overdose deaths (Table 4b) 

•	 In 2017, 15,482 persons in the United States died from drug overdoses involving heroin; the ageadjusted rate was 4.9 per 100,000. 

– By sex, the rate was 7.3 among males and 2.5 among females. 

– By age, rates were highest among persons aged 25-34 years (10.8) and persons aged 35-44 years (9.1). 

– By race/ ethnicity, rates ranged from 0.5 among non-Hispanic Asians/Pacific Islanders to 6.1 among 

non-Hispanic Whites. 

– By region, age-adjusted death rates for drug overdoses involving heroin ranged from 2.8 in the West to 

7.8 in the Northeast. 

– By urbanization, age-adjusted death rates for drug overdoses involving heroin ranged from 2.4 in 

noncore counties to 5.8 in large fringe metropolitan counties. 

•	 In 2017, 14,762 persons in the United States died from unintentional drug overdoses involving heroin; 

the age-adjusted rate was 4.6. A total of 573 persons died of drug overdoses of undetermined intent 

involving heroin; the age-adjusted rate was 0.2. 

Overdose deaths involving synthetic opioids other than methadone (Table 4b) 

•	 In 2017, 28,466 persons in the United States died from drug overdoses involving synthetic opioids other 

than methadone (e.g., prescription and illicit fentanyl, tramadol); the age-adjusted rate was 9.0 per 100,000. 

– By sex, the rate was 13.0 among males and 5.0 among females. 

– By age, rates were highest among persons aged 25-34 years (19.5) and persons aged 35-44 years (17.3). 

– By race/ethnicity, rates ranged from 0.8 among non-Hispanic Asians/Pacific Islanders to 11.9 among 

non-Hispanic Whites. 

– By region, age-adjusted death rates for drug overdoses involving synthetic opioids other than
 

methadone ranged from 1.9 in the West to 16.2 in the Northeast.
 

– By urbanization, age-adjusted death rates for drug overdoses involving synthetic opioids other than 

methadone ranged from 6.0 in noncore counties to 11.6 in large fringe metropolitan counties. 

•	 In 2017, 26,211 persons in the United States died from unintentional drug overdoses involving synthetic 

opioids other than methadone; the age-adjusted rate was 8.3. A total of 1,707 persons died of drug 

overdoses of undetermined intent involving synthetic opioids other than methadone; the age-adjusted 

rate was 0.5. 

36 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

Selected Stimulant Overdose Deaths (Table 4c) 

Cocaine-involved overdose deaths 

•	 In 2017, 13,942 persons in the United States died from drug overdoses involving cocaine; the ageadjusted rate was 4.3 per 100,000. 

– By sex, the rate was 6.2 among males and 2.5 among females. 

– By age, rates were highest among persons aged 45-54 years (8.3) and persons aged 35-44 years (8.0). 

– By race/ethnicity, rates ranged from 0.6 among non-Hispanic Asians/Pacific Islanders to 8.3 among 

non-Hispanic Blacks. 

– By region, age-adjusted death rates for drug overdoses involving cocaine ranged from 1.3 in the West 

to 7.0 in the Northeast. 

– By urbanization, age-adjusted death rates for drug overdoses involving cocaine ranged from 1.6 in 

noncore counties to 5.3 in large central metropolitan counties. 

•	 In 2017, 13,253 persons in the United States died from unintentional drug overdoses involving cocaine; 

the age-adjusted rate was 4.1. A total of 558 persons died of drug overdoses of undetermined intent 

involving cocaine; the age-adjusted rate was 0.2. 

Overdose deaths involving psychostimulants with abuse potential 

•	 In 2017, a total of 10,333 persons in the United States died from drug overdoses involving 

psychostimulants with abuse potential (e.g., methamphetamine, 3,4-methylenedioxymethamphetamine [MDMA, Ecstasy], amphetamines); the age-adjusted rate was 3.2 per 100,000. 

– By sex, the rate was 4.5 among males and 1.9 among females. 

– By age, rates were highest among persons aged 35-44 years (6.2) and persons aged 45-54 years (5.8). 

– By race/ethnicity, rates ranged from 1.0 among non-Hispanic Asians/Pacific Islanders to 8.5 among 

non-Hispanic American Indians/Alaska Natives. 

– By region, age-adjusted death rates for drug overdoses involving psychostimulants with abuse 

potential ranged from 1.2 in the Northeast to 5.3 in the West. 

– By urbanization, age-adjusted death rates for drug overdoses involving psychostimulants with abuse 

potential ranged from 2.3 in large fringe metropolitan counties to 4.1 in medium metropolitan and 

noncore counties. 

•	 In 2017, 9,786 persons in the United States died from unintentional drug overdoses involving 

psychostimulants with abuse potential; the age-adjusted rate was 3.1. A total of 269 persons died of 

drug overdoses of undetermined intent involving psychostimulants with abuse potential; the ageadjusted rate was 0.1. 

Mortality Trends 

Age-adjusted rates per 100,000 population of drug overdose deaths and drug overdose deaths 

involving any opioid, for all intents and for unintentional intent by year — United States, 1999-2017 

(Figure 2a and Supplemental data supporting Figure 2a) 

•	 The age-adjusted rate of drug overdose deaths of all intents increased from 6.1 per 100,000 in 1999 to 

21.7 in 2017 (p < 0.05). Unintentional drug overdose death rates increased from 4.0 per 100,000 in 1999 

to 19.1 in 2017 (p < 0.05). 

•	 The rate of drug overdose deaths involving any opioid of all intents increased from 2.9 per 100,000 in 

1999 to 14.9 in 2017 (p < 0.05). Unintentional drug overdose death rates involving any opioid increased 

from 2.1 per 100,000 in 1999 to 13.5 per 100,000 in 2017 (p < 0.05). 

•	 During 1999 to 2017, age-adjusted rates increases for drug overdose deaths of all intents and 

unintentional drug overdose deaths were the largest from 2014 to 2017. Rate increases for drug 

37 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

overdose deaths involving any opioid of all intents and unintentional drug overdoses involving any 

opioid were the largest from 2013 to 2017. 

– The rate increased on average by 16% annually for drug overdose deaths of all intents (p < 0.05), and 

18% annually for unintentional drug overdose deaths (p < 0.05) between 2014 and 2017. The rate 

increased on average by 18% annually for drug overdose deaths involving any opioid of all intents 

(p < 0.05), and 19% for unintentional drug overdoses involving any opioid (p < 0.05) between 2013 

and 2017. 

Age-adjusted rates per 100,000 population of drug overdose deaths by drug or drug class and year 

— United States, 1999–2017 (Figure 2b and Supplemental Table 3a) 

•	 The age-adjusted rate of drug overdose deaths involving prescription opioids increased from 1.2 per 

100,000 persons in 1999 to 5.2 in 2016 and 2017. 

– Rates for drug overdose deaths involving prescription opioids increased on average 19% annually from 

1999 to 2006 (p < 0.05). From 2006 to 2017, rates increased from 3.9 per 100,000 to 5.2, an average 

increase of 2.0% annually (p < 0.05). 

•	 For drug overdoses involving synthetic opioids other than methadone, the rate increased from 0.3 per 

100,000 in 1999 to 9.0 in 2017. 

– Rates for drug overdose deaths involving synthetic opioids other than methadone increased on 

average 8.4% annually from 1999 to 2013 (p < 0.05). From 2013 to 2017, rates increased on average 

69.8% annually (p < 0.05). 

•	 The age-adjusted rate of drug overdose deaths involving heroin increased from 0.7 per 100,000 in 1999 

to 4.9 in 2016 and 2017. 

– Rates for drug overdose deaths involving heroin did not change significantly from 1999 to 2004 (p = 

0.42) and increased on average 9.9% annually from 2004 to 2010 (p < 0.05). Heroin rates increased on 

average 31.4% annually from 2010 to 2015 (p < 0.05) and 7.2% annually from 2015 to 2017, although 

the increase was not significant (p = 0.10). 

•	 The age-adjusted rate of drug overdose deaths involving cocaine increased from 1.4 per 100,000 in 1999 

to 4.3 in 2017. 

– Rates for drug overdose deaths involving cocaine increased on average 10.1% annually from 1999 

to 2006 (p < 0.05), decreased on average 14.1% annually from 2006 to 2010, (p < 0.05), there was no 

significant change from 2010 to 2014 (p = 0.26), and then increased on average 37.6% annually from 

2014 to 2017 (p < 0.05). 

•	 The age-adjusted rate of drug overdose deaths involving psychostimulants with abuse potential 

increased from 0.2 per 100,000 in 1999 to 3.2 in 2017. 

– Rates for drug overdose deaths involving psychostimulants with abuse potential increased on average 

19.2% annually from 1999 to 2005 (p < 0.05), there was no significant change from 2005 to 2008 (p = 

0.59), increased an average of 20.2% annually from 2008 to 2012, and increased an average of 30.1% a 

year from 2012 to 2017 (p < 0.05). 

Rates per 100,000 population of drug overdose deaths by drug or drug class and age category — 

United States, 2017 (Figure 2c and Supplemental data supporting Figure 2c) 

•	 Among persons aged 15 to 24 years, the rate of drug overdose deaths involving synthetic opioids other 

than methadone was 6.1 per 100,000 persons; the rate involving heroin was 3.4; and the rate involving 

38 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

prescription opioids was 2.4. 

•	 Among persons aged 25 to 34 years, the rate of drug overdose deaths involving synthetic opioids other 

than methadone was 19.5 per 100,000 persons; the rate involving heroin was 10.8; and the rate involving 

prescription opioids was 7.5. 

•	 Among persons aged 35 to 44 years, the rate of drug overdose deaths involving synthetic opioids other 

than methadone was 17.3 per 100,000 persons; the rate involving heroin was 9.1; and the rate involving 

prescription opioids was 9.1. 

•	 Among persons aged 45 to 54 years, the rate of drug overdose deaths involving synthetic opioids other 

than methadone was 13.6 per 100,000 persons; the rate involving heroin was 7.2; and the rate involving 

prescription opioids was 10.0. 

•	 Among persons aged 55 to 64 years, the rate of drug overdose deaths involving synthetic opioids other 

than methadone was 8.3 per 100,000 persons; the rate involving heroin was 4.8; and the rate involving 

prescription opioids was 8.4. 

•	 Among persons aged 65 years and older, the rate of drug overdose deaths involving synthetic opioids 

other than methadone was 1.2 per 100,000 persons; the rate involving heroin was 0.7; and the rate 

involving prescription opioids was 2.1. 

•	 Rates of drug overdose deaths involving cocaine were 8.3 per 100,000 among persons aged 45 to 

54 years, 8.0 among persons aged 35 to 44 years, 7.6 among persons aged 25 to 34 years, 5.6 among 

persons aged 55 to 64, 2.1 among persons aged 15 to 24 years, and 0.8 among persons aged 65 years 

and older. 

•	 Rates of deaths involving psychostimulants with abuse potential were 6.2 among persons aged 35 to 

44 years, 5.8 per 100,000 among persons aged 45 to 54 years, 5.7 among persons aged 25 to 34 years, 

3.9 among persons aged 55 to 64 years, 1.8 among persons aged 15 to 24 years, and 0.5 among persons 

aged 65 years and older. 

Age-adjusted rates per 100,000 population of drug overdose deaths by state — United States, 2017 

(Figure 2d) 

•	 Rates of drug overdose deaths ranged from 8.1 per 100,000 in Nebraska to 57.8 in West Virginia in 2017. 

– States with the highest drug overdose death rates were West Virginia (57.8 per 100,000), Ohio (46.3), 

Pennsylvania (44.3), the District of Columbia (44.0), Kentucky (37.2), Delaware (37.0), and New 

Hampshire (37.0). 

– States with the lowest drug overdose death rates were Nebraska (8.1 per 100,000), South Dakota (8.5), 

North Dakota (9.2), Texas (10.5), and Iowa (11.5). 

39 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

LIMITATIONS 

This report has important limitations. To describe drug use and outcomes in the United States 

comprehensively, four independent data sources were used. Therefore, terms and definitions were not 

uniform across data sources. Further, the most recent year of available data varied. Collectively, these 

factors limit universal comparability across data sources. Consumers of the report should carefully review 

technical notes and footnotes to ensure correct interpretation of results, particularly when comparing 

information across sections. 

Starting with 2017 data, IQVIATM changed the frame of measurement from number of prescriptions 

“dispensed to bin” to number of prescriptions “sold to the patient.”This change, which was not available for 

data prior to 2017, resulted in a 1.9% downward shift in prescriptions filled for 2017-2018. When analyzing 

trends using IQVIATM data, we compared data with and without this modification and found no significant 

differences in our findings. Also, prescriptions filled through public health, prison systems, Veterans Health 

Administration, or by mail order are not included in IQVIATM data. 

For the National Survey on Drug Use and Health (NSDUH), data on substance use behavior are obtained 

through self-report. Therefore, these data might be subject to social desirability bias, leading to over- or 

underreporting of certain behaviors. NSDUH employs various methods to minimize these potential biases, 

such as assuring confidentiality of responses and using computer-assisted self-interviewing to maintain 

privacy. In SAMHSA’s published report of 2018 data, different age categorizations were included in 

comparison to 2017 data. Therefore, some age categorizations differed between the 2017 and 2018 

data tables. 

Given the Healthcare Cost and Utilization Project transitioned from using International Classification of 

Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes to International Classification 

of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) on October 

1, 2015 (the beginning of fiscal year 2016), we were unable to present trend analyses on ED visits and 

hospitalizations. 

For the National Vital Statistics System, approximately 20% of drug overdose deaths from 1999 to 2017 

involved drugs that were unspecified. Although this lack of specificity varies over time and across states, 

the drug specificity continues to improve over time. Through 2013, over 20% of death certificates annually 

lacked information about the drugs involved. In 2017, 12% of death certificates lacked information about 

which drugs were involved. Therefore, trend analysis should be interpreted with caution. In addition, 

this report does not consider co-involvement of drugs in overdose deaths. Recent analyses suggest that 

increases in stimulant-involved deaths are in part attributable to opioid co-involvement.9

Finally, the report does not address polysubstance use (i.e., the consumption of more than one drug over 

a defined period, simultaneously or at different times for either therapeutic or recreational purposes) or 

overdose. However, this report does not exclude overdoses where multiple substances were involved. 

Although this topic is important and an emerging threat in this evolving drug overdose landscape, it is 

currently beyond the scope of this report. 

40 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

CDC’s Opioid Overdose Surveillance, Prevention, 

and Research Efforts 

CDC’s mission in addressing the opioid overdose epidemic is to prevent opioid-related morbidity and 

mortality by: 

1 Conducting surveillance and research to improve data quality and track trends using timely data; 

2 Building state, local, and tribal capacity by scaling up and improving effective public health 

interventions; 

3 Supporting providers, health systems, and payers with tools, recommendations, and guidance to 

improve patient safety; 

4 Partnering with public safety to respond quicker and more effectively in innovative ways; and 

5 Empowering consumers to make safe choices through education. 

Conducting surveillance and research, and building state, local, and 

tribal capacity 

CDC’s National Center for Injury Prevention and Control (NCIPC) has funded several opioid surveillance and 

prevention efforts to build up public health surveillance of opioids at the state and federal levels to inform 

and enhance prevention activities. Through its funding to states, localities, territories, and tribes, CDC has 

strengthened response efforts. NCIPC funded multiple programs whose activities align with the integration 

of public health strategies to address the epidemic. Programs include the following: 

1	 Enhanced State Opioid Overdose Surveillance (ESOOS) – funded 32 states and Washington, D.C. to: 

a	 Increase the timeliness of nonfatal opioid overdose reporting to serve as an early warning system 

to detect sharp increases (i.e., potential outbreaks) or decreases (i.e., rapidly identify successful 

intervention efforts) 

b Increase the timeliness of fatal opioid overdose and associated risk factor reporting 

c Disseminate surveillance findings to key stakeholders working to prevent or respond to opioid 

overdoses 

(Funding period: September 1, 2016-August 31, 2019) 

2	 Prevention for States (PfS) – funded 29 states to: 

a Enhance and maximize prescription drug monitoring programs (PDMPs) 

b Implement community, insurer mechanism, or health systems interventions 

c Evaluate the effectiveness of prescription opioid-related state policies 

d Implement quick, flexible projects to respond to changing circumstances on the ground 

(Funding period: September 1, 2015-August 31, 2019) 

3	 Data-Driven Prevention Initiative (DDPI) – funded 13 states and Washington, D.C. to: 

a Improve data collection and analysis around opioid use, misuse, and overdose 

b Develop strategies that affect behavior driving prescription opioid abuse 

c Work with communities to develop more comprehensive opioid overdose prevention programs 

(Funding period: September 1, 2016-August 31, 2019) 

4 Opioid Prevention in States – Surge Support (OPIS-S2) – funded 50 states and 4 territories to: 

a Advance the understanding of the opioid overdose epidemic, and scale up prevention and response 

activities to make an immediate impact and save lives 

(Funding period: September 1, 2018-August 31, 2019) 

41 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

5	 Opioid Overdose Prevention for Tribes – funded 11 Tribal Epidemiology Centers and 15 tribal 

entities to: 

a Improve epidemiologic surveillance and public health data infrastructure to address issues of data 

quality and timeliness 

b Implement evidence-based health systems interventions that are appropriate to tribal communities 

c Implement innovative community-based strategies (such as public health/public safety 

collaborations) that build upon strengths inherent to tribal organizations 

(Funding period: September 1, 2018-August 31, 2019) 

Starting in September 2019, NCIPC expanded overdose surveillance and prevention funding to cover 

47 states and 16 localities through Overdose Data to Action (OD2A). Overall, the objective of OD2A is to 

improve and expand surveillance and prevention capacity in order to use their data to inform their state 

and local prevention and response efforts. This will be accomplished by collecting higher quality, more 

comprehensive, and timelier data on drug overdose morbidity and mortality along with prevention 

activities, such as linkage to care and enhancing prescription drug monitoring programs (PDMPs). 

Additionally, there will be more flexibility with innovative surveillance and prevention strategies so that 

specific needs can be met at the local level. 

Overdose Data to Action (OD2A): New CDC effort conducting surveillance and research, and building 

state, local, and tribal capacity (September 2019-August 2022) 

1 Surveillance component 

a Collect and disseminate timely ED data on suspected all drug, all opioid, heroin, and all 

stimulant overdoses 

b	 Collect and disseminate descriptions of drug overdose death circumstances using death
 

certificates and medical examiner/coroner reports, including toxicology results, on all
 

unintentional or undetermined intent drug overdose deaths
 

c	 Implement innovative surveillance to support OD2A interventions 

2	 Prevention component 

a Improving PDMPs 

b State and local integration to coordinate and leverage capacity and technical support 

c Systems-level approaches to connect individuals in need of care with those who provide that care 

(e.g., peer navigators, warm hand-offs, pre-arrest diversion and post-release linkages, community 

health workers) 

d Guarantee that providers and health systems are equipped to contribute to prevention and response 

solutions (e.g., academic detailing, guideline implementation support, coordinated care programs) 

e Optional strategies: 

i.	 Public safety partnerships (e.g., data sharing and programs) 

ii.	 Empowering individuals through communications awareness of risks, options, treatment 

resources, and risk-reduction strategies 

iii.	 Prevention-specific innovative projects 

iv.	 Peer-to-peer learning coordinators for state programs to serve as subject matter experts for 

other states on specific prevention aspects 

Tribal opioid overdose prevention support 

The opioid overdose epidemic is affecting every part of the United States, with tribal communities being 

affected especially hard. Deaths involving prescription opioids for American Indian and Alaska Natives 

are higher than the national rate.1 NCIPC provides support to tribes and key partners to strengthen their 

capacity in data collection, use, and sharing, to address a number of key issues including improving 

42 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

racial classification, expanding data sharing to enhance non-fatal overdose data collection from EDs, 

and improving data abstraction from death certificates to collect timely data on opioid-related overdose 

deaths. CDC is also supporting strategic planning to implement or expand evidence-based health 

systems interventions and innovative community-based strategies with tribal communities. These 

activities will help address the critical need for public health prevention and intervention by directly 

funding American Indian and Alaska Native Tribal Nations and American Indian and Alaska Native regional 

Tribal-serving Organizations. 

Funding extramural research 

CDC supports extramural research to help combat the opioid overdose epidemic. Historically, NCIPC’s 

research priorities have focused on: identifying risk and protective factors for drug overdose; evaluating 

the impact of prevention strategies on drug overdose, such as drug formulary management, state policies, 

and prescription drug monitoring programs; and furthering the adoption and implementation of clinical 

practice guidelines for opioid prescribing. Priorities are expanding with new research investments focusing 

on enhancing access to naloxone, improving linkage to treatment for opioid use disorder, and building 

partnerships between public health and public safety. 

Supporting providers, health systems, and payers 

The CDC Guideline for Prescribing Opioids for Chronic Pain,

10

 released in March 2016, serves as a useful 

resource to providers treating adult patients with chronic pain in primary care settings outside of end-of-life, 

palliative, and active cancer care. Its 12 recommendations allow patients and clinicians to determine risks 

and benefits of opioid therapy and to determine optimal ways to manage pain. These recommendations 

include consideration of nonopioid options that may be safer and more effective at treating chronic pain, 

such as physical therapy. Tools and resources, such as the Opioid Guideline App, which contains a morphine 

milligram equivalent calculator, help disseminate information contained in the guideline, and make it easier 

for physicians to make better-informed decisions about prescribing. More information can be found at 

https://www.cdc.gov/drugoverdose/prescribing/resources.html. 

To encourage uptake of the guidelines, CDC developed a comprehensive implementation plan, Quality 

Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic 

Pain.

11

 Since healthcare systems have the potential to improve pain management, including safer use of 

opioids through guideline-concordant care on a broad scale, CDC developed quality improvement (QI) 

measures based on the guideline, with stakeholder engagement. These are voluntary QI measures intended 

to support practice improvement for primary care practices by tracking opioid prescribing and providing 

feedback to clinicians through a data dashboard. Six large healthcare systems are part of a 12-month 

Opioid QI Collaborative to pilot implementation of the QI measures and track their progress. In addition, 

CDC has developed clinical decision support tools also based on the guideline that healthcare systems 

can incorporate into clinical workflow in their electronic health records. The resource and operational QI 

measures can be found at https://www.cdc.gov/drugoverdose/prescribing/qi-cc.html. 

CDC, in collaboration with the Office of the National Coordinator for Health Information Technology 

(ONC), developed clinical decision support tools (such as value sets, alerts, follow-up reminders) that can 

be embedded in electronic health records to incorporate the recommendation statements contained 

in the CDC Guideline into clinical workflow. More information is posted here: https://cds.ahrq.gov/ 

cdsconnect/artifact/factors-consider-managing-chronic-pain-pain-management-summary. 

CDC also funds cutting-edge research on ways to prevent opioid use disorder and overdose. For example, 

research priorities include identifying factors that increase risk for morbidity and mortality, evaluating the 

impact of state policies and strategies on prescribing behavior and health outcomes, and understanding 

effective approaches to integrate evidence-based guidelines and recommendations into clinical practice. 

43 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Partnering with public safety 

Addressing the opioid overdose epidemic requires partnerships across sectors. In addition to the critical 

partnership with states and other federal agencies, CDC has been working with law enforcement partners, 

such as the Drug Enforcement Administration (DEA) and the High Intensity Drug Trafficking Area (HIDTAs) 

program. Working together, public health and public safety can share data to identify hotspots or overdose 

spikes, help equip first responders and community partners with naloxone to prevent deaths from overdoses 

in these areas, and link people with treatment and recovery services. 

As a part of this work with public safety, CDC is leading the public health component of the Overdose 

Response Strategy, a collaboration with the Office of the National Drug Control Policy and 11 HIDTAs. The 

goals of this partnership are three-fold: to coordinate data sharing across public health and law enforcement; 

to develop and support the implementation of evidence-based practices; and to strengthen the 

engagement of local communities. As a part of the Overdose Response Strategy, CDC is supporting over a 

dozen community-level projects that will implement and evaluate innovative strategies at the intersection of 

public health and public safety to build evidence around programs that work. These projects tackle complex 

issues, such as linking people to treatment upon release from emergency departments and correctional 

facilities and forming multidisciplinary post-overdose outreach teams to connect with populations at 

high risk of overdose. Our hope is that communities can leverage these strategies to create local, targeted 

responses. 

Empowering consumers 

CDC raises awareness about the risks of opioid misuse in order to empower people to make safe choices. 

CDC created the Rx Awareness campaign to educate everyone about the dangers and risks of prescription 

opioids. The Rx Awareness campaign tells the real stories of people whose lives were torn apart by misuse 

of prescription opioids through videos, radio spots, social media, signs and billboards, and online ads. State 

and local health departments and community organizations can use the tested campaign materials and 

resources to launch campaigns, support local prevention activities, and raise awareness about the risks of 

prescription opioids. More information can be found at https://www.cdc.gov/rxawareness/index.html. 

Moving forward 

Although there are early indications of a slight decrease of drug overdose deaths and a stabilization of 

deaths involving specific opioid categories, urgent work remains to continue to respond to the opioid 

overdose epidemic in the United States. Additional measures are needed to address a diverse and evolving 

array of drug types, including polysubstance use. As new drug threats emerge, it is pertinent for public 

health and public safety to be well equipped to respond. To address the evolving drug landscape, CDC’s 

National Center for Injury Prevention and Control (NCIPC) is expanding surveillance efforts to better capture 

and monitor emerging drug threats, including synthetic cannabinoids and stimulants. For example, with 

Overdose Data to Action (OD2A), surveillance data will now include nonfatal stimulant overdoses and all 

unintentional or undetermined intent drug overdose deaths. NCIPC will continue to be nimble as the drug 

overdose crisis continues to evolve and change. Improving drug overdose surveillance, empowering and 

equipping states, territories, counties, and cities with the resources and information they need, improving 

ways that opioids are prescribed through clinical practice guidelines, and forming critical partnerships are 

central to NCIPC’s work to combat the overdose epidemic. 

44 
TECHNICAL 

NOTES 

 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

TECHNICAL NOTES
 

Data Sources, Definitions and Analysis
 

This report uses the most recently available data from four sources.
 

Information on opioid prescribing practices were obtained from the IQVIATM Xponent and Total Patient 

Tracker (TPT). Estimated prescribing rates focus on information from 2018, but data are presented on 

prescribing trends from 2006 to 2018. Substance use and misuse data were obtained from the Substance 

Abuse and Mental Health Services Administration’s (SAMHSA) 2017 and 2018 National Survey on Drug Use 

and Health (NSDUH). Information on medically attended non-fatal drug-related poisonings were obtained 

from the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) and Nationwide 

Emergency Department Sample (NEDS) 2016 surveys. Mortality rates were obtained from the National 

Vital Statistics System’s (NVSS) 2017 mortality file, and trends were presented from 1999-2017. Variables for 

demographic characteristics (age, gender/sex, race and ethnicity, and geographic region) were standardized 

across data sources to the extent possible. In this report, when reporting findings by state, Washington, D.C. 

is included and referred to as a state. 

Opioid Prescribing 

Data Source 

Data on opioid prescriptions filled were derived from the IQVIATM Xponent and Total Patient Tracker (TPT), 

both of which are projections weighted to the national level. Xponent provided estimates of the number of 

opioid prescriptions filled in the United States from retail pharmacies. TPT provided national estimates of the 

total number of unique persons who had at least one opioid prescription filled during the year examined in 

the retail outpatient setting from U.S. retail pharmacies. Prescription coverage is 92% in both data sources. A 

prescription is an initial or refill pharmaceutical paid for by a commercial third party, Medicaid, Medicare Part 

D, or cash. Prescriptions filled through public health, prison systems, Veterans Health Administration, or by 

mail order are not included in IQVIATM data. 

Opioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, 

oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol, and Butrans® (buprenorphine), were 

identified using the National Drug Code. Cough and cold formulations containing opioids were not 

included. Formulations of buprenorphine, an opioid primarily used for treatment of opioid use disorder, 

were not included, except for Butrans®, a transdermal buprenorphine formulation, and Belbuca®, an oral 

buprenorphine formulation, both used for pain management. In addition, methadone dispensed through 

methadone maintenance treatment programs is not included in IQVIATM data. 

46 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Definitions 

•	 Days of supply: Number of days the supply of a filled medication will last if taken as prescribed. 

•	 Long-acting (LA) or extended-release (ER) opioids: Slower-acting opioids with a longer duration of 

pain-relieving action, including the following branded and generic drug products: 

– Extended-release, oral dosage forms containing:
 

· Hydromorphone
 

· Morphine
 

· Oxycodone
 

· Oxymorphone
 

· Tapentadol
 

– Extended-release, transdermal delivery systems containing:
 

· Fentanyl
 

· Buprenorphine
 

– Long-acting tablets and solutions used as analgesics containing:
 

· Methadone
 

•	 Morphine milligram equivalents (MME): For a comparison of opioid doses, a methodology was 

developed to equate the many different opioids into one standard value. This standard value is based on 

morphine and its potency, referred to as morphine milligram equivalents (MME). MME helps determine 

the potency of persons’ opioid doses and is useful if converting from one opioid to another. This measure 

provides the amount of opioids dispensed (i.e., dosage). 

•	 Morphine milligram equivalent per day (MME/day): 

– MME/day = strength per unit x (number of units/days of supply) x MME conversion factor 

– “Number of units” and “days of supply” come from the prescription. “Strength per unit” and “MME 

conversion factor” can be determined from the National Drug Code. 

– The MME data file of select prescription opioids by National Drug Codes with conversion factors is 

available upon request by sending an email to OREInfo@cdc.gov. For combination drugs, “strength” 

refers to the strength of the controlled substance component of the drug per unit specified in unit of 

measure. 

– Examples:
 

· 10 mg oxycodone tablets x (120 tablets/30 days) x 1.5 = 60 MME/day
 

· 25 μg/hr fentanyl patch x (10 patches/30 days) x 7.2 = 60 MME/day
 

High-dose prescription: prescriptions with a dose greater than or equal to 90 MME/day. 

•	 Examples: 

– 90 mg of hydrocodone (9 tablets of hydrocodone 10 mg+ acetaminophen 325 mg) 

– 60 mg of oxycodone (2 tablets of oxycodone extended-release 30 mg) 

– ~20 mg of methadone (4 tablets of methadone 5 mg) 

Statistical Analyses 

The percentage of persons who had at least one prescription filled for an opioid is derived using unique 

counts from TPT and census population numbers. Annual resident population denominator estimates were 

obtained from the Population Estimates Program, U.S. Census Bureau. For population data, 2000–2010 

Intercensal Estimates of the Resident Population for Counties and States were used for 2006–2010 

rate calculations; 2010–2017 Postcensal Estimates of the Resident Population for Counties and 

National were used for 2011-2018. For data stratified by age groups, the patient counts by age group for 

each sex do not sum to the total for each sex because the totals were calculated separately from TPT to avoid 

potential double counting of persons due to age progression and weighted estimates. 

47 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

Annual opioid prescription fill rates were calculated by dividing the total number of opioid 

prescriptions filled in a given year, or state, as appropriate, by the census population. All rates are per 

100 persons of all ages. 

Temporal trends of national opioid prescription fill rate and amounts of opioids filled from 2006 to 2018 

were evaluated by applying joinpoint regression methodology.12 This modeling approach simultaneously 

identified statistically significant trends as well as shifts in trends that occurred within a time series. A 

maximum of two joinpoints were allowed, and the permutation method was used for model selection. 

The most parsimonious models were selected to report the estimated annual percent change (APC) for 

each time segment detected and the average annual percent change (AAPC) for the full study period. The 

terms “increasing” or “decreasing” were used to describe the trend when APC for each time segment was 

statistically significantly different from zero (p<0.05); otherwise, the trend was described as “not significant.” 

Year categories presented in Table 1d represented year groupings as determined by joinpoint regression. 

Drug Use, Misuse, Substance Use Disorder, and Treatment 

Data Source 

The National Survey on Drug Use and Health (NSDUH) is an annual face-to-face household survey 

administered by the Substance Abuse and Mental Health Services Administration.13

 NSDUH includes 

questions about substance use behavior, substance use initiation, substance use disorders, substance use 

treatment, and mental health. NSDUH collects data from civilian, noninstitutionalized persons aged 12 

years and older residing in all 50 states and the District of Columbia. Noninstitutionalized persons include 

residents living in some group settings (e.g., shelters, boarding houses, college dormitories). NSDUH 

excludes persons with no fixed address (e.g., homeless and/or transient people not in shelters), active-duty 

military personnel, and residents of institutional group quarters (e.g., correctional facilities, nursing homes, 

mental institutions, long-term care hospitals). 

Sampling and Data Collection 

NSDUH collects data using a state-based, multistage area probability sample.13 Each state is stratified into 

sampling regions of approximately equal population sizes. Census tracts are selected within sampling 

regions, census block groups are selected within census tracts, area segments are selected within census 

block groups, and dwelling units are selected within area segments. A maximum of two residents per 

dwelling unit, 12 years of age or older, are selected to participate in the interview. Because NSDUH collects 

information from self-reports of substance use behavior, these data might be subject to social desirability 

bias, leading to over- or underreporting of certain behaviors. NSDUH employs various methods to 

minimize these potential biases, such as assuring confidentiality of responses and using computer-assisted 

self-interviewing to maintain privacy. NSDUH data reflect prevalence estimates for the entire U.S. noninstitutionalized population aged 12 years and older. 

Although substantial modifications were made to the prescription drug questions in the 2015 NSDUH,14

making it incomparable to previous years, no significant changes to questions producing the variables 

included in this report were made in the 2017 and 2018 NSDUH. Therefore, the 2017 and 2018 data are 

comparable to the 2016 data. Additionally, the 2017 NSDUH slightly altered question wording surrounding 

the use and misuse of prescription psychotherapeutics compared to the 2016 NSDUH. For the 2017 NSDUH, 

text was added to the questions about misuse of “any other” prescription pain reliever, stimulant, or sedative 

to remind respondents not to include over the counter medications (e.g., Tylenol®, Dexatrim®, Sominex®). 

In SAMHSA’s report of 2018 NSDUH data, there were minor imputation changes from the 2017 report. 

Furthermore, the 2018 NSDUH reported benzodiazepine use and misuse for 2017 and 2018. Please see 

48 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

SAMHSA’s published reports of 2018 NSDUH results for further details. 

Definitions 

In specific tables in this report, estimates are provided for the combination of illicit drug use and 

prescription drug misuse. NSDUH defines prescription drug misuse as use in any way not directed by a 

prescriber, including use without a prescription of one’s own; use in greater amounts, more often, or longer 

than told; or use in any other not directed ways. 

NSDUH defines a broad category of “illicit drug use” as use of illicit drugs including marijuana, cocaine 

(including crack), heroin, hallucinogens (including PCP, LSD, peyote, mescaline, psilocybin or mushrooms, 

ecstasy or MDMA, ketamine, DMT, AMT, or Foxy, and Salvia divinorum), inhalants, methamphetamine, or 

prescription psychotherapeutics that were misused. Prescription psychotherapeutics include pain relievers, 

tranquilizers, stimulants, and sedatives and do not include over-the-counter drugs. 

We avoid using the term “illicit drug use” to mean use of illicit drugs and misuse of prescription drugs 

collectively in this report and prefer to keep misuse of prescription drugs distinct from the use of illicit 

drugs to maintain consistency with other data sources included. 

Included in this report are misuse and overall prevalence estimates for the following prescription drug 

categories, together referred to by NSDUH as “prescription psychotherapeutics”: 

•	 Prescription pain relievers included prescribed opioids that covered the following drug 

subcategories: hydrocodone products, oxycodone products, tramadol products, codeine products, 

morphine products, fentanyl products, buprenorphine products, oxymorphone products, meperidine 

products, hydromorphone products, methadone, or any other prescription pain reliever not including 

over-the-counter pain relievers; 

•	 Prescription tranquilizers included drugs prescribed to reduce anxiety, specifically benzodiazepines 

(e.g., alprazolam, lorazepam, clonazepam, or diazepam), or to quell muscle spasms, specifically muscle 

relaxants (e.g., cyclobenzaprine); 

•	 Prescription stimulants included drugs prescribed for treatment of attention-deficit hyperactivity 

disorder (e.g., dextroamphetamine, methylphenidate), obesity (e.g., benzphetamine, phentermine), or 

to promote wakefulness (e.g., Provigil®), and does not include over the counter stimulants; and 

•	 Prescription sedatives included prescribed drugs intended to manage sleep disorders, such as 

zolpidem, eszopiclone, zaleplon, benzodiazepine sedatives (e.g., flurazepam, temazepam, triazolam), 

and barbiturates (e.g., butabarbital, secobarbital), and does not include over-the- counter sedatives. 

This report also provides NSDUH prevalence estimates of use for the following illicit substances: 

•	 Marijuana was classified as an illicit substance in NSDUH despite being legalized in the states of some 

respondents since it remains an illegal substance (Schedule I drug) under federal law; 

•	 Opioids were a combination of heroin use and prescription pain reliever misuse; 

•	 Heroin; 

•	 Cocaine included powder, crack, free base, and coca paste; and 

•	 Methamphetamine. 

Census regions were defined by the following jurisdictions: 

•	 Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, 

Rhode Island, and Vermont; 

•	 Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, 

49 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

South Dakota, and Wisconsin; 

•	 South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West 

Virginia; and 

•	 West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, 

Utah, Washington, and Wyoming. 

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. 

Department of Agriculture.13, 15

•	 Large metropolitan statistical areas (MSAs) had a total population of 1 million or more. 

•	 Small metropolitan areas had a total population of fewer than 1 million. 

•	 Nonmetropolitan counties were classified according to the aggregate size of their urban population. 

Nonmetropolitan areas include counties in micropolitan statistical areas and counties outside of both 

metropolitan and micropolitan statistical areas and are classified as follows: 

– “urbanized” 

– “less urbanized” 

– “completely rural” 

The Office of Management and Budget (OMB) defined nonmetropolitan counties according to (a) the size 

of the population in urbanized areas within the county (i.e., a population of 20,000 or more in urbanized 

areas, a population of at least 2,500 but fewer than 20,000 in urbanized areas, or a population of fewer 

than 2,500 in urbanized areas); and (b) whether these counties were adjacent or not adjacent to a 

metropolitan area. For NSDUH, the terms "urbanized," "less urbanized," and "completely rural" for counties 

were not based on the relative proportion of the county population in urbanized areas, but rather on 

the absolute size of the population in urbanized areas. For example, some counties classified as "less 

urbanized" had over 50 percent of the county population residing in urbanized areas, but this percentage 

represented fewer than 20,000 persons in the county.13

Substance use disorder, and treatment were defined in the following manner: 

•	 Substance use disorder was defined as meeting criteria for illicit or prescription drug dependence or 

abuse based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental 

Disorders (DSM-IV);16 and 

•	 Substance use treatment refers to treatment received in order to reduce or stop illicit or prescription 

drug use, or for medical problems associated with illicit or prescription drug use. It includes treatment 

at any of the following locations: a hospital overnight as an inpatient, a residential drug rehabilitation 

facility where they stayed overnight, a drug rehabilitation facility as an outpatient, a mental health 

facility as an outpatient, an emergency room, a private doctor's office, a prison or jail, a self-help group, 

or some other place. Of these locations, emergency rooms, private doctors' offices, prisons or jails, and 

self-help groups were considered non-specialty substance use treatment facilities. Reports of treatment 

in some other place were considered to be treatment in specialty substance use treatment facilities 

only if respondents specified a location that corresponded to drug rehabilitation facilities (inpatient or 

outpatient), hospitals (inpatient only), or mental health centers. 

50 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Statistical Analysis 

No statistical analyses were conducted; instead, estimates were obtained from SAMHSA’s published reports 

of 201717 and 201818 NSDUH results. Data on heroin use stratified by gender, age category, U.S. census region, 

and county type were provided by SAMHSA. In this report, the highest and lowest values are presented, but 

we did not test for statistical differences across groups. Statistical differences can be calculated based on the 

provided point estimates and standard errors. In the 2018 report, there were minor imputation changes from 

the 2017 report. Please see SAMHSA’s published reports of 2018 NSDUH results for further details. 

Nonfatal Overdose Hospitalizations and Emergency Department (ED) Visits 

Data Sources 

Information on medically attended, nonfatal drug poisonings were obtained from the 2016 HCUP. The drug 

poisoning ICD-10-CM discharge codes available in HCUP are used as a proxy for overdose. Drug-related 

inpatient hospitalizations were obtained from HCUP’s National Inpatient Sample (NIS). The NIS uses a 

stratified systematic random sampling design to produce nationally representative estimates of hospital 

discharges in the United States. It is the largest publicly available all-payer database in the United States and 

was conducted in 46 states plus the District of Columbia in 2016 and approximates a 20% stratified sample 

of discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care facilities. The 

sample was stratified by the following hospital characteristics: U.S. census division, urban or rural location, 

teaching status, ownership, and bed size. 

Discharge data for emergency department visits were obtained from the Nationwide Emergency 

Department Sample (NEDS), which is a stratified sample of billing records designed to produce national 

representative estimates of hospital-based ED visits in the United States. In 2016, data were obtained 

from 953 hospitals located in 36 states and the District of Columbia, approximating a 20 percent stratified 

sample of U.S. hospital-based EDs. The sample was drawn from non-federal, short-term, general, and other 

specialty hospitals and stratified by the following hospital characteristics: geographic region, trauma center 

designation, urban or rural location, teaching status, and hospital ownership. 

The 2016 NIS and NEDS include a full calendar year of data with diagnosis and procedure codes reported 

using the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System 

(ICD-10-CM/PCS). 

Definitions 

ICD-10-CM/PCS diagnosis injury codes were used to classify drug-related poisonings. All diagnoses (not 

just principal) and all encounters (initial and subsequent) were included. Tables for all intents as well as 

for unintentional and undetermined intents were included. These definitions differ from last year’s report 

due to HCUP’s transition from ICD-9-CM to ICD-10-CM and changes in coding guidance within ICD-10-CM. 

Moreover, in last year’s report, we included both ICD-9-CM and ICD-10-CM codes. Therefore, numbers and 

rates should not be compared between the two reports. 

All intent tables included poisonings of accidental (unintentional), undetermined intent, intentional selfharm, and assault. All intent tables included the following ICD-10-CM/PCS codes: 

•	 All drug poisoning, all intent:* T36.0X1x–T36.0X4x, T36.1X1x–T36.1X4x, T36.2X1x–T36.2X4x, 

T36.3X1x–T36.3X4x, T36.4X1x–T36.4X4x, T36.5X1x–T36.5X4x, T36.6X1x–T36.6X4x, T36.7X1x–T36.7X4x, 

T36.8X1x–T36.8X4x, T36.91Xx–T36.94Xx, T37.0X1x–T37.0X4x, T37.1X1x–T37.1X4x, T37.2X1x–T37.2X4x, 

51 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

T37.3X1x–T37.3X4x, T37.4X1x–T37.4X4x, T37.5X1x–T37.5X4x, T37.8X1x–T37.8X4x, T37.91Xx–T37.94Xx,
 

T38.0X1x–T38.0X4x, T38.1X1x–T38.1X4x, T38.2X1x–T38.2X4x, T38.3X1x–T38.3X4x, T38.4X1x–T38.4X4x,
 

T38.5X1x–T38.5X4x, T38.6X1x–T38.6X4x, T38.7X1x–T38.7X4x, T38.801x–T38.804x, T38.811x–T38.814x,
 

T38.891x–T38.894x, T38.901x–T38.904x, T38.991x–T38.994x, T39.011x–T39.014x, T39.091x–T39.094x,
 

T39.1X1x–T39.1X4x, T39.2X1x–T39.2X4x, T39.311x–T39.314x, T39.391x–T39.394x, T39.4X1x–T39.4X4x,
 

T39.8X1x–T39.8X4x, T39.91Xx–T39.94Xx, T40.0X1x–T40.0X4x, T40.1X1x–T40.1X4x, T40.2X1x–T40.2X4x,
 

T40.3X1x–T40.3X4x, T40.4X1x–T40.4X4x, T40.5X1x–T40.5X4x, T40.601x–T40.604x, T40.691x–T40.694x,
 

T40.7X1x–T40.7X4x, T40.8X1x–T40.8X4x, T40.901x–T40.904x, T40.991x–T40.994x, T41.0X1x–T41.0X4x,
 

T41.1X1x–T41.1X4x, T41.201x–T41.204x, T41.291x–T41.294x, T41.3X1x–T41.3X4x, T41.41Xx–T41.44Xx,
 

T41.5X1x–T41.5X4x, T42.0X1x–T42.0X4x, T42.1X1x–T42.1X4x, T42.2X1x–T42.2X4x, T42.3X1x–T42.3X4x,
 

T42.4X1x–T42.4X4x, T42.5X1x–T42.5X4x, T42.6X1x–T42.6X4x, T42.7X1x–T42.7X4x, T42.8X1x–T42.8X4x,
 

T43.011x–T43.014x, T43.021x–T43.024x, T43.1X1x–T43.1X4x, T43.201x–T43.204x, T43.211x–T43.214x,
 

T43.221x–T43.224x, T43.291x–T43.294x, T43.3X1x–T43.3X4x, T43.4X1x–T43.4X4x, T43.501x–T43.504x,
 

T43.591x–T43.594x, T43.601x–T43.604x, T43.611x–T43.614x, T43.621x–T43.624x, T43.631x– T43.634x,
 

T43.691x–T43.694x, T43.8X1x–T43.8X4x, T43.91Xx–T43.94Xx, T44.0X1x–T44.0X4x, T44.1X1x–T44.1X4x,
 

T44.2X1x–T44.2X4x, T44.3X1x–T44.3X4x, T44.4X1x– T44.4X4x, T44.5X1x–T44.5X4x, T44.6X1x–T44.6X4x,
 

T44.7X1x–T44.7X4x, T44.8X1x– T44.8X4x, T44.901x–T44.904x, T44.991x–T44.994x, T45.0X1x–T45.0X4x,
 

T45.1X1x– T45.1X4x, T45.2X1x–T45.2X4x, T45.3X1x–T45.3X4x, T45.4X1x–T45.4X4x, T45.511x– T45.514x,
 

T45.521x–T45.524x, T45.601x–T45.604x, T45.611x–T45.614x, T45.621x– T45.624x, T45.691x–T45.694x,
 

T45.7X1x–T45.7X4x, T46.8X1x–T46.8X4x, T46.901x– T46.904x, T46.991x–T46.994x, T47.0X1x–T47.0X4x,
 

T47.1X1x–T47.1X4x, T47.2X1x– T47.2X4x, T47.3X1x–T47.3X4x, T47.4X1x–T47.4X4x, T47.5X1x–T47.5X4x,
 

T48.6X1x– T48.6X4x, T48.901x–T48.904x, T49.0X1x–T49.0X4x, T49.1X1x–T49.1X4x, T49.2X1x– T49.2X4x,
 

T49.3X1x–T49.3X4x, T49.4X1x–T49.4X4x, T49.5X1x–T49.5X4x, T49.6X1x– T49.6X4x, T49.7X1x–T49.7X4x,
 

T49.8X1x–T49.8X4x, T49.91Xx–T49.94Xx, T50.0X1x– T50.0X4x, T50.1X1x–T50.1X4x, T50.2X1x–T50.2X4x,
 

T50.3X1x–T50.3X4x, T50.4X1x– T50.4X4x, T50.5X1x–T50.5X4x, T50.6X1x–T50.6X4x, T50.7X1x–T50.7X4x,
 

T50.8X1x– T50.8X4x, T50.A11x–T50.A14x, T50.A21x–T50.A24x, T50.A91x–T50.A94x, T50.B91x– T50.B94x,
 

T50.Z11x–T50.Z14x, T50.Z91x–T50.Z94x, T50.901x–T50.904x, T50.991x–T50.994x
 

•	 Opioid drug poisoning, all intents:* T40.0X1x–T40.0X4x, T40.1X1x–T40.1X4x, T40.2X1x–T40.2X4x,
 

T40.3X1x–T40.3X4x, T40.4X1x–T40.4X4x, T40.601x–T40.604x, T40.691x–T40.694x
 

•	 Heroin poisoning, all intents:* T40.1X1x–T40.1X4x 

•	 Methadone poisoning, all intents:* T40.3X1x–T40.3X4x 

•	 Poisoning by other opioids, all intents:* T40.0X1x–T40.0X4x, T40.2X1x–T40.2X4x, T40.4X1x–T40.4X4x,
 

T40.601x–T40.604x
 

•	 Cocaine poisoning, all intents:* T40.5X1x–T40.5X4x 

•	 Methamphetamine poisoning, all intents:* T43.621x–T43.624x

 *where x = A, D, or S 

Unintentional and undetermined intent tables included poisonings of accidental (unintentional) or 

undetermined intent only, and they excluded poisonings attributable to intentional self-harm and assault. 

Unintentional and undetermined intent tables included the following ICD-10-CM/PCS codes: 

•	 All drug poisoning, unintentional or undetermined intent:* T36.0X1x, T36.0X4x, T36.1X1x, T36.1X4x,
 

T36.2X1x, T36.2X4x, T36.3X1x, T36.3X4x, T36.4X1x, T36.4X4x, T36.5X1x, T36.5X4x, T36.6X1x, T36.6X4x,
 

T36.7X1x, T36.7X4x, T36.8X1x, T36.8X4x, T36.91Xx, T36.94Xx, T37.0X1x, T37.0X4x, T37.1X1x, T37.1X4x,
 

52 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

T37.2X1x, T37.2X4x, T37.3X1x, T37.3X4x, T37.4X1x, T37.4X4x, T37.5X1x, T37.5X4x, T37.8X1x, T37.8X4x,
 

T37.91Xx, T37.94Xx, T38.0X1x, T38.0X4x, T38.1X1x, T38.1X4x, T38.2X1x, T38.2X4x, T38.3X1x, T38.3X4x,
 

T38.4X1x, T38.4X4x, T38.5X1x, T38.5X4x, T38.6X1x, T38.6X4x, T38.7X1x, T38.7X4x, T38.801x, T38.804x,
 

T38.811x, T38.814x, T38.891x, T38.894x, T38.901x, T38.904x, T38.991x, T38.994x, T39.011x, T39.014x,
 

T39.091x, T39.094x, T39.1X1x, T39.1X4x, T39.2X1x, T39.2X4x, T39.311x, T39.314x, T39.391x, T39.394x,
 

T39.4X1x, T39.4X4x, T39.8X1x, T39.8X4x, T39.91Xx, T39.94Xx, T40.0X1x, T40.0X4x, T40.1X1x, T40.1X4x,
 

T40.2X1x, T40.2X4x, T40.3X1x, T40.3X4x, T40.4X1x, T40.4X4x, T40.5X1x, T40.5X4x, T40.601x, T40.604x,
 

T40.691x, T40.694x, T40.7X1x, T40.7X4x, T40.8X1x, T40.8X4x, T40.901x, T40.904x, T40.991x, T40.994x,
 

T41.0X1x, T41.0X4x, T41.1X1x, T41.1X4x, T41.201x, T41.204x, T41.291x, T41.294x, T41.3X1x, T41.3X4x,
 

T41.41Xx, T41.44Xx, T41.5X1x, T41.5X4x, T42.0X1x, T42.0X4x, T42.1X1x, T42.1X4x, T42.2X1x, T42.2X4x,
 

T42.3X1x, T42.3X4x, T42.4X1x, T42.4X4x, T42.5X1x, T42.5X4x, T42.6X1x, T42.6X4x, T42.7X1x, T42.7X4x,
 

T42.8X1x, T42.8X4x, T43.011x, T43.014x, T43.021x, T43.024x, T43.1X1x, T43.1X4x, T43.201x, T43.204x,
 

T43.211x, T43.214x, T43.221x, T43.224x, T43.291x, T43.294x, T43.3X1x, T43.3X4x, T43.4X1x, T43.4X4x,
 

T43.501x, T43.504x, T43.591x, T43.594x, T43.601x, T43.604x, T43.611x, T43.614x, T43.621x, T43.624x,
 

T43.631x, T43.634x, T43.691x, T43.694x, T43.8X1x, T43.8X4x, T43.91Xx, T43.94Xx, T44.0X1x, T44.0X4x,
 

T44.1X1x, T44.1X4x, T44.2X1x, T44.2X4x, T44.3X1x, T44.3X4x, T44.4X1x, T44.4X4x, T44.5X1x, T44.5X4x,
 

T44.6X1x, T44.6X4x, T44.7X1x, T44.7X4x, T44.8X1x, T44.8X4x, T44.901x, T44.904x, T44.991x, T44.994x,
 

T45.0X1x, T45.0X4x, T45.1X1x, T45.1X4x, T45.2X1x, T45.2X4x, T45.3X1x, T45.3X4x, T45.4X1x, T45.4X4x,
 

T45.511x, T45.514x, T45.521x, T45.524x, T45.601x, T45.604x, T45.611x, T45.614x, T45.621x, T45.624x,
 

T45.691x, T45.694x, T45.7X1x, T45.7X4x, T46.8X1x, T46.8X4x, T46.901x, T46.904x, T46.991x, T46.994x,
 

T47.0X1x, T47.0X4x, T47.1X1x, T47.1X4x, T47.2X1x, T47.2X4x, T47.3X1x, T47.3X4x, T47.4X1x, T47.4X4x,
 

T47.5X1x, T47.5X4x, T48.6X1x, T48.6X4x, T48.901x, T48.904x, T49.0X1x, T49.0X4x, T49.1X1x, T49.1X4x,
 

T49.2X1x, T49.2X4x, T49.3X1x, T49.3X4x, T49.4X1x, T49.4X4x, T49.5X1x, T49.5X4x, T49.6X1x, T49.6X4x,
 

T49.7X1x, T49.7X4x, T49.8X1x, T49.8X4x, T49.91Xx, T49.94Xx, T50.0X1x, T50.0X4x, T50.1X1x, T50.1X4x,
 

T50.2X1x, T50.2X4x, T50.3X1x, T50.3X4x, T50.4X1x, T50.4X4x, T50.5X1x, T50.5X4x, T50.6X1x, T50.6X4x,
 

T50.7X1x, T50.7X4x, T50.8X1x, T50.8X4x, T50.A11x, T50.A14x, T50.A21x, T50.A24x, T50.A91x, T50.A94x,
 

T50.B91x, T50.B94x, T50.Z11x, T50.Z14x, T50.Z91x, T50.Z94x, T50.901x, T50.904x, T50.991x, T50.994x
 

•	 Opioid drug poisoning:* T40.0X1x, T40.0X4x, T40.1X1x, T40.1X4x, T40.2X1x, T40.2X4x, T40.3X1x,
 

T40.3X4x, T40.4X1x, T40.4X4x, T40.601x, T40.604x, T40.691x, T40.694x
 

•	 Heroin poisoning:* T40.1X1x, T40.1X4x 

•	 Methadone poisoning:* T40.3X1x, T40.3X4x 

•	 Poisoning by other opioids:* T40.0X1x, T40.0X4x, T40.2X1x, T40.2X4x, T40.4X1x, T40.4X4x, T40.601x,
 

T40.604x
 

•	 Cocaine poisoning:* T40.5X1x, T40.5X4x 

•	 Methamphetamine poisoning:* T43.621x, T43.624x

 *where x = A, D, or S 

As poisoning-related hospitalizations and ED visits may involve more than one type of drug, poisonings 

presented are not mutually exclusive. 

Information about persons’ race and ethnicity was not available for ED visits; therefore, it was not included in 

any HCUP analyses. 

Census regions were defined earlier in this report under the section, “Drug Use, Misuse, Substance Use 

Disorder, Drug Initiation, and Treatment.” 

53 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

Urbanization of patient residence is based on the 2013 National Center for Health Statistics Urban-Rural 

Classification Scheme for Counties.19 The categories are defined as follows: 

•	 Large central metro: Counties in metropolitan statistical areas (MSAs) of 1 million or more population that: 

– Contain the entire population of the largest principal city of the MSA, or 

– Have their entire population contained in the largest principal city of the MSA, or 

– Contain at least 250,000 inhabitants of any principal city of the MSA. 

•	 Large fringe metro: Counties in MSAs of 1 million or more population that did not qualify as large 

central metro counties. 

•	 Medium metro: Counties in MSAs of populations of 250,000 to 999,999. 

•	 Small metro: Counties in MSAs of populations less than 250,000. 

•	 Micropolitan: Nonmetropolitan counties in micropolitan statistical areas. 

•	 Noncore: Nonmetropolitan counties that did not qualify as micropolitan. 

Statistical Analysis 

Data were weighted to provide national estimates of annual numbers and rates per 100,000 population. Rates 

were based on U.S. population estimates according to sex, age, U.S. census region, and 2013 urbanization 

status.19, 20

 Age-adjusted rates were standardized to the U.S. census population estimates for 2000 by the direct 

method. Estimates were considered unreliable and not reported if the relative standard error was > 30% or 

the standard error = 0. All statistical analyses accounted for the complex sampling design and were performed 

using SAS Version 9.4 (SAS Institute, Cary, North Carolina). 

To minimize the possibility of duplicate counting within this section or across other sections of this report, we 

excluded certain records. Hospital transfers and hospital admissions that occurred directly from the ED were 

excluded because of potential duplication with the hospitalization data. In-hospital deaths were excluded from 

the ED visits and hospitalization estimates because these would be included in the mortality section. 

In this report, the highest and lowest values are presented, but we did not test for statistical differences across 

groups. Statistical differences can be calculated based on the provided point estimates and standard errors 

provided. 

Mortality Rates 

Data Source 

Mortality data were obtained from the Mortality Component of the National Vital Statistics System. Drug 

overdose deaths were analyzed using the multiple cause of death query system from CDC Wide-ranging 

Online Data for Epidemiologic Research (CDC WONDER).2

 Data from death certificates filed in the 50 states and 

the District of Columbia are based on underlying and multiple causes of death fields.21

Definitions 

Drug overdose deaths were identified using the International Classification of Diseases, Tenth Revision (ICD10), based on the ICD-10 underlying cause-of-death codes X40–44 (unintentional), X60–64 (suicide), X85 

(homicide), or Y10–Y14 (undetermined intent). 

54 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

Among deaths with drug overdose as the underlying cause, the type of drugs involved in the deaths were 

indicated by the following ICD-10 multiple cause-of-death codes (i.e., T-codes): 

•	 Heroin (T40.1); 

•	 Natural/semisynthetic opioids (T40.2), which includes drugs such as hydrocodone and oxycodone; 

•	 Methadone (T40.3); 

•	 Synthetic opioids other than methadone (T40.4), which includes drugs such as fentanyl and tramadol; 

•	 Deaths involving any opioid (T40.0 (opium), T40.1, T40.2, T40.3, T40.4 and T40.6 (other and unspecified 

narcotics)), which includes drugs such as those listed above, as well as opioids where the type of opioid 

was not specified; 

•	 Deaths involving a prescription opioid (T40.2) natural and semi-synthetic opioids and (T40.3) 

methadone; 

•	 Cocaine (T40.5); and 

•	 Psychostimulants with abuse potential (T43.6), which includes such drugs as methamphetamine, 

3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, 

methylphenidate (Ritalin), and caffeine. 

As drug overdose deaths may involve more than one type of drug, some deaths are included in the rates in 

more than one subcategory. Therefore, categories of drug overdose deaths presented were not mutually 

exclusive. Additionally, in 2017, approximately 12% of drug overdose deaths did not specify which drugs 

were involved. 

Census regions were defined under the section on “Drug Use, Misuse, Substance Use Disorder, Drug 

Initiation, and Treatment.” 

Death rates are calculated by decedent’s place of residence, not place of occurrence of the death. Decedent’s 

county of residence was determined according to categories of the 2013 National Center for Health Statistics 

Urban-Rural Classification Scheme for Counties.19 These are defined above in the section for “Nonfatal 

Overdose Hospitalizations and Emergency Department (ED) Visits.” 

All records where Hispanic origin was not stated were not included in estimates by Hispanic origin but 

were included in the overall estimates. 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.22

Statistical Analyses 

Rates were calculated per 100,000 resident population, age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data year. Crude rates were presented for age groups. Significance 

testing for trends over time was performed with joinpoint software from the National Cancer Institute.12

Significance tests used a Monte Carlo Permutation method.23 The most parsimonious models were selected 

to report the estimated annual percent change (APC) for each time segment detected that was statistically 

significantly different from zero (p<0.05); otherwise, the term “not significant” was used. 

55 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

REFERENCES
 

1	 Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United 

States, 2013-2017. MMWR MorbMortal Wkly Rep. 2019 Jan 4; 67(5152):1419. 

2	 CDC WONDER. US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov/. 

Accessed April 2019. 

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

counts. National Center for Health Statistics. 2019. https://www.cdc.gov/nchs/nvss/vsrr/drugoverdose-data.htm 

4	 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. 

5	 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. 

6	 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. 

10.15585/mmwr.mm6533a2 

7	 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. 

8	 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. 10.15585/mmwr.mm6643e1 

9	 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 MorbMortal Wkly Rep. 2019 

May 3; 68(17):388. 

10	 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 

2016. MMWR MorbMortal Wkly Recomm Rep. 2016; 65(1):1-49. 

11	 Centers for Disease Control and Prevention. Quality improvement and care coordination: implementing 

the CDC guideline for prescribing opioids for chronic pain. Atlanta, GA: National Center for Injury 

Prevention and Control, Division of Unintentional Injury Prevention; 2018. 

12	 Joinpoint Regression Program, Version 4.5.0.0 [computer program]. May 2017. Statistical Methodology 

and Applications Branch, Surveillance Research Program, National Cancer Institute. 

13	 Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: 

methodological summary and definitions. Rockville, MD: Substance Abuse and Mental Health Services 

Administration; 2018. 

14	 Center for Behavioral Health Statistics and Quality. 2015 National Survey on Drug Use and Health: 

summary of the effects of the 2015 NSDUH questionnaire redesign implications for data users. Rockville, 

MD: Substance Abuse and Mental Health Services Administration; 2016. 

15	 United States Department of Agriculture. Rural-urban continuum codes [Internet]. Economic Research 

Service. 2012 [cited 11 July 2019]. Available from: https://www.ers.usda.gov/data-products/ruralurban-continuum-codes.aspx 

56 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

16	 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; 

1994. 

17	 Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: 

detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018. 

18	 Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health: 

detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2019. 

19	 Ingram D, Franco S. 2013 NCHS urban–rural classification scheme for counties. National Center for Health 

Statistics; 2014. 

20	 Barrett M, Hickey K, Coffey R, Levit K. Population denominator data for use with the HCUP databases 

(Updated with 2015 Population Data). U.S. Agency for Healthcare Research and Quality; 2016. 

21	 Centers for Disease Control and Prevention. About the National Vital Statistics System. Atlanta, GA: US 

Department of Health and Human Services, CDC; 2016. 

22	 Arias E, Heron M, Hakes J. The validity of race and Hispanic-origin reporting on death certificates in the 

United States: an update. Vital Health Stat 2. 2016 Aug 01; (172):1-21. 

23	 Kim HJ, Fay, MP, Feuer, EJ, Midthune, DN. Permutation tests for joinpoint regression with applications to 

cancer rates. Stat Med. 2000 Feb 15; 19(3):335-351. 

57 
 

 

 

 

TABLES 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

TABLE 1A
 National estimates of total number and percentage of persons who had at least one 

prescription filled for an opioid, by age and sex — United States, 2018 

Age group (years) Gender Number Percenta

Total 768,962 1.3 

0–14 Male 399,704 1.3 

Female 369,258 1.2 

Total 1,876,304 8.9 

15–19 Male 837,436 8.1 

Female 1,038,868 10.1 

Total 2,468,395 11.2 

20–24 Male 925,544 8.2 

Female 1,542,851 14.3 

Total 6,786,718 14.7 

25–34 Male 2,491,609 10.6 

Female 4,295,109 19.0 

Total 7,417,100 17.9 

35–44 Male 3,010,659 14.5 

Female 4,406,440 21.3 

Total 8,547,366 20.4 

45–54 Male 3,677,678 17.8 

Female 4,869,688 23.0 

Total 10,184,432 23.9 

55–64 Male 4,612,416 22.4 

Female 5,572,016 25.3

Total 13,177,942 25.0 

≥ 65 Male 5,531,474 23.5 

Female 7,646,467 26.1 

Total 49,515,948 15.0 

All agesb Male 20,780,572 12.8 

Female 28,735,376 17.2 

Source: IQVIATM Total Patient Tracker (TPT), 2018. Data extracted in 2019. 

a

The annual percentage of population who filled an opioid prescription by age group was calculated as populationbased by weighting raw values to national populations of study year. 

b

Patient numbers by age group for each sex do not sum to the total number for each sex because the total number for 

each sex was calculated separately from TPT to avoid potential double counting of persons due to age progression. 

59 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

TABLE 1B
 Total number and rate of opioid prescriptions and morphine milligram equivalents (MME) dispensed 

per 100 persons annually — United States, 2018 

Opioids prescribed Number Ratea

Prescriptions (Rx)

 All opioids 168,158,611 51.4

 LA/ER opioidsb 14,811,160 4.5

 Days of supply per Rx

 < 30 days 96,196,574 29.4

 ≥ 30 days 71,962,037 22.0

 < 3 days 26,792,643 8.2

 < 7 days 59,492,722 18.2

 ≥ 3 days and < 7 days 32,700,079 10.0

 Average opioid Rx per patientc 3.4

 Average days of supply per Rx 18.4 

MME 

Total MME 138,900,570,581

 MME per capita 424.6

 Average MME per Rx 828.1

 Average daily MME per Rx 42.9

 Daily dosage per Rx

 < 50 MME 129,792,025 39.7

≥ 50 but < 90 MME 25,769,022 7.9

 ≥ 90 MME (high-dose) 12,597,565 3.9 

Source: IQVIATM Xponent 2018. Data extracted in 2019.
 

Abbreviations: MME, morphine milligram equivalents; Rx, prescriptions.
 

aRate per 100 persons adjusted to the U.S. census population.
 

b

LA/ER represents opioids that are long acting (LA) or extended release (ER).
 

c

Based on number of patients who filled an opioid prescription.
 

60 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TABLE 1C
 Ratesa

 of opioid prescriptions filled per 100 persons by type, dosage, and state 

— United States, 2018 

Alabama 97.5 6.9 81.5 10.8 5.1 Montana 54.0 5.3 40.2 9.7 4.1 

Alaska 44.9 6.3 27.4 10.7 6.8 Nebraska 50.6 4.8 39.8 7.7 3.1 

Arizona 50.7 5.5 36.1 9.6 5.1 Nevada 55.5 6.0 39.6 11.2 4.7 

Arkansas 93.5 5.8 78.1 10.8 4.6 New Hampshire 46.1 7.0 30.3 9.4 6.4 

California 35.1 3.0 27.6 4.8 2.6 New Jersey 38.9 4.4 26.7 7.2 5.0 

Colorado 45.1 4.5 33.1 8.6 3.4 New Mexico 49.4 3.6 37.8 8.3 3.4 

Connecticut 43.0 4.6 29.8 8.4 4.8 New York 34.0 3.6 25.2 5.2 3.6 

Delaware 60.6 10.1 42.3 10.5 7.8 North Carolina 61.5 5.9 45.4 11.6 4.5 

District of Columbia 25.0 1.6 21.6 2.2 1.1 North Dakota 37.4 3.9 29.1 6.0 2.3 

Florida 53.7 5.8 38.3 9.9 5.5 Ohio 53.5 4.2 44.4 6.0 3.1 

Georgia 63.2 4.7 49.5 9.3 4.4 Oklahoma 79.1 7.4 58.8 15.0 5.3 

Hawaii 33.4 3.5 24.5 5.1 3.8 Oregon 57.3 5.6 41.3 11.6 4.4 

Idaho 61.9 6.3 43.1 13.3 5.4 Pennsylvania 49.9 5.4 37.0 7.7 5.2 

Illinois 45.2 2.9 37.3 5.7 2.2 Rhode Island 43.0 4.0 35.1 4.4 3.6 

Indiana 65.8 5.0 52.5 9.2 4.1 South Carolina 69.2 5.5 53.2 11.2 4.7 

Iowa 49.3 4.2 39.8 6.4 3.1 South Dakota 42.6 4.1 33.7 6.0 2.8 

Kansas 64.3 5.8 46.4 12.4 5.4 Tennessee 81.8 7.0 59.6 16.7 5.5 

Kentucky 79.5 4.6 63.2 12.1 4.2 Texas 47.2 2.8 40.4 4.8 2.0 

Louisiana 79.4 4.4 66.0 9.5 3.8 Utah 57.1 6.0 38.9 11.6 6.7 

Maine 48.1 6.3 35.2 8.3 4.6 Vermont 42.4 7.0 29.1 6.6 6.8 

Maryland 45.1 5.7 31.5 9.2 4.4 Virginia 44.8 4.1 34.5 6.5 3.8 

Massachusetts 35.3 3.9 26.6 5.5 3.2 Washington 49.3 4.9 35.0 10.4 3.9 

Michigan 62.7 5.5 52.5 6.1 4.1 West Virginia 69.3 5.0 56.9 7.9 4.4 

Minnesota 35.5 3.4 26.7 6.6 2.3 Wisconsin 45.8 4.8 34.3 8.2 3.3 

Mississippi 76.8 4.7 65.2 7.9 3.7 Wyoming 57.1 6.2 40.8 10.5 5.8 

Missouri 63.4 5.2 48.7 10.1 4.7 

State 

Opioid Type Daily Dosage Per Rx (MME/Day) Opioid Type Daily Dosage Per Rx (MME/Day) 

All LA/ERb < 50 ≥ 50 and < 90 ≥ 90 All LA/ERb < 50 ≥ 50 and < 90 ≥ 90 

Source: IQVIATM Xponent 2018. Data extracted in 2019.
 

Abbreviations: MME, morphine milligram equivalents; Rx, prescriptions.
 

a

Rate per 100 persons adjusted to the U.S. census population.
 

b

LA/ER represents opioids that are long acting (LA) or extended release (ER).
 

61 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

TABLE 1D
 Trend analyses of opioid prescriptions filled and morphine milligram equivalents 

(MME) dispensed — United States, 2006–2018a

Opioid prescribing 

2006 2018 

Average APC 

(95% CL) 

Trend 1 Trend 2 Trend 3 

Prescription fill rateb Yearsc APC (95% CL) Yearsc APC (95% CL) Yearsc APC (95% CL) 

All opioid Rx 72.4 51.4 -3.0 (-4.1,-2.0)d 2006-2012 1.9 (0.9,2.9)d 2012-2016 -5.2 (-7.9,-2.5)d 2016-2018 -12.4 (-17.3,-7.2)d

High-dosage Rxe 11.5 3.9 -8.6 (-11.9,-5.2)d 2006-2009 -0.5 (-10.5,10.5) 2009-2016 -8.9 (-12.1,-5.6)d 2016-2018 -18.5 (-34.0,0.7) 

Days of supply ≥ 30 17.6 22.0 1.8 (1.0,2.7)d 2006-2010 10.3 (8.5,12.1)d 2010-2015 1.9 (0.2,3.5)d 2015-2018 -8.4 (-10.7,-6.0)d

Days of supply < 30 54.7 29.4 -5.2 (-6.3,-4.1)d 2006-2012 -0.5 (-1.6,0.5) 2012-2016 -7.6 (-10.4,-4.7)d 2016-2018 -13.7 (-18.8,-8.3)d

Days of supply < 3 16.2 8.2 -5.7 (-6.4,-5.0)d 2006-2012 -2.4 (-3.0,-1.7)d 2012-2016 -8.2 (-9.9,-6.4)d 2016-2018 -10.5 (-13.8,-7.1)d

Days of supply < 7 35.3 18.2 -5.5 (-6.4,-4.6)d 2006-2010 -1.1 (-2.8, 0.7) 2010-2014 -5.3 (-7.9,-2.5)d 2014-2018 -10.0 (-11.6,-8.4)d

Days of supply > 3 19.1 10.0 -5.4 (-6.3,-4.6)d 2006-2010 -0.6 (-2.3,1.1) 2010-2014 -5.3 (-7.9,-2.6)d 2014-2018 -10.2 (-11.8,-8.6)d

and < 7 

Number 

Average daily MME 59.7 42.9 -2.6 (-3.4,-1.7) 2006-2010 -1.1 (-2.3,0.2) 2010-2013 -4.3 (-8.2,-0.2)d 2013-2018 -2.7 (-3.6,-1.8)d

per Rx 

Average days of 13.3 18.4 2.7 (2.5,2.9)d 2006-2010 4.0 (3.5,4.4)d 2010-2016 2.6 (2.3,2.8)d 2016-2018 0.7 (-0.5,2.0) supply per Rx 

Source: IQVIATM Xponent 2006-2018. Data extracted in 2019.
 

Abbreviations: APC, annual percent change; CL, confidence limits; MME, morphine milligram equivalent; Rx, prescription.
 

a

When analyzing trends using IQVIATM data, data were compared with and without the IQVIATM data modification starting in
 

2017 and found no significant differences in our findings. 

b

Rate per 100 persons adjusted to the U.S. census population. 

c

Year category presented in each trend represents groupings as determined by joinpoint regression. 

d

Indicates that the annual percent change was significantly different from 0 (p<0.05). 

e

High-dose prescriptions were defined as opioid prescriptions resulting in a daily dosage of ≥ 90 MME. 

62 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

TABLE 2A
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2017 

Socio-demographic 

characteristic 

All illicit drug use and 

prescription drug misuse 

Prescription pain 

relievers 

Prescription 

tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 30,476 11.2 0.19 3,239 1.2 0.06 1,727 0.6 0.04 1,841 0.7 0.04 352 0.1 0.02 

Gender

 Male 18,134 13.7 0.29 1,760 1.3 0.09 920 0.7 0.06 1037 0.8 0.06 224 0.2 0.03

 Female 12,342 8.8 0.21 1,479 1.1 0.08 807 0.6 0.05 803 0.6 0.05 128 0.1 0.02 

Age (years)

 12–17 1,966 7.9 0.26 214 0.9 0.09 128 0.5 0.06 123 0.5 0.07 19 0.1 0.02

 18–25 8,302 24.2 0.47 634 1.8 0.13 552 1.6 0.13 715 2.1 0.16 52 0.2 0.04

≥ 26 20,208 9.5 0.22 2,391 1.1 0.07 1,047 0.5 0.04 1,002 0.5 0.04 281 0.1 0.02

 26–34 6,891 17.4 0.51 790 2.0 0.18 383 1.0 0.11 554 1.4 0.16 49 0.1 0.04

≥ 35 13,317 7.7 0.23 1,600 0.9 0.08 664 0.4 0.05 448 0.3 0.03 232 0.1 0.03

 35–39 2,619 12.6 0.63 259 1.2 0.17 125 0.6 0.13 181 0.9 0.15 62 0.3 0.11

 40–44 2,009 10.1 0.58 231 1.2 0.19 90 0.5 0.12 91 0.5 0.13 21 0.1 0.05

 45–49 1,805 9.0 0.54 230 1.1 0.20 121 0.6 0.15 71 0.4 0.11 14 0.1 0.04

 50–54 1,892 9.0 0.78 207 1.0 0.27 129 0.6 0.17 65 0.3 0.15 62 0.3 0.13

 55–59 2,089 9.5 0.79 269 1.2 0.32 115 0.5 0.20 22 0.1 0.07 49 0.2 0.11

 60–64 1,421 7.1 0.65 169 0.8 0.24 18 0.1 0.07 11 0.1 0.05 23 0.1 0.10

g g g ≥ 65 1,482 3.0 0.30 235 0.5 0.14 67 0.1 0.06 7 0.0f 0.01 

Race/ethnicityd

White 19,760 11.6 0.24 2,190 1.3 0.08 1,351 0.8 0.06 1,466 0.9 0.06 277 0.2 0.03

 Black 4,308 13.1 0.53 322 1.0 0.12 97 0.3 0.07 72 0.2 0.06 37 0.1 0.05

 Hispanic 4,500 9.8 0.40 550 1.2 0.16 230 0.5 0.07 226 0.5 0.09 37 0.1 0.04 

American Indian or g g g 256 17.6 1.93 21 1.4 0.47 7 0.5 0.30 16 1.1 0.46 Alaska Native 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; 

use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not 

include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever 

misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include 

illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers. 

usda.gov/data-products/rural-urban-continuum-codes.aspx. 

f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are 

rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Fewer than 500 persons. 

h

Low precision, no estimate reported. 

63 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

TABLE 2A
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic 

characteristic 

All illicit drug use and 

prescription drug misuse 

Prescription pain 

relievers 

Prescription 

tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE Number % SE 

Native Hawaiian or 

other Pacific Islander 115 10.4 3.08 6 0.6 0.40 1 0.1 0.07 1 0.1 0.07 g g g

g g g Asian 677 4.5 0.45 55 0.4 0.11 10 0.1 0.04 34 0.2 0.09 

U.S. census region of 

residence

 Northeast 5,535 11.5 0.40 541 1.1 0.16 328 0.7 0.11 354 0.7 0.10 66 0.1 0.04

 Midwest 6,102 10.7 0.34 649 1.1 0.11 452 0.8 0.09 544 1.0 0.08 46 0.1 0.03

 South 9,605 9.4 0.27 1,335 1.3 0.10 671 0.7 0.05 613 0.6 0.06 143 0.1 0.03 

West 9,233 14.3 0.51 714 1.1 0.13 277 0.4 0.07 329 0.5 0.08 98 0.2 0.05 

County typee

Large metropolitan 17,948 11.7 0.27 1,720 1.1 0.09 982 0.6 0.05 1,117 0.7 0.06 217 0.1 0.03 

Small metropolitan 8,879 11.1 0.30 1,058 1.3 0.10 496 0.6 0.06 545 0.7 0.07 96 0.1 0.03 

Non-metropolitan 3,648 9.3 0.40 461 1.2 0.13 249 0.6 0.09 178 0.5 0.06 39 0.1 0.04 

Urbanized 1,807 10.8 0.64 185 1.1 0.16 85 0.5 0.11 95 0.6 0.09 11 0.1 0.05 

Less Urbanized 1,631 8.6 0.59 238 1.3 0.20 128 0.7 0.14 71 0.4 0.08 25 0.1 0.06 

Completely Rural 210 6.2 0.89 37 1.1 0.39 36 1.1 0.42 12 0.4 0.19 2 0.1 0.06 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; 

use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not 

include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever 

misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include 

illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers. 

usda.gov/data-products/rural-urban-continuum-codes.aspx. 

f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are 

rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Fewer than 500 persons. 

h

Low precision, no estimate reported. 

64 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

TABLE 2A
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc (heroin use 

or prescription pain 

reliever misuse) 

Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 25,997 9.6 0.18 494 0.2 0.02 3,549 1.3 0.06 2,167 0.8 0.05 774 0.3 0.03 

Gender

 Male 15,720 11.9 0.28 369 0.3 0.04 1,996 1.5 0.10 1,493 1.1 0.08 515 0.4 0.05

 Female 10,277 7.3 0.20 125 0.1 0.02 1,552 1.1 0.08 675 0.5 0.05 259 0.2 0.03 

Age (years)

 12–17 1,613 6.5 0.24 2 0.0f 0.01 215 0.9 0.09 26 0.1 0.03 16 0.1 0.02

 18–25 7,591 22.1 0.46 102 0.3 0.06 695 2.0 0.16 665 1.9 0.14 151 0.4 0.08

 ≥ 26 16,792 7.9 0.20 390 0.2 0.03 2,638 1.2 0.08 1,476 0.7 0.06 607 0.3 0.03

 26–34 5,872 14.8 0.47 194 0.5 0.09 882 2.2 0.19 676 1.7 0.17 156 0.4 0.07

 ≥ 35 10,920 6.3 0.21 196 0.1 0.02 1,757 1.0 0.08 800 0.5 0.06 451 0.3 0.04

 35–39 2,199 10.6 0.58 53 0.3 0.08 301 1.4 0.19 179 0.9 0.20 119 0.6 0.14

 40–44 1,746 8.8 0.55 21 0.1 0.04 242 1.2 0.20 80 0.4 0.14 41 0.2 0.07

 45–49 1,493 7.4 0.50 16 0.1 0.04 242 1.2 0.20 124 0.6 0.16 61 0.3 0.09

 50–54 1,500 7.1 0.70 43 0.2 0.10 242 1.2 0.28 147 0.7 0.23 94 0.4 0.14

 55–59 1,577 7.2 0.68 63 0.3 0.13 326 1.5 0.34 164 0.8 0.26 66 0.3 0.14

g 60–64 1,238 6.2 0.62 0.0g 0.00g 169 0.8 0.24 21 0.1 0.07 61 0.3 0.15

g ≥ 65 1,168 2.4 0.26 0.0g 0.00g 235 0.5 0.14 83 0.2 0.09 9 0.0f 0.01 

Race/ethnicityd 

White 16,808 9.8 0.22 387 0.2 0.03 2,434 1.4 0.08 1,284 0.8 0.06 564 0.3 0.04

 Black 3,808 11.6 0.49 29 0.1 0.04 345 1.1 0.12 356 1.1 0.23 22 0.1 0.03

 Hispanic 3,718 8.1 0.36 39 0.1 0.04 573 1.3 0.17 352 0.8 0.10 138 0.3 0.08 

American Indian or 225 15.5 1.90 3 0.2 0.16 23 1.6 0.49 18 1.3 0.47 21 1.4 0.48 Alaska Native 

Native Hawaiian or g h h h h h h 101 9.1 2.96 0.0f 0.00 6 0.6 0.40 other Pacific Islander 

Asian 557 3.7 0.42 17 0.1 0.09 69 0.5 0.14 48 0.3 0.15 7 0.0f 0.04 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; 

use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not 

include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever 

misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include 

illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers. 

usda.gov/data-products/rural-urban-continuum-codes.aspx. 

f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are 

rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Fewer than 500 persons. 

h

Low precision, no estimate reported. 

65 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

               

 

 

TABLE 2A
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc

 (heroin use 

or prescription pain 

reliever misuse) 

Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

U.S. census region of 

residence

 Northeast 4,721 9.8 0.37 160 0.3 0.07 657 1.4 0.17 469 1.0 0.14 32 0.1 0.03

 Midwest 5,164 9.1 0.30 104 0.2 0.05 720 1.3 0.11 346 0.6 0.08 171 0.3 0.06

 South 7,964 7.8 0.25 186 0.2 0.04 1,428 1.4 0.10 699 0.7 0.07 274 0.3 0.05 

West 8,149 12.6 0.47 46 0.1 0.02 744 1.2 0.13 653 1.0 0.11 297 0.5 0.08 

County typee 

Large metropolitan 15,284 10.0 0.26 286 0.2 0.03 1,900 1.2 0.09 1,373 0.9 0.07 314 0.2 0.03 

Small metropolitan 7,595 9.5 0.28 159 0.2 0.04 1,158 1.5 0.11 549 0.7 0.07 244 0.3 0.05 

Non-metropolitan 3,118 8.0 0.36 49 0.1 0.04 490 1.3 0.13 245 0.6 0.14 216 0.6 0.10 

Urbanized 1,569 9.3 0.61 21 0.1 0.05 197 1.2 0.17 154 0.9 0.25 58 0.3 0.11 

Less Urbanized 1,378 7.3 0.51 29 0.2 0.07 256 1.3 0.21 82 0.4 0.18 127 0.7 0.17 

g Completely Rural 172 5.0 0.76 0.0g 0.00g 37 1.1 0.39 9 0.3 0.14 31 0.9 0.43 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; 

use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not 

include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever 

misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include 

illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers. 

usda.gov/data-products/rural-urban-continuum-codes.aspx. 

f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are 

rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Fewer than 500 persons. 

h

Low precision, no estimate reported. 

66 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2B
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2017 

Socio-demographic characteristic 

All illicit drug use and prescription drug misuse Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Prescription benzodiazepines 

Number % SE Number % SE Number % SE Number % SE Number % SE Number % SE 

All 51,795 19.0 0.24 11,077 4.1 0.10 5,944 2.2 0.08 5,839 2.1 0.07 1,351 0.5 0.04 5,674 2.1 0.07 

Gender

 Male 29,058 22.0 0.36 6,018 4.6 0.16 3,001 2.3 0.11 3,466 2.6 0.11 629 0.5 0.06 2,900 2.2 0.11

 Female 22,736 16.2 0.29 5,059 3.6 0.13 2,943 2.1 0.1 2,372 1.7 0.08 722 0.5 0.06 2,774 2.0 0.10 

Age (years)

 12–17 4,069 16.3 0.37 767 3.1 0.16 458 1.8 0.13 452 1.8 0.14 74 0.3 0.05 441 1.8 0.13

 18–25 13,522 39.4 0.54 2,460 7.2 0.26 1,880 5.5 0.23 2,545 7.4 0.29 199 0.6 0.07 1,830 5.3 0.23

≥ 26 34,203 16.1 0.27 7,850 3.7 0.12 3,605 1.7 0.09 2,841 1.3 0.07 1,079 0.5 0.05 3,403 1.6 0.08

i i i 26–34 11,345 28.7 0.60 2,370 6.0 0.29 1,327 3.4 0.23 1,602 4.1 0.27 216 0.5 0.09 i i i ≥ 35 22,859 13.2 0.30 5,480 3.2 0.13 2,278 1.3 0.09 1,239 0.7 0.06 862 0.5 0.06 

35–39 4,518 21.7 0.75 1,085 5.2 0.37 450 2.2 0.25 435 2.1 0.24 118 0.6 0.14 422 2.0 0.24

 40–44 3,391 17.1 0.75 798 4.0 0.36 352 1.8 0.25 292 1.5 0.22 76 0.4 0.13 307 1.6 0.24

 45–49 3,190 15.9 0.68 874 4.3 0.37 349 1.7 0.24 216 1.1 0.18 87 0.4 0.11 340 1.7 0.25

 50–54 3,124 14.9 0.99 708 3.4 0.46 304 1.4 0.27 128 0.6 0.19 216 1.0 0.26 261 1.2 0.25

 55–59 3,298 15.1 0.97 652 3.0 0.43 377 1.7 0.32 104 0.5 0.20 145 0.7 0.20 336 1.5 0.31

 60–64 2,506 12.5 0.86 585 2.9 0.46 124 0.6 0.20 52 0.3 0.11 135 0.7 0.22 131 0.7 0.21

≥ 65 2,833 5.7 0.44 777 1.6 0.22 321 0.6 0.15 13 0.0f 0.02 85 0.2 0.08 344 0.7 0.17 

Race/ethnicityd

White 33,709 19.7 0.30 7,481 4.4 0.14 4,431 2.6 0.11 4,514 2.6 0.10 1,044 0.6 0.06 4,224 2.5 0.10 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. a Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, 

hallucinogens, inhalants, or methamphetamine. 

b Misuse of prescription drugs is defined as use in any way not directed by a doctor, 

including use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c This category includes heroin use, prescription pain reliever misuse, or both; therefore 

the numbers for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription 

fentanyl but does not include illicitly manufactured fentanyl. 

d All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more 

races are not included. 

e County type was determined according to the “Rural-Urban Continuum Codes”, a product 

of the U.S. Department of Agriculture: https://www.ers.usda.gov/data-products/ruralurban-continuum-codes.aspx. 

f Percentages are rounded to the nearest tenth. Because of the rounding, some percentages 

equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g Low precision, no estimate reported. h Fewer than 500 persons. iAge category was not available in SAMSHA report. 

67 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2B
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic characteristic 

All illicit drug use and prescription drug misuse Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Prescription benzodiazepines 

Number % SE Number % SE Number % SE Number % SE Number % SE Number % SE

 Black 6,739 20.5 0.64 1,136 3.5 0.24 396 1.2 0.13 254 0.8 0.10 82 0.2 0.08 391 1.2 0.14

 Hispanic 7,991 17.5 0.53 1,833 4.0 0.27 841 1.8 0.15 763 1.7 0.14 185 0.4 0.08 794 1.7 0.15 

American Indian or 426 29.3 2.74 84 5.7 1.05 22 1.5 0.52 24 1.7 0.52 4 0.3 0.25 15 1.0 0.35 Alaska Native 

Native Hawaiian or 

g g g 140 12.7 3.14 24 2.2 0.87 17 1.6 0.71 16 1.4 0.71 17 1.6 0.71 other Pacific Islander 

Asian 1,440 9.5 0.72 273 1.8 0.31 104 0.7 0.29 165 1.1 0.22 10 0.1 0.04 100 0.7 0.29 

 census region of U.S.

residence

 Northeast 9,060 18.8 0.50 1,715 3.6 0.23 1,088 2.3 0.18 1,137 2.4 0.19 205 0.4 0.08 1,054 2.2 0.18

 Midwest 10,628 18.6 0.46 2,423 4.2 0.20 1,362 2.4 0.15 1,604 2.8 0.17 208 0.4 0.06 1,306 2.3 0.15

 South 17,034 16.6 0.36 4,105 4.0 0.15 2,276 2.2 0.12 1,959 1.9 0.11 524 0.5 0.07 2,190 2.1 0.12 

West 15,072 23.4 0.61 2,834 4.4 0.25 1,218 1.9 0.17 1,139 1.8 0.15 415 0.6 0.11 1,124 1.7 0.17 

County typee

Large metropolitan 30,500 19.9 0.34 6,048 3.9 0.14 3,380 2.2 0.11 3,454 2.3 0.10 785 0.5 0.06 3,199 2.1 0.11 

Small metropolitan 15,115 18.9 0.39 3,458 4.3 0.18 1,773 2.2 0.12 1,729 2.2 0.12 385 0.5 0.07 1,711 2.1 0.12 

Non-metropolitan 6,179 15.8 0.52 1,571 4.0 0.24 792 2.0 0.17 656 1.7 0.14 181 0.5 0.10 763 2.0 0.17 

Urbanized 2,864 17.0 0.78 654 3.9 0.33 326 1.9 0.23 330 2.0 0.22 42 0.3 0.10 313 1.9 0.23 

Less Urbanized 2,832 15.0 0.75 771 4.1 0.36 401 2.1 0.27 273 1.4 0.19 108 0.6 0.15 392 2.1 0.28 

Completely Rural 484 14.2 1.75 146 4.3 0.95 64 1.9 0.48 53 1.6 0.49 31 0.9 0.50 58 1.7 0.45 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. a Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, 

hallucinogens, inhalants, or methamphetamine. 

b Misuse of prescription drugs is defined as use in any way not directed by a doctor, 

including use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c This category includes heroin use, prescription pain reliever misuse, or both; therefore 

the numbers for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

d All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more 

races are not included. 

e County type was determined according to the “Rural-Urban Continuum Codes”, a product 

of the U.S. Department of Agriculture: www.ers.usda.gov/data-products/rural-urbancontinuum-codes.aspx. 

f Percentages are rounded to the nearest tenth. Because of the rounding, some percentages 

equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g Low precision, no estimate reported. h Fewer than 500 persons. 

68 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2B
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic characteristic 

Marijuana Heroin 

Opioidsc (heroin or prescription 

pain relievers) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 40,935 15.0 0.22 886 0.3 0.03 11,401 4.2 0.1 5,943 2.2 0.08 1,633 0.6 0.04 

Gender Male 23,451 17.8 0.34 600 0.5 0.05 6,252 4.7 0.17 3,964 3.0 0.13 1,048 0.8 0.07

 Female 17,483 12.5 0.25 286 0.2 0.03 5,148 3.7 0.13 1,979 1.4 0.09 585 0.4 0.04 

Age (years)

 12–17 3,094 12.4 0.33 14 0.1 0.02 769 3.1 0.16 127 0.5 0.06 48 0.2 0.04

 18–25 11,956 34.9 0.53 214 0.6 0.08 2,494 7.3 0.26 2,128 6.2 0.26 375 1.1 0.11

 ≥ 26 25,885 12.2 0.24 658 0.3 0.03 8,138 3.8 0.12 3,688 1.7 0.09 1,210 0.6 0.05

 26–34 9,240 23.4 0.56 312 0.8 0.11 2,467 6.2 0.29 1,768 4.5 0.28 421 1.1 0.12

 ≥ 35 16,645 9.6 0.26 346 0.2 0.03 5,761 3.3 0.13 1,920 1.1 0.09 789 0.5 0.05

 35–39 3,415 16.4 0.72 118 0.6 0.12 1,133 5.4 0.38 482 2.3 0.29 248 1.2 0.2

 40–44 2,594 13.1 0.68 54 0.3 0.08 821 4.1 0.36 225 1.1 0.20 102 0.5 0.12

 45–49 2,307 11.5 0.60 16 0.1 0.04 874 4.3 0.37 318 1.6 0.25 105 0.5 0.12

 50–54 2,294 10.9 0.88 83 0.4 0.16 761 3.6 0.48 320 1.5 0.35 149 0.7 0.2

 55–59 2,318 10.6 0.83 75 0.3 0.14 721 3.3 0.44 327 1.5 0.34 88 0.4 0.16

 60–64 1,872 9.4 0.74 h 0.0f 0.00 585 2.9 0.46 98 0.5 0.17 73 0.4 

≥ 65 1,844 3.7 0.34 h 0.0f 0.00 777 1.6 0.22 150 0.3 0.11 24 0.0f

Race/ethnicityd 

White 26,654 15.6 0.27 712 0.4 0.04 7,747 4.5 0.14 3,854 2.3 0.10 1,164 0.7 0.05 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health 

(NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or 

methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a 

prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin 

use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not 

included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. 

Department of Agriculture: www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are 

displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. hFewer than 500 persons. iAge category was not available in SAMSHA report. 

69 

0.160.02 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2B
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2017 

CONTINUED 

Socio-demographic characteristic 

Marijuana Heroin 

Opioidsc (heroin or prescription 

pain relievers) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE

 Black 5,675 17.3 0.59 44 0.1 0.05 1,162 3.5 0.24 657 2.0 0.27 58 0.2 0.06

 Hispanic 5,954 13.0 0.47 72 0.2 0.04 1,842 4.0 0.27 1,008 2.2 0.19 280 0.6 0.11 

American Indian or Alaska Native 354 24.3 2.23 11 0.7 0.31 88 6.1 1.08 52 3.6 0.82 62 4.3 1.56 

Native Hawaiian or other Pacific h g g g 125 11.3 2.99 0.0f 0.00 24 2.2 0.87 11 1.0 Islander 

 Asian 1,045 6.9 0.59 26 0.2 0.10 289 1.9 0.32 140 0.9 0.22 17 0.1 0.07 

 census region of residence U.S.

 Northeast 7,213 15.0 0.46 234 0.5 0.08 1,804 3.8 0.24 1,131 2.4 0.21 75 0.2 0.04

 Midwest 8,317 14.6 0.39 204 0.4 0.06 2,509 4.4 0.21 1,144 2.0 0.14 334 0.6 0.07

 South 13,002 12.7 0.32 326 0.3 0.05 4,228 4.1 0.16 1,962 1.9 0.12 632 0.6 0.07 

West 12,403 19.2 0.56 122 0.2 0.04 2,859 4.4 0.25 1,706 2.6 0.20 592 0.9 0.12 

County typee 

Large metropolitan 24,304 15.9 0.32 489 0.3 0.04 6,230 4.1 0.15 3,724 2.4 0.12 640 0.4 0.05 

Small metropolitan 11,899 14.9 0.35 306 0.4 0.05 3,583 4.5 0.19 1,587 2.0 0.12 601 0.8 0.08 

Non-metropolitan 4,732 12.1 0.44 91 0.2 0.05 1,588 4.1 0.24 632 1.6 0.18 393 1.0 0.13 

Urbanized 2,247 13.4 0.71 32 0.2 0.06 662 3.9 0.33 340 2.0 0.31 146 0.9 0.19 

Less Urbanized 2,145 11.3 0.62 58 0.3 0.09 780 4.1 0.36 257 1.4 0.24 211 1.1 0.20 

Completely Rural 340 10.0 1.34 2 0.1 0.06 146 4.3 0.95 35 1.0 0.28 36 1.1 0.43 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health 

(NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or 

methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a 

prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for 

heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of polydrug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not 

included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. 

Department of Agriculture: www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are 

displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. hFewer than 500 persons. iAge category was not available in SAMSHA report. 

70 

0.69
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

TABLE 2C
 Self-reported prevalence of any prescription drug use (including misusea

) in the past year, 

persons 12+ years old, by drug type, numbers in thousands — United States, 2017 

Socio-demographic 

characteristic 

Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE 

All 90,799 33.4 0.29 38,168 14.0 0.23 18,629 6.8 0.14 16,741 6.2 0.15 

Gender

 Male 40,806 30.9 0.39 13,687 10.4 0.27 9,282 7.0 0.19 6,605 5.0 0.21

 Female 49,993 35.7 0.41 24,480 17.5 0.34 9,347 6.7 0.18 10,136 7.2 0.23 

Age (in years)

 12-17 4,346 17.4 0.38 1,139 4.6 0.20 1,787 7.2 0.25 563 2.3 0.14

 18-25 10,262 29.9 0.45 4,098 11.9 0.33 5,038 14.7 0.38 1,151 3.4 0.19

≥ 26 76,191 35.8 0.35 32,931 15.5 0.27 11,805 5.5 0.16 15,027 7.1 0.19 

Race/ethnicityb

White 61,125 35.8 0.36 29,486 17.3 0.30 13,912 8.1 0.18 12,712 7.4 0.20

 Black 11,330 34.5 0.81 2,757 8.4 0.47 1,194 3.6 0.27 1,463 4.5 0.35

 Hispanic 12,572 27.5 0.70 4,353 9.5 0.47 2,397 5.2 0.34 1,768 3.9 0.34 

American Indian or Alaska 596 41.0 3.12 183 12.6 1.96 134 9.2 2.11 133 9.1 2.49 Native 

Native Hawaiian or other Pacific 476 43.0 5.24 76 6.9 2.43 57 5.1 1.86 46 4.2 2.10 Islander 

 Asian 2,867 18.9 1.12 620 4.1 0.61 490 3.2 0.44 293 1.9 0.55 

U.S. census region of residence

 Northeast 13,886 28.9 0.70 6,480 13.5 0.51 3,014 6.3 0.35 2,728 5.7 0.37

 Midwest 19,536 34.3 0.58 8,259 14.5 0.42 4,272 7.5 0.30 3,098 5.4 0.27

 South 35,961 35.1 0.46 15,302 14.9 0.37 7,542 7.4 0.22 6,997 6.8 0.28 

West 21,416 33.2 0.64 8,127 12.6 0.47 3,800 5.9 0.27 3,917 6.1 0.32 

County typec

 Large metropolitan 48,216 31.5 0.39 19,940 13.0 0.30 10,482 6.8 0.19 8,757 5.7 0.22

 Small metropolitan 28,437 35.6 0.49 12,547 15.7 0.44 5,754 7.2 0.25 5,566 7.0 0.30

 Non-metropolitan 14,146 36.1 0.69 5,680 14.5 0.49 2,393 6.1 0.31 2,418 6.2 0.37 

Urbanized 6,061 36.1 1.09 2,254 13.4 0.70 1,078 6.4 0.47 925 5.5 0.51 

Less Urbanized 6,859 36.2 0.98 2,891 15.3 0.73 1,121 5.9 0.44 1,205 6.4 0.54 

Completely Rural 1,226 36.0 2.33 536 15.7 1.40 193 5.7 0.91 288 8.4 1.57 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; 

use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not 

include over-the-counter drugs. 

b

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

c

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: 

https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

71 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2D
 Self-reported prevalence of past year initiation of illicit drug use and prescription drug misusea, persons 12+ years old, by drug type, numbers in thousands — United States, 2017 

Sociodemographic characteristic 

Prescription pain relievers 

Prescription tranquilizers 

Prescription stimulants Prescription sedatives Marijuana Heroin Cocaine Methamphetamine 

No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE 

All 2,010 0.7 0.04 1,446 0.5 0.04 1,192 0.4 0.03 271 0.1 0.02 3,033 1.1 0.04 81 0.0b 0.01 1,037 0.4 0.03 195 0.1 0.01 

Age (years)

 12–17 316 1.3 0.11 223 0.9 0.09 217 0.9 0.10 34 0.1 0.04 1,204 4.8 0.21 9 0.0b 0.02 98 0.4 0.05 27 0.1 0.03 18–25 465 1.4 0.12 473 1.4 0.12 581 1.7 0.14 51 0.1 0.03 1,304 3.8 0.21 46 0.1 0.04 729 2.1 0.15 95 0.3 0.05

≥ 26 1,229 0.6 0.05 749 0.4 0.04 394 0.2 0.03 186 0.1 0.02 525 0.2 0.03 26 0.0b 0.01 210 0.1 0.02 73 0.0b 0.01 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug bPercentages are rounded to the nearest tenth. Because of the rounding, some percentages 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 (SAMSHA), Rockville, MD. percent and do not represent an absence of persons displaying a particular characteristic. 

Abbreviations: No., number; SE, standard error. 

aMisuse of prescription drugs is defined as use in any way not directed by a doctor, including 

use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

72 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

TABLE 2E
 Self-reported prevalence of substance use disordera

 for specific substances in the 

past year, persons 12+ years old, numbers in thousands — United States, 2017 

Socio-demographic 

characteristic 

All illicit drugsb

Prescription pain 

relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Number %d SE Number % SE Number % SE Number % SE Number % SE 

All 7,545 2.8 0.08 1,678 0.6 0.04 739 0.3 0.02 572 0.2 0.02 198 0.1 0.01 

Age (years)

 12–17 741 3.0 0.15 99 0.4 0.06 80 0.3 0.06 62 0.2 0.05 10 0.0e 0.02

 18–25 2,512 7.3 0.27 339 1.0 0.09 278 0.8 0.09 187 0.5 0.06 24 0.1 0.02

≥ 26 4,292 2.0 0.09 1,240 0.6 0.05 380 0.2 0.02 323 0.2 0.02 164 0.1 0.02 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc (heroin use or 

prescription pain 

reliever misuse) Cocained Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 4,057 1.5 0.06 652 0.2 0.02 2,110 0.8 0.05 966 0.4 0.03 964 0.4 0.03 

Age (in years)

 12–17 557 2.2 0.13 4 0.0e 0.01 103 0.4 0.06 19 0.1 0.02 24 0.1 0.03

 18–25 1,799 5.2 0.24 165 0.5 0.07 445 1.3 0.11 243 0.7 0.08 188 0.5 0.08

 ≥ 26 1,701 0.8 0.06 483 0.2 0.03 1,562 0.7 0.05 703 0.3 0.04 751 0.4 0.04 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Substance use disorder is defined as meeting criteria for illicit drug dependence or abuse. Dependence or abuse is based on definitions found in 

the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 

b

Illicit drug use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, 

inhalants, or methamphetamine. 

c

This category includes prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

Including crack. 

e

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates 

are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

73 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

TABLE 2F
 Prevalence of self-reported treatment for illicit drug use and prescription drug misusea

 in the past year, 

persons 12+ years old, by demographic characteristics, numbers in thousands — United States, 2017 

Socio-demographic characteristic 

Any location Specialty facilityb

Number % SE Number % SE 

All 2,448 0.9 0.05 1,674 0.6 0.04 

Gender

 Male 1,564 1.2 0.09 1,016 0.8 0.07

 Female 884 0.6 0.05 658 0.5 0.04 

Age (years)

 12–17 143 0.6 0.07 56 0.2 0.04

 18–25 442 1.3 0.11 319 0.9 0.09

≥ 26 1,864 0.9 0.06 1,299 0.6 0.05 

Race/ethnicityc

White 1,686 1.0 0.06 1,151 0.7 0.05

 Black 275 0.8 0.15 208 0.6 0.14

 Hispanic 326 0.7 0.12 211 0.5 0.09

 American Indian or Alaska Native 59 4.0 1.10 31 2.1 0.75

e e e e e e Native Hawaiian or other Pacific Islander 

 Asian 23 0.2 0.06 9 0.1 0.03 

U.S. census region of residence

 Northeast 412 0.9 0.10 298 0.6 0.08

 Midwest 454 0.8 0.09 305 0.5 0.07

 South 1,029 1.0 0.09 713 0.7 0.07 

West 553 0.9 0.12 357 0.6 0.10 

County typed

 Large metropolitan 1,266 0.8 0.07 850 0.6 0.06

 Small metropolitan 804 1.0 0.09 550 0.7 0.08

 Non-metropolitan 378 1.0 0.11 274 0.7 0.10

 Urbanized 180 1.1 0.20 131 0.8 0.17

 Less Urbanized 176 0.9 0.13 123 0.7 0.12

 Completely Rural 23 0.7 0.30 19 0.6 0.29 

Source: Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit or prescription drug treatment refers to treatment received in order to reduce or stop illicit drug use or prescription drug misuse, or for medical 

problems associated with illicit drug use or prescription drug use. It includes treatment received at any location, such as a hospital (inpatient), 

rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor's office, self-help group, or prison/jail. Illicit 

drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Prescription drug misuse 

includes the misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. 

b

A specialty facility includes a hospital (inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center.
 

c

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included.
 

d

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers.
 

usda.gov/data-products/rural-urban-continuum-codes.aspx. e Low precision, no estimate reported. 

74 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

TABLE 2G
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the 

past month, persons 12+ years old, numbers in thousands — United States, 2018 

Socio-demographic 

characteristic 

All illicit drug use and 

prescription drug misuse 

Prescription pain 

relievers 

Prescription 

tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 31,918 11.7 0.21 2,852 1.0 0.06 1,634 0.6 0.04 1,670 0.6 0.04 243 0.1 0.02 

Gender

 Male 18,542 14.0 0.31 1,434 1.1 0.09 754 0.6 0.06 943 0.7 0.06 128 0.1 0.03

 Female 13,376 9.5 0.23 1,418 1.0 0.07 880 0.6 0.06 726 0.5 0.05 115 0.1 0.02 

Age (years)

 12–17 2,000 8.0 0.27 161 0.6 0.09 81 0.3 0.05 120 0.5 0.06 9 0.0f 0.02

 18–25 8,130 23.9 0.48 475 1.4 0.11 395 1.2 0.10 587 1.7 0.14 43 0.1 0.03

≥ 26 21,788 10.1 0.24 2,216 1.0 0.07 1,159 0.5 0.05 963 0.4 0.04 191 0.1 0.02

h h h h h h h h h h h h h h h 26-34 

h h h h h h h h h h h h h h h ≥ 35 

35–39 3,116 14.2 0.64 328 1.5 0.21 209 1.0 0.16 212 1.0 0.20 37 0.2 0.07

 40–44 2,374 12.1 0.65 264 1.3 0.21 62 0.3 0.09 33 0.2 0.07 13 0.1 0.04

 45–49 1,881 9.7 0.55 250 1.3 0.20 86 0.4 0.12 63 0.3 0.10 7 0.0f 0.02

 50–54 1,733 8.4 0.75 187 0.9 0.26 91 0.4 0.18 18 0.1 0.09 15 0.1 0.06

 55–59 1,811 8.3 0.78 218 1.0 0.28 66 0.3 0.12 29 0.1 0.07 20 0.1 0.07

 60–64 1,641 8.1 0.79 152 0.7 0.25 128 0.6 0.22 31 0.1 0.11 17 0.1 0.06

≥ 65 1,660 3.2 0.38 191 0.4 0.12 127 0.2 0.11 23 0.0f 0.03 39 0.1 0.05 

Race/ethnicityd

White 20,532 12.0 0.26 1,951 1.1 0.08 1,268 0.7 0.06 1232 0.7 0.05 196 0.1 0.02

 Black 4,514 13.7 0.56 337 1.0 0.16 113 0.3 0.08 112 0.3 0.08 3 0.0f 0.01

 Hispanic 4,535 9.7 0.41 406 0.9 0.12 206 0.4 0.08 158 0.3 0.06 17 0.0f 0.02 

American Indian or 290 17.4 2.46 23 1.4 0.44 8 0.5 0.25 6 0.3 0.23 9 0.6 0.45 Alaska Native 

Native Hawaiian or g g g g g g g g g 98 9.4 2.16 12 1.1 0.73 other Pacific Islander 

Asian 1,047 6.7 0.82 50 0.3 0.10 9 0.1 0.03 110 0.7 0.22 2 0.0f 0.01 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services 

Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater 

amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever misuse do not add to 

those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. Department of Agriculture: https://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes.aspx. f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are rounded down 

from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Low precision, no estimate reported. 

h

Age category was not available in SAMSHA report. 

75 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

               

 

TABLE 2G
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic 

characteristic 

All illicit drug use and 

prescription drug misuse 

Prescription pain 

relievers 

Prescription 

tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE Number % SE 

U.S. census region of 

residence

 Northeast 5,741 12.0 0.47 400 0.8 0.11 300 0.6 0.13 275 0.6 0.07 41 0.1 0.03

 Midwest 6,352 11.1 0.40 520 0.9 0.13 348 0.6 0.08 452 0.8 0.09 58 0.1 0.03

 South 10,101 9.7 0.29 1,336 1.3 0.11 664 0.6 0.07 556 0.5 0.06 92 0.1 0.02 

West 9,723 14.9 0.57 595 0.9 0.11 322 0.5 0.07 387 0.6 0.08 52 0.1 0.04 

County typee

Large metropolitan 18,588 12.2 0.30 1,511 1.0 0.08 909 0.6 0.06 972 0.6 0.05 118 0.1 0.02 

Small metropolitan 9,647 11.8 0.35 889 1.1 0.09 504 0.6 0.07 498 0.6 0.06 63 0.1 0.02 

Non-metropolitan 3,682 9.3 0.40 452 1.1 0.15 221 0.6 0.09 200 0.5 0.08 62 0.2 0.07 

Urbanized 1,844 10.4 0.68 186 1.1 0.17 100 0.6 0.15 111 0.6 0.14 37 0.2 0.14 

Less Urbanized 1,586 8.8 0.56 195 1.1 0.22 112 0.6 0.15 74 0.4 0.10 23 0.1 0.08 

Completely Rural 252 6.8 1.17 71 1.9 0.87 9 0.2 0.09 15 0.4 0.19 2 0.1 0.06 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services 

Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater 

amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever misuse do not add to 

those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. Department of Agriculture: https://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes.aspx. f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are rounded down 

from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Low precision, no estimate reported. 

h

Age category was not available in SAMSHA report. 

76 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

TABLE 2G
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc

 (heroin use 

or prescription pain 

reliever misuse) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 27,667 10.1 0.20 354 0.1 0.02 3,042 1.1 0.06 1,949 0.7 0.05 1,001 0.4 0.04 

Gender

 Male 16,338 12.3 0.30 221 0.2 0.03 1,569 1.2 0.09 1,320 1.0 0.08 641 0.5 0.06

 Female 11,328 8.0 0.21 134 0.1 0.02 1,473 1.0 0.07 630 0.4 0.05 360 0.3 0.04 

Age (years)

 12–17 1,658 6.7 0.25 8 0.0 0.02 169 0.7 0.09 12 0.0f 0.02 17 0.1 0.02

 18–25 7,528 22.1 0.47 61 0.2 0.04 508 1.5 0.11 524 1.5 0.13 90 0.3 0.04

 ≥ 26 18,481 8.6 0.22 285 0.1 0.02 2,366 1.1 0.07 1,414 0.7 0.05 894 0.4 0.05

h h h h h h h h h h h h h h h 26-34 

h h h h h h h h h h h h h h h ≥ 35 

35–39 2,651 12.1 0.58 66 0.3 0.10 366 1.7 0.22 192 0.9 0.19 118 0.5 0.12

 40–44 2,050 10.5 0.61 24 0.1 0.05 275 1.4 0.21 129 0.7 0.15 68 0.3 0.09

 45–49 1,514 7.8 0.49 24 0.1 0.06 261 1.3 0.21 126 0.6 0.15 101 0.5 0.13

 50–54 1,447 7.0 0.71 2 0.0 0.01 188 0.9 0.26 64 0.3 0.13 106 0.5 0.18

 55–59 1,449 6.7 0.71 11 0.1 0.04 229 1.1 0.28 93 0.4 0.16 71 0.3 0.13

 60–64 1,384 6.8 0.75 29 0.1 0.12 152 0.7 0.25 173 0.8 0.28 82 0.4 0.22

 ≥ 65 1,284 2.5 0.35 7 0.0 0.01 198 0.4 0.12 8 0.0f 0.01 59 0.1 0.07 

Race/ethnicityd 

White 17,608 10.3 0.23 240 0.1 0.02 2,091 1.2 0.08 1,129 0.7 0.05 730 0.4 0.05

 Black 4,028 12.2 0.54 58 0.2 0.09 366 1.1 0.17 338 1.0 0.17 25 0.1 0.04

 Hispanic 3,986 8.5 0.39 35 0.1 0.03 422 0.9 0.12 316 0.7 0.11 174 0.4 0.11 

American Indian or 243 14.6 2.41 4 0.2 0.16 24 1.4 0.45 8 0.5 0.32 23 1.4 0.56 Alaska Native 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services 

Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater 

amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever misuse do not add to 

those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. Department of Agriculture: https://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes.aspx. f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are rounded down 

from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Low precision, no estimate reported. 

h

Age category was not available in SAMSHA report. 

77 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

TABLE 2G
 Self-reported prevalence of illicit drug usea

 and prescription drug misuseb in the past month, 

persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc

 (heroin use 

or prescription pain 

reliever misuse) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

Native Hawaiian or other 

Pacific Islander 80 7.7 1.92 g g g 12 1.1 0.73 6 0.6 0.33 g g g

 Asian 870 5.6 0.77 4 0.0 0.02 53 0.3 0.10 81 0.5 0.19 10 0.1 0.05 

U.S. census region of 

residence

 Northeast 4,990 10.4 0.43 134 0.3 0.07 472 1.0 0.12 436 0.9 0.14 94 0.2 0.06

 Midwest 5,464 9.6 0.37 76 0.1 0.04 571 1.0 0.13 315 0.6 0.09 244 0.4 0.09

 South 8,405 8.1 0.25 96 0.1 0.02 1,386 1.3 0.11 579 0.6 0.06 280 0.3 0.04 

West 8,808 13.5 0.55 48 0.1 0.02 613 0.9 0.11 620 1.0 0.12 383 0.6 0.10 

County typee 

Large metropolitan 16,223 10.6 0.28 184 0.1 0.03 1,615 1.1 0.08 1,309 0.9 0.07 461 0.3 0.05 

Small metropolitan 8,307 10.2 0.32 122 0.1 0.03 949 1.2 0.10 503 0.6 0.07 339 0.4 0.07 

Non-metropolitan 3,137 7.9 0.38 48 0.1 0.04 479 1.2 0.15 137 0.3 0.07 201 0.5 0.08 

Urbanized 1,623 9.2 0.66 27 0.2 0.07 199 1.1 0.18 83 0.5 0.14 91 0.5 0.11 

Less Urbanized 1,343 7.4 0.51 20 0.1 0.04 208 1.2 0.22 51 0.3 0.08 89 0.5 0.13 

Completely Rural 171 4.6 0.78 2 0.0 0.03 72 1.9 0.87 3 0.1 0.04 20 0.5 0.31 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services 

Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. 

b

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater 

amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

c

This category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers for heroin use and prescription pain reliever misuse do not add to 

those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

e

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. Department of Agriculture: https://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes.aspx. f

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates are rounded down 

from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

g

Low precision, no estimate reported. 

h

Age category was not available in SAMSHA report. 

78 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2H
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2018 

Socio-demographic characteristic 

All illicit drug use and prescription drug misuse Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Prescription benzodiazepines 

Number % SE Number % SE Number % SE Number % SE Number % SE Number % SE 

All 53,182 19.4 0.26 9,948 3.6 0.10 5,742 2.1 0.08 5,109 1.9 0.06 1,084 0.4 0.04 5,438 2.0 0.08 

Gender Male 29,248 22.0 0.38 5,154 3.9 0.16 2,865 2.2 0.13 2,812 2.1 0.10 605 0.5 0.06 2,759 2.1 0.12

 Female 23,933 17.0 0.30 4,794 3.4 0.14 2,877 2.0 0.10 2,296 1.6 0.08 479 0.3 0.04 2,679 1.9 0.10 

Age (years)

 12–17 4,151 16.7 0.37 695 2.8 0.17 423 1.7 0.13 369 1.5 0.11 63 0.3 0.05 399 1.6 0.13

 18–25 13,168 38.7 0.54 1,858 5.5 0.21 1,566 4.6 0.21 2,216 6.5 0.27 194 0.6 0.07 1,526 4.5 0.21

≥ 26 35,863 16.7 0.30 7,395 3.4 0.13 3,753 1.7 0.10 2,524 1.2 0.06 827 0.4 0.04 3,513 1.6 0.09

 35–39 4,924 22.5 0.76 1,091 5.0 0.38 569 2.6 0.27 458 2.1 0.26 140 0.6 0.15 542 2.5 0.27

 40–44 3,778 19.3 0.77 773 3.9 0.37 306 1.6 0.22 206 1.1 0.18 73 0.4 0.12 289 1.5 0.22

 45–49 3,026 15.6 0.67 700 3.6 0.34 316 1.6 0.23 161 0.8 0.17 60 0.3 0.09 286 1.5 0.22

 50–54 3,076 14.9 1.00 700 3.4 0.52 334 1.6 0.39 60 0.3 0.14 59 0.3 0.13 329 1.6 0.39

 55–59 3,301 15.2 1.03 763 3.5 0.52 399 1.8 0.46 33 0.2 0.07 100 0.5 0.17 333 1.5 0.43

 60–64 2,648 13.0 0.98 487 2.4 0.45 174 0.9 0.25 33 0.2 0.11 62 0.3 0.17 174 0.9 0.25

≥ 65 2,897 5.7 0.47 681 1.3 0.22 234 0.5 0.14 34 0.1 0.04 79 0.2 0.06 210 0.4 0.14 

Race/ethnicityd

White 34,530 20.2 0.32 6,583 3.9 0.14 4,159 2.4 0.11 3,766 2.2 0.09 811 0.5 0.05 3,960 2.3 0.10

 Black 6,868 20.8 0.68 1,103 3.3 0.28 344 1.0 0.12 293 0.9 0.11 33 0.1 0.04 324 1.0 0.12 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, 

hallucinogens, inhalants, or methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including 

use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore 

the numbers for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more 

races are not included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes,” a product 

of the U.S. Department of Agriculture: https://www.ers.usda.gov/data-products/ruralurban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages 

equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. 

79 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2H
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic characteristic 

All illicit drug use and prescription drug misuse Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Prescription benzodiazepines 

Number % SE Number % SE Number % SE Number % SE Number % SE Number % SE

 Hispanic 7,996 17.1 0.53 1,644 3.5 0.26 944 2.0 0.25 630 1.4 0.12 167 0.4 0.10 881 1.9 0.24 

American Indian or 

474 28.5 2.86 96 5.8 1.10 40 2.4 0.79 24 1.4 0.45 15 0.9 0.54 25 1.5 0.53 Alaska Native 

Native Hawaiian or 220 21.2 3.51 87 8.4 2.47 22 2.1 1.13 14 1.4 0.95 2 0.2 0.23 22 2.1 1.13 other Pacific Islander 

Asian 1,752 11.2 0.93 216 1.4 0.23 106 0.7 0.16 243 1.6 0.29 16 0.1 0.05 102 0.7 0.16 

 census region of U.S.

residence Northeast 9,598 20.1 0.59 1,367 2.9 0.20 982 2.1 0.22 1,034 2.2 0.16 199 0.4 0.07 944 2.0 0.22

 Midwest 10,853 19.0 0.49 2,026 3.5 0.21 1,246 2.2 0.16 1,192 2.1 0.16 217 0.4 0.06 1,170 2.0 0.15

 South 17,321 16.7 0.37 4,039 3.9 0.18 2,139 2.1 0.13 1,671 1.6 0.10 334 0.3 0.05 2,019 1.9 0.12 

West 15,410 23.7 0.68 2,516 3.9 0.25 1,375 2.1 0.20 1,212 1.9 0.14 334 0.5 0.10 1,305 2.0 0.19 

County typee

Large metropolitan 30,826 20.2 0.38 5,234 3.4 0.15 3,457 2.3 0.13 2,937 1.9 0.09 633 0.4 0.05 3,289 2.2 0.13 

Small metropolitan 16,149 19.8 0.44 3,255 4.0 0.18 1,627 2.0 0.12 1,653 2.0 0.11 265 0.3 0.05 1,511 1.8 0.11 

Non-metropolitan 6,207 15.7 0.52 1,459 3.7 0.23 658 1.7 0.14 519 1.3 0.12 185 0.5 0.11 638 1.6 0.14 

Urbanized 3,020 17.1 0.85 688 3.9 0.35 325 1.8 0.21 267 1.5 0.19 101 0.6 0.19 316 1.8 0.21 

Less Urbanized 2,721 15.0 0.72 635 3.5 0.34 302 1.7 0.22 218 1.2 0.17 65 0.4 0.15 291 1.6 0.22 

Completely Rural 466 12.5 1.47 136 3.7 0.91 31 0.8 0.20 33 0.9 0.25 20 0.5 0.41 31 0.8 0.20 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, 

hallucinogens, inhalants, or methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including 

use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore 

the numbers for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly manufactured fentanyl. 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more 

races are not included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes,” a product 

of the U.S. Department of Agriculture: https://www.ers.usda.gov/data-products/ruralurban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages 

equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. 

80 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2H
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic characteristic 

Marijuana Heroin 

Opioidsc (heroin use or 

prescription pain reliever misuse) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 43,486 15.9 0.24 808 0.3 0.04 10,250 3.7 0.11 5,529 2.0 0.07 1,867 0.7 0.04 

Gender Male 24,542 18.5 0.36 516 0.4 0.06 5,351 4.0 0.16 3,482 2.6 0.12 1,108 0.8 0.07

 Female 18,944 13.4 0.27 292 0.2 0.03 4,899 3.5 0.14 2,047 1.5 0.08 758 0.5 0.05 

Age (years)

 12–17 3,110 12.5 0.33 10 0.0f 0.02 699 2.8 0.17 112 0.4 0.07 43 0.2 0.04

 18–25 11,829 34.8 0.53 157 0.5 0.07 1,895 5.6 0.21 1,967 5.8 0.26 273 0.8 0.09

 ≥ 26 28,548 13.3 0.28 641 0.3 0.04 7,656 3.6 0.13 3,451 1.6 0.08 1,551 0.7 0.05

 35–39 4,027 18.4 0.71 119 0.5 0.14 1,123 5.1 0.38 482 2.2 0.28 250 1.1 0.18

 40–44 3,052 15.6 0.71 60 0.3 0.08 788 4.0 0.37 268 1.4 0.22 162 0.8 0.15 45–49 2,245 11.6 0.59 31 0.2 0.06 708 3.6 0.34 254 1.3 0.21 157 0.8 0.16 50–54 2,285 11.1 0.84 88 0.4 0.26 751 3.6 0.55 190 0.9 0.28 110 0.5 0.18 55–59 2,348 10.8 0.86 46 0.2 0.11 809 3.7 0.54 156 0.7 0.20 107 0.5 0.17 60–64 2,153 10.6 0.92 39 0.2 0.13 496 2.4 0.46 252 1.2 0.31 126 0.6 0.25 ≥ 65 2,103 4.1 0.43 7 0.0f 0.01 688 1.3 0.22 30 0.1 0.03 59 0.1 0.07 

Race/ethnicityd 

White 28,146 16.5 0.29 531 0.3 0.03 6,747 4.0 0.14 3,630 2.1 0.09 1,346 0.8 0.06 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health 

(NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or 

methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without 

a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers 

for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because 

of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly
 manufactured fentanyl.
 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not 

included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. 

Department of Agriculture: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are 

displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. 

81 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2H
 Self-reported prevalence of illicit drug usea and prescription drug misuseb in the past year, persons 12+ years old, numbers in thousands — United States, 2018 

CONTINUED 

Socio-demographic characteristic 

Marijuana Heroin 

Opioidsc (heroin use or 

prescription pain reliever misuse) Cocaine Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE

 Black 5,859 17.8 0.64 135 0.4 0.2 1,203 3.7 0.33 577 1.8 0.27 64 0.2 0.06

 Hispanic 6,319 13.6 0.48 107 0.2 0.09 1,673 3.6 0.26 891 1.9 0.17 319 0.7 0.12 

American Indian or Alaska Native 384 23.0 2.89 5 0.3 0.16 97 5.8 1.10 31 1.9 0.60 39 2.4 0.69 

Native Hawaiian or other Pacific 

g g g 184 17.7 3.22 87 8.4 2.47 17 1.6 0.77 19 1.8 1.12 Islander 

 Asian 1,395 8.9 0.87 7 0.0f 0.03 219 1.4 0.23 226 1.4 0.30 27 0.2 0.08 

 census region of residence U.S.

 Northeast 8,067 16.9 0.56 244 0.5 0.15 1,462 3.1 0.23 1,167 2.4 0.23 150 0.3 0.07

 Midwest 8,802 15.4 0.44 153 0.3 0.06 2,097 3.7 0.21 994 1.7 0.15 416 0.7 0.10

 South 13,494 13.0 0.34 238 0.2 0.04 4,108 4.0 0.18 1,613 1.6 0.10 569 0.5 0.06 

West 13,123 20.2 0.64 172 0.3 0.07 2,584 4.0 0.25 1,755 2.7 0.19 732 1.1 0.13 

County typee 

Large metropolitan 25,560 16.8 0.35 454 0.3 0.06 5,411 3.5 0.16 3,435 2.3 0.11 855 0.6 0.06 

Small metropolitan 13,043 16.0 0.41 251 0.3 0.05 3,340 4.1 0.19 1,589 1.9 0.12 652 0.8 0.09 

Non-metropolitan 4,883 12.4 0.47 103 0.3 0.05 1,499 3.8 0.23 505 1.3 0.14 359 0.9 0.10 

Urbanized 2,434 13.8 0.79 50 0.3 0.09 702 4.0 0.35 287 1.6 0.27 155 0.9 0.14 

Less Urbanized 2,095 11.6 0.60 51 0.3 0.07 660 3.6 0.34 193 1.1 0.16 179 1.0 0.17 

Completely Rural 355 9.5 1.21 2 0.0f 0.03 137 3.7 0.91 25 0.7 0.25 26 0.7 0.33 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health 

(NSDUH). Substance Abuse and Mental Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. aIllicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or 

methamphetamine. 

bMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without 

a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

cThis category includes heroin use, prescription pain reliever misuse, or both; therefore the numbers 

for heroin use and prescription pain reliever misuse do not add to those for opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but does not include illicitly 

manufactured fentanyl. 

dAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not 

included. 

eCounty type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. 

Department of Agriculture: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

fPercentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are 

displayed. These prevalence estimates are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

gLow precision, no estimate reported. 

82 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

TABLE 2I
 Self-reported prevalence of any prescription drug use (including misusea

) in the past year, 

persons 12+ years old, by drug type, numbers in thousands — United States, 2018 

Socio-demographic 

characteristic 

Prescription pain 

relievers 

Prescription 

tranquilizers Prescription stimulants Prescription sedatives Benzodiazepines 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 86,548 31.6 0.29 37,610 13.7 0.22 18,008 6.6 0.14 16,775 6.1 0.16 30,755 11.2 0.21 

Gender

 Male 39,229 29.5 0.41 14,139 10.6 0.30 8,568 6.5 0.20 6,655 5.0 0.21 11,659 8.8 0.28

 Female 47,319 33.6 0.41 23,471 16.7 0.32 9,441 6.7 0.18 10,120 7.2 0.24 19,097 13.5 0.30 

Age (years)

 12–17 4,141 16.6 0.36 1,001 4.0 0.19 1,752 7.0 0.25 502 2.0 0.13 769 3.1 0.16

 18–25 8,931 26.2 0.44 3,681 10.8 0.30 4,473 13.1 0.37 1,049 3.1 0.17 3,230 9.5 0.29

≥ 26 73,476 34.2 0.36 32,928 15.3 0.27 11,783 5.5 0.15 15,225 7.1 0.20 26,757 12.5 0.26 

Race/ethnicityb

White 57,151 33.5 0.36 28,413 16.6 0.28 13,258 7.8 0.19 12,657 7.4 0.21 23,870 14.0 0.28

 Black 11,076 33.6 0.84 2,792 8.5 0.48 1,371 4.2 0.30 1,512 4.6 0.45 2,120 6.4 0.44

 Hispanic 12,301 26.4 0.65 4,591 9.8 0.52 2,299 4.9 0.29 1,472 3.2 0.30 3,408 7.3 0.47 

American Indian or 606 36.4 3.19 172 10.3 1.74 88 5.3 1.04 121 7.3 1.79 126 7.6 1.47 Alaska Native 

Native Hawaiian or d d d d d d 397 38.1 4.67 37 3.5 1.89 48 4.6 2.05 other Pacific Islander 

Asian 3,051 19.5 1.20 867 5.5 0.92 511 3.3 0.44 567 3.6 0.78 670 4.3 0.86 

U.S. census region of 

residence

 Northeast 13,356 27.9 0.69 6,593 13.8 0.53 3,103 6.5 0.35 2,356 4.9 0.31 5,488 11.5 0.50

 Midwest 17,927 31.3 0.57 7,794 13.6 0.45 4,151 7.3 0.31 3,133 5.5 0.29 6,269 11.0 0.41

 South 34,960 33.7 0.48 14,631 14.1 0.37 7,045 6.8 0.23 6,950 6.7 0.28 11,952 11.5 0.34 

West 20,305 31.2 0.64 8,593 13.2 0.52 3,709 5.7 0.23 4,337 6.7 0.43 7,046 10.8 0.52 

County typec

Large metropolitan 45,508 29.8 0.42 20,076 13.2 0.32 9,846 6.5 0.19 9,115 6.0 0.24 16,678 10.9 0.31 

Small metropolitan 27,526 33.7 0.47 12,083 14.8 0.38 5,983 7.3 0.25 5,291 6.5 0.28 9,741 11.9 0.34 

Non-metropolitan 13,513 34.2 0.74 5,452 13.8 0.56 2,179 5.5 0.29 2,369 6.0 0.39 4,336 11.0 0.54 

Urbanized 6,107 34.6 1.12 2,556 14.5 0.81 1,100 6.2 0.46 1,105 6.3 0.64 2,013 11.4 0.69 

Less Urbanized 6,227 34.4 1.07 2,322 12.8 0.71 914 5.1 0.38 1,085 6.0 0.58 1,857 10.3 0.70 

Completely Rural 1,179 31.7 2.41 574 15.4 2.49 164 4.4 1.02 179 4.8 0.90 466 12.5 2.47 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services 

Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater 

amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

b

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included. 

c

County type was determined according to the “Rural-Urban Continuum Codes”, a product of the U.S. Department of Agriculture: https://www.ers.usda.gov/dataproducts/rural-urban-continuum-codes.aspx. d

Low precision, no estimate reported. 

83 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 2J
 Self-reported prevalence of past year initiation of illicit drug use and prescription drug misusea, persons 12+ years old, by drug type, numbers in thousands — United States, 2018 

Sociodemographic characteristic 

Prescription pain relievers 

Prescription tranquilizers 

Prescription stimulants Prescription sedatives Marijuana Heroin Cocaine Methamphetamine 

No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE No. % SE 

All 1,908 0.7 0.04 1,210 0.4 0.03 1,001 0.4 0.02 251 0.1 0.01 3,061 1.1 0.04 117 0.0b 0.01 874 0.3 0.02 205 0.1 0.01 

Age (years)

 12–17 310 1.2 0.11 215 0.9 0.09 181 0.7 0.08 36 0.1 0.04 1,339 5.4 0.22 7 0.0b 0.02 74 0.3 0.06 31 0.1 0.03 18–25 464 1.4 0.11 434 1.3 0.11 517 1.5 0.12 73 0.2 0.05 1,197 3.5 0.19 35 0.1 0.03 616 1.8 0.15 68 0.2 0.04

≥ 26 1,134 0.5 0.05 560 0.3 0.04 302 0.1 0.2 143 0.1 0.02 525 0.2 0.03 75 0.0b 0.01 184 0.1 0.02 106 0.0b 0.01 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug bPercentages are rounded to the nearest tenth. Because of the rounding, some percentages 

Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 (SAMSHA), Rockville, MD. percent and do not represent an absence of persons displaying a particular characteristic. 

Abbreviations: No., number; SE, standard error. 

aMisuse of prescription drugs is defined as use in any way not directed by a doctor, including 

use without a prescription of one’s own medication; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs. 

84 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

TABLE 2K
 Self-reported prevalence of substance use disordera

 for specific substances in the 

past year, persons 12+ years old, numbers in thousands — United States, 2018 

Socio-demographic 

characteristic 

All illicit drugsb

Prescription pain 

relievers Prescription tranquilizers Prescription stimulants Prescription sedatives 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 8,094 3.0 0.10 1,694 0.6 0.05 673 0.2 0.02 561 0.2 0.02 113 0.0e 0.01 

Age (years)

 12–17 681 2.7 0.16 104 0.4 0.07 61 0.2 0.05 53 0.2 0.04 12 0.0e 0.02

 18–25 2,599 7.6 0.27 248 0.7 0.08 223 0.7 0.07 185 0.5 0.08 9 0.0e 0.01

≥ 26 4,814 2.2 0.11 1,343 0.6 0.06 390 0.2 0.03 323 0.2 0.02 91 0.0e 0.01 

CONTINUED 

Socio-demographic 

characteristic 

Marijuana Heroin 

Opioidsc (heroin use or 

prescription pain 

reliever misuse) Cocained Methamphetamine 

Number % SE Number % SE Number % SE Number % SE Number % SE 

All 4,421 1.6 0.06 526 0.2 0.03 2,028 0.7 0.06 977 0.4 0.03 1,051 0.4 0.03 

Age (in years)

 12–17 512 2.1 0.14 4 0.0e 0.01 108 0.4 0.07 5 0.0e 0.01 18 0.1 0.02

 18–25 2,003 5.9 0.25 101 0.3 0.06 312 0.9 0.09 212 0.6 0.08 134 0.4 0.06

 ≥ 26 1,907 0.9 0.06 421 0.2 0.04 1,608 0.7 0.07 760 0.4 0.04 899 0.4 0.04 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Substance use disorder is defined as meeting criteria for illicit drug dependence or abuse. Dependence or abuse is based on definitions found in 

the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 

b

Illicit drug use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, 

inhalants, or methamphetamine. 

c

This category includes prescription fentanyl but does not include illicitly manufactured fentanyl. 

d

Including crack. 

e

Percentages are rounded to the nearest tenth. Because of the rounding, some percentages equal to 0.0 are displayed. These prevalence estimates 

are rounded down from < 0.05 percent and do not represent an absence of persons displaying a particular characteristic. 

85 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

TABLE 2L
 Prevalence of self-reported treatmenta

 for illicit drug use and prescription drug misuse in the past year, 

persons 12+ years old, by demographic characteristics, numbers in thousands — United States, 2018 

Socio-demographic characteristic 

Any location Specialty facilityb

Number % SE Number % SE 

All 2,097 0.8 0.04 1,392 0.5 0.04 

Gender

 Male 1,214 0.9 0.07 793 0.6 0.06

 Female 884 0.6 0.05 599 0.4 0.04 

Age (years)

 12–17 130 0.5 0.08 80 0.3 0.06

 18–25 311 0.9 0.09 201 0.6 0.07

≥ 26 1,656 0.8 0.05 1,111 0.5 0.04 

Race/ethnicityc

White 1,543 0.9 0.06 1,067 0.6 0.05

 Black 240 0.7 0.12 138 0.4 0.09

 Hispanic 234 0.5 0.08 144 0.3 0.06

 American Indian or Alaska Native 17 1.0 0.35 2 0.1 0.08

 Native Hawaiian or other Pacific Islander 5 0.5 0.28 2 0.2 0.12

 Asian 24 0.2 0.10 23 0.1 0.10 

U.S. census region of residence

 Northeast 442 0.9 0.10 304 0.6 0.08

 Midwest 373 0.7 0.08 252 0.4 0.07

 South 799 0.8 0.08 514 0.5 0.06 

West 483 0.7 0.10 322 0.5 0.08 

County typed

 Large metropolitan 1,020 0.7 0.06 713 0.5 0.05

 Small metropolitan 750 0.9 0.09 464 0.6 0.07

 Non-metropolitan 328 0.8 0.13 215 0.5 0.09

 Urbanized 129 0.7 0.16 111 0.6 0.16

 Less Urbanized 180 1.0 0.21 93 0.5 0.11

 Completely Rural 19 0.5 0.25 11 0.3 0.21 

Source: Center for Behavioral Health Statistics and Quality. 2018 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental 

Health Services Administration (SAMSHA), Rockville, MD. 

Abbreviation: SE, standard error. 

a

Illicit or prescription drug treatment refers to treatment received in order to reduce or stop illicit drug use or prescription drug misuse, or for 

medical problems associated with illicit drug use or prescription drug use. It includes treatment received at any location, such as a hospital 

(inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor's office, self-help group, or prison/ 

jail. Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Prescription 

drug misuse includes the misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. 

b

A specialty facility includes a hospital (inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center.
 

c

All race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included.
 

d

County type was determined according to the “Rural-Urban Continuum Codes,” a product of the U.S. Department of Agriculture:
 

https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. 

86 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3A
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related hospitalizations by selected substances, all intentsc— United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 326,200 98.1 0.67 91,840 26.6 0.26 22,360 7.0 0.14 5,675 1.6 0.05 65,110 18.4 0.19 20,090 6.1 0.15 17,725 5.7 0.12 Sex Male 145,750 89.3 0.75 44,420 26.7 0.34 15,525 9.7 0.21 2,935 1.7 0.08 26,890 15.8 0.24 13,425 8.2 0.23 11,285 7.2 0.19 Female 180,450 106.8 0.85 47,420 26.3 0.32 6,835 4.3 0.13 2,740 1.6 0.07 38,220 20.7 0.27 6,665 4.1 0.14 6,440 4.1 0.13 Age Groups

l l l l l l l l l 0–14 9,380 15.4 0.87 640 1.0 0.11 600 1.0 0.11 410 0.7 0.08

 15–19 22,880 108.2 3.15 2,005 9.5 0.50 435 2.1 0.21 145 0.7 0.13 1,445 6.8 0.43 345 1.6 0.20 925 4.4 0.34

 20–24 26,495 118.4 2.30 6,245 27.9 0.92 3,410 15.2 0.65 300 1.3 0.18 2,685 12.0 0.55 1,395 6.2 0.39 1,855 8.3 0.47

 25–34 53,380 119.2 2.08 15,530 34.7 0.85 8,035 17.9 0.59 965 2.2 0.16 6,935 15.5 0.48 3,775 8.4 0.38 5,215 11.6 0.44

 35–44 49,265 121.5 2.12 12,840 31.7 0.80 4,195 10.3 0.45 885 2.2 0.17 8,005 19.7 0.57 3,915 9.7 0.45 4,015 9.9 0.43

 45–54 58,065 135.6 2.33 17,140 40.0 0.89 3,350 7.8 0.44 1,180 2.8 0.20 12,940 30.2 0.7 5,610 13.1 0.76 3,115 7.3 0.45

 55–64 53,780 129.7 2.07 20,205 48.7 1.01 2,400 5.8 0.34 1,440 3.5 0.23 16,575 40.0 0.85 4,115 9.9 0.62 1,715 4.1 0.29

≥ 65 52,955 107.5 1.58 17,235 35.0 0.75 530 1.1 0.11 715 1.5 0.13 15,925 32.3 0.71 885 1.8 0.16 475 1.0 0.10 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

87 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3A
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related hospitalizations by selected substances, all intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

Region Northeast 57,355 97.3 1.62 16,945 28.4 0.65 6,440 11.5 0.42 1,260 2.0 0.15 9,575 15.4 0.41 5,750 9.9 0.56 1,195 2.3 0.15 Midwest 77,200 113.0 1.65 21,240 30.0 0.65 6,460 9.8 0.39 1,120 1.6 0.12 14,005 19.1 0.43 3,905 5.7 0.26 3,115 4.9 0.23 South 129,100 102.5 1.11 36,010 27.5 0.41 6,640 5.5 0.19 2,025 1.6 0.08 27,825 20.8 0.33 8,820 7.1 0.25 6,505 5.6 0.18 

West 62,545 79.1 1.16 17,645 21.3 0.43 2,820 3.6 0.17 1,270 1.5 0.10 13,705 16.4 0.37 1,615 2.0 0.13 6,910 9.0 0.35 

Patient Residence 

Large central 94,070 91.3 1.45 26,270 24.7 0.52 7,360 7.0 0.27 2,040 1.9 0.11 17,380 16.3 0.37 9,095 8.6 0.37 5,075 5.0 0.20 metropolitan 

Large fringe 74,645 90.2 1.41 22,665 26.8 0.56 6,710 8.7 0.31 1,120 1.3 0.09 15,140 17.1 0.39 4,265 5.3 0.23 3,065 4.0 0.19 metropolitan 

Medium metropolitan 75,170 109.7 2.24 21,265 29.9 0.75 4,730 7.2 0.32 1,185 1.7 0.13 15,575 21.3 0.56 3,835 5.8 0.28 4,200 6.5 0.31 

Small metropolitan 33,690 113.4 2.95 8,695 28.0 0.95 1,610 5.7 0.38 470 1.5 0.17 6,695 21.1 0.77 1,125 3.9 0.31 2,195 7.9 0.54 

Micropolitan 28,100 102.3 1.96 7,535 25.7 0.77 1,195 4.9 0.34 385 1.3 0.16 6,000 19.7 0.65 760 3.0 0.28 1,605 6.5 0.39 

Noncore 17,500 92.8 2.22 4,615 22.8 0.89 395 2.5 0.30 370 2.0 0.25 3,940 18.8 0.77 450 2.6 0.31 1,105 7.0 0.53 

m m m m m m m m m m m m m m Unknown 3,025 795 360 105 380 560 480 

Abbreviations: No., number; SE, standard error. 

aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

88 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3B
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related hospitalizations by selected substances, unintentional and undetermined intentsc — United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf Methadone poisoningsg Poisonings by other opioidsh Cocaine poisoningsi Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 193,150 56.2 0.43 73,650 21.1 0.22 19,325 6.0 0.12 4,810 1.4 0.05 50,515 14.0 0.16 17,620 5.3 0.14 14,005 4.4 0.11 Sex Male 97,320 58.9 0.57 36,880 22.0 0.31 13,525 8.4 0.19 2,595 1.5 0.07 21,545 12.6 0.21 11,975 7.3 0.22 9,450 6.0 0.17 Female 95,830 53.2 0.49 36,770 19.9 0.27 5,800 3.6 0.12 2,215 1.2 0.06 28,970 15.2 0.22 5,645 3.4 0.13 4,555 2.9 0.10 Age Groups

l l l l l l l l l 0–14 4,765 7.8 0.50 465 0.8 0.09 425 0.7 0.09 310 0.5 0.07

 15–19 5,190 24.5 0.93 900 4.3 0.33 370 1.7 0.20 85 0.4 0.10 455 2.2 0.24 300 1.4 0.19 430 2.0 0.23 20–24 11,385 50.9 1.27 4,715 21.1 0.79 2,995 13.4 0.61 260 1.2 0.17 1,590 7.1 0.42 1,180 5.3 0.35 1,395 6.2 0.40 25–34 28,030 62.6 1.26 12,040 26.9 0.72 6,805 15.2 0.52 795 1.8 0.14 4,745 10.6 0.38 3,145 7.0 0.34 4,005 8.9 0.38 35–44 25,860 63.8 1.29 9,715 24.0 0.68 3,650 9.0 0.41 740 1.8 0.16 5,560 13.7 0.47 3,285 8.1 0.42 3,215 7.9 0.40 45–54 33,935 79.3 1.63 13,125 30.7 0.78 2,865 6.7 0.41 1,010 2.4 0.18 9,495 22.2 0.59 4,995 11.7 0.73 2,645 6.2 0.42 55–64 38,845 93.7 1.69 17,135 41.3 0.91 2,135 5.1 0.32 1,245 3.0 0.21 13,900 33.5 0.77 3,825 9.2 0.60 1,575 3.8 0.28

≥ 65 45,140 91.6 1.42 15,555 31.6 0.70 500 1.0 0.11 630 1.3 0.13 14,345 29.1 0.67 845 1.7 0.16 430 0.9 0.10 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

b In-hospital deaths and patients who transferred from another hospital were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

c Includes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

d Includes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. e Includes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. f Includes ICD-10-CM/PCS code T40.1. 

g Includes ICD-10-CM/PCS code T40.3. h Includes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. j Includes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard 

population using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

m Rates cannot be calculated based on the available data. 

89 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3B
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related hospitalizations by selected substances, unintentional and undeter­ mined intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf Methadone poisoningsg Poisonings by other opioidsh Cocaine poisoningsi Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

Region Northeast 35,635 58.6 1.17 13,915 23.0 0.57 5,610 10.0 0.37 1,090 1.7 0.14 7,525 11.9 0.36 5,170 8.8 0.54 850 1.6 0.13 Midwest 41,325 58.0 0.97 16,605 23.1 0.56 5,540 8.4 0.36 915 1.3 0.10 10,405 13.8 0.35 3,350 4.8 0.24 2,185 3.4 0.20 South 78,705 60.5 0.70 29,025 21.9 0.35 5,725 4.7 0.17 1,710 1.3 0.08 21,945 16.1 0.28 7,665 6.2 0.23 5,000 4.3 0.16 

West 37,485 46.2 0.77 14,105 16.9 0.38 2,450 3.1 0.16 1,095 1.3 0.09 10,640 12.5 0.32 1,435 1.8 0.12 5,970 7.8 0.33 

Patient Residence 

Large central metropolitan 60,060 57.3 1.00 21,540 20.1 0.46 6,515 6.2 0.25 1,795 1.7 0.10 13,665 12.7 0.31 8,240 7.8 0.35 4,235 4.2 0.19 

Large fringe metropolitan 44,690 52.5 0.88 18,320 21.4 0.48 5,755 7.5 0.27 910 1.1 0.08 11,875 13.2 0.33 3,710 4.6 0.21 2,345 3.0 0.16 

Medium metropolitan 42,350 59.5 1.25 16,690 23.1 0.62 4,000 6.1 0.28 1,025 1.5 0.12 11,830 15.8 0.46 3,275 4.9 0.25 3,250 5.0 0.27 Small metropolitan 17,975 57.8 1.63 6,775 21.5 0.79 1,335 4.8 0.35 385 1.2 0.15 5,095 15.7 0.63 920 3.2 0.27 1,675 6.0 0.48 Micropolitan 15,655 53.6 1.20 5,915 19.7 0.65 1,040 4.3 0.31 300 1.0 0.14 4,605 14.6 0.54 590 2.3 0.24 1,255 5.0 0.35 Noncore 10,350 50.3 1.43 3,705 17.7 0.76 365 2.3 0.29 295 1.6 0.23 3,115 14.2 0.65 390 2.2 0.27 825 5.2 0.45 

m m m m m m m m m m m m m m Unknown 2,070 705 315 100 330 495 420 

Abbreviations: No., number; SE, standard error. 

aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional informati1on. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

90 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3C
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related emergency department visits by selected substances, all intentsc United States, 2016 —

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 577,794 183.2 3.31 197,970 62.0 2.37 123,272 39.1 1.94 3,434 1.0 0.05 72,065 22.1 0.52 8,617 2.7 0.11 16,341 5.3 0.15 Sex Male 290,607 184.2 4.04 124,643 78.2 3.18 84,453 53.3 2.59 1,810 1.1 0.08 38,967 24.2 0.72 5,654 3.6 0.15 10,268 6.7 0.23 Female 287,187 182.4 2.85 73,328 45.7 1.62 38,819 24.9 1.33 1,625 1.0 0.06 33,099 19.9 0.42 2,963 1.9 0.10 6,073 4.0 0.13 Age Groups

l l l 0–14 77,450 127.0 5.89 2,716 4.5 0.32 114 0.2 0.04 2,533 4.2 0.29 62 0.1 0.03 1,810 3.0 0.19

 15–19 63,321 299.4 10.66 6,130 29.0 1.52 2,548 12.0 1.11 80 0.4 0.09 3,497 16.5 0.85 409 1.9 0.22 1,673 7.9 0.47 20–24 68,156 304.5 14.08 29,350 131.1 9.77 21,603 96.5 8.18 298 1.3 0.21 7,594 33.9 2.04 1,200 5.4 0.48 2,504 11.2 0.71 25–34 133,555 298.3 16.51 71,975 160.8 13.35 53,291 119.0 11.10 802 1.8 0.19 18,324 40.9 2.59 2,828 6.3 0.51 5,219 11.7 0.66 35–44 81,061 199.9 10.13 36,385 89.7 7.56 23,962 59.1 6.02 549 1.4 0.14 12,078 29.8 1.77 1,841 4.5 0.39 2,876 7.1 0.53 45–54 66,409 155.1 6.41 25,939 60.6 4.41 13,799 32.2 3.32 698 1.6 0.21 11,489 26.8 1.32 1,454 3.4 0.30 1,589 3.7 0.35 55–64 46,682 112.5 4.08 17,219 41.5 2.63 6,988 16.8 1.80 608 1.5 0.21 9,668 23.3 1.09 738 1.8 0.21 512 1.2 0.15

≥ 65 41,161 83.5 2.46 8,256 16.8 0.67 1,031 2.1 0.26 284 0.6 0.08 6,882 14.0 0.55 86 0.2 0.04 158 0.3 0.07 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample 

(NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

91 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3C
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related emergency department visits by selected substances, all intentsc United States, 2016 —

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

Region Northeast 103,639 191.0 8.49 49,338 89.8 6.32 35,202 64.7 5.26 631 1.1 0.11 13,717 24.5 1.42 1,752 3.2 0.25 1,077 2.1 0.16 Midwest 149,216 228.6 9.10 56,896 87.4 6.80 38,858 60.3 5.46 596 0.9 0.10 17,638 26.5 1.51 1,673 2.6 0.22 3,656 5.8 0.31 South 206,343 173.0 5.66 65,632 54.4 4.13 38,145 32.2 3.40 1,178 1.0 0.08 26,712 21.6 0.85 4,042 3.4 0.22 5,703 5.0 0.19 

West 118,597 156.0 3.68 26,105 33.1 1.51 11,067 14.2 1.09 1,029 1.3 0.14 13,999 17.7 0.56 1,150 1.5 0.14 5,906 7.8 0.46 

Patient Residence 

Large central metropolitan 159,308 159.7 4.93 48,726 46.8 2.41 29,267 28.0 1.89 1,322 1.2 0.11 18,318 17.7 0.67 2,752 2.7 0.19 4,795 4.8 0.27 

Large fringe metropolitan 127,661 166.0 6.69 55,351 72.4 5.00 37,490 49.8 4.09 539 0.7 0.07 17,524 22.2 1.18 1,845 2.4 0.19 2,434 3.3 0.19 

Medium metropolitan 135,762 207.8 9.91 51,675 79.3 7.72 33,899 52.8 6.30 652 1.0 0.09 17,387 25.9 1.56 2,341 3.6 0.28 3,190 5.0 0.26 

Small metropolitan 56,864 200.6 8.06 15,118 53.3 4.30 8,457 30.5 3.45 327 1.1 0.15 6,361 21.8 1.11 615 2.3 0.26 1,951 7.1 0.54 

Micropolitan 57,860 225.2 6.99 16,729 66.0 4.66 9,061 37.1 3.43 296 1.1 0.16 7,475 28.2 1.48 571 2.3 0.25 2,094 8.7 0.50 

Noncore 33,927 196.3 4.78 7,061 40.6 2.02 2,768 17.7 1.49 209 1.2 0.21 4,097 21.8 1.00 269 1.7 0.24 1,356 8.7 0.63 

m m m m m m l m m m m m m l m m Unknown 6,413 3,311 2,330 903 223 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample 

(NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

92 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3D
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related emergency department visits by selected substances, unintentional and undetermined intentsc — United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 435,983 137.2 2.94 183,147 57.3 2.33 119,465 37.9 1.91 3,038 0.9 0.05 61,318 18.7 0.5 7,399 2.4 0.10 13,131 4.3 0.14 Sex Male 243,504 154.1 3.80 117,939 73.9 3.13 81,874 51.6 2.55 1,612 1.0 0.07 34,941 21.7 0.70 4,867 3.1 0.14 8,532 5.5 0.21 Female 192,479 120.0 2.22 65,208 40.5 1.58 37,591 24.1 1.30 1,426 0.8 0.05 26,377 15.6 0.37 2,532 1.6 0.09 4,600 3.0 0.11 Age Groups

l l l 0–14 64,701 106.1 4.75 2,376 3.9 0.29 101 0.2 0.04 2,223 3.6 0.27 57 0.1 0.03 1,638 2.7 0.17

l l l 15–19 27,126 128.2 4.36 4,152 19.6 1.34 2,421 11.4 1.10 1,670 7.9 0.52 318 1.5 0.20 994 4.7 0.35

 20–24 49,091 219.3 12.12 27,254 121.8 9.55 20,910 93.4 8.01 285 1.3 0.20 6,197 27.7 1.89 1,021 4.6 0.45 2,015 9.0 0.65

 25–34 106,591 238.1 15.34 68,086 152.1 13.14 51,692 115.5 10.93 718 1.6 0.18 16,065 35.9 2.54 2,458 5.5 0.46 4,218 9.4 0.59

 35–44 61,935 152.7 9.19 33,753 83.2 7.44 23,176 57.2 5.94 446 1.1 0.12 10,299 25.4 1.70 1,570 3.9 0.36 2,330 5.7 0.48

 45–54 50,211 117.3 5.56 23,775 55.5 4.30 13,458 31.4 3.28 584 1.4 0.20 9,769 22.8 1.22 1,250 2.9 0.27 1,381 3.2 0.34

 55–64 38,332 92.4 3.58 16,017 38.6 2.57 6,765 16.3 1.77 577 1.4 0.20 8,710 21.0 1.03 652 1.6 0.20 408 1.0 0.14

≥ 65 37,997 77.1 2.29 7,734 15.7 0.65 1,009 2.0 0.26 279 0.6 0.08 6,384 13.0 0.53 72 0.1 0.04 147 0.3 0.07 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample 

(NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

93 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3D
 Estimated numbersa,b and age-adjusted rates per 100,000 population of drug poisoning-related emergency department visits by selected substances, unintentional and undetermined intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

Region Northeast 87,219 160.0 7.66 47,472 86.4 6.19 34,355 63.1 5.15 579 1.0 0.11 12,740 22.7 1.39 1,630 3.0 0.23 919 1.8 0.15 Midwest 112,195 170.8 8.22 52,998 81.4 6.68 37,571 58.3 5.36 506 0.8 0.09 15,067 22.6 1.47 1,377 2.1 0.19 2,787 4.4 0.27 South 156,672 130.5 5.07 60,496 50.1 4.07 37,005 31.2 3.36 1,019 0.8 0.07 22,819 18.4 0.81 3,404 2.9 0.20 4,387 3.8 0.16 

West 79,897 103.8 2.85 22,181 27.9 1.45 10,534 13.5 1.07 934 1.1 0.14 10,692 13.3 0.48 988 1.3 0.14 5,038 6.7 0.43 

Patient Residence 

Large central metropolitan 117,108 116.0 3.88 44,721 42.8 2.34 28,314 27.1 1.86 1,245 1.2 0.11 15,339 14.7 0.61 2,334 2.3 0.17 4,035 4.0 0.25 

Large fringe metropolitan 103,166 134.0 6.11 52,651 68.9 4.90 36,680 48.7 4.03 474 0.6 0.06 15,694 19.9 1.13 1,671 2.2 0.18 1,936 2.6 0.16 

Medium metropolitan 103,345 157.5 8.97 47,779 73.2 7.58 32,723 50.9 6.20 540 0.8 0.08 14,717 21.8 1.49 1,957 3.0 0.26 2,460 3.9 0.22 Small metropolitan 40,973 143.7 6.46 13,576 47.8 4.14 8,161 29.5 3.37 288 0.9 0.14 5,142 17.5 0.98 520 1.9 0.24 1,461 5.4 0.46 

Micropolitan 41,966 161.6 6.15 15,107 59.5 4.58 8,708 35.6 3.36 224 0.9 0.14 6,255 23.4 1.43 505 2.1 0.23 1,721 7.1 0.45 

Noncore 24,107 136.1 3.60 6,145 35.1 1.90 2,602 16.7 1.43 179 1.0 0.19 3,355 17.4 0.87 209 1.3 0.22 1,041 6.7 0.55 

m m m m m m l m m m m m m l m m Unknown 5,319 3,167 2,277 817 203 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample 

(NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits 

with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. Age-adjusted to the 2000 U.S. standard population 

using the vintage year population of the data. Rates for age groups are crude rates. 

lBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

94 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3E
 Estimated numbera,b and percentage of drug poisoning-related hospitalization and emergency department visits by primary payer, all intentsc — United States, 2016 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf Methadone poisoningsg

Hospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) 

Total 326,200 577,794 91,840 197,970 22,360 123,272 5,675 3,434 Primary Payer 

Medicare 96,935 29.7 (0.27) 80,220 13.9 (0.29) 33,350 36.3 (0.44) 22,437 11.3 (0.44) 2,335 10.4 (0.47) 7,072 5.7 (0.32) 1,765 31.1 (1.46) 651 18.9 (1.68) 

Medicaid 105,990 32.5 (0.37) 217,944 37.7 (0.96) 28,435 31.0 (0.49) 80,025 40.4 (1.88) 10,610 47.5 (0.95) 54,477 44.2 (2.47) 2,305 40.6 (1.64) 1,586 46.2 (2.64) Private 77,330 23.7 (0.32) 153,260 26.5 (0.67) 18,145 19.8 (0.38) 36,190 18.3 (0.74) 4,660 20.8 (0.78) 19,638 15.9 (0.82) 880 15.5 (1.16) 490 14.3 (1.61) Uninsured 33,980 10.4 (0.25) 101,471 17.6 (0.83) 8,925 9.7 (0.30) 50,759 25.6 (1.68) 3,960 17.7 (0.73) 36,536 29.6 (2.19) 590 10.4 (0.95) 537 15.6 (2.18) Other 11,475 3.5 (0.17) 23,774 4.1 (0.40) 2,845 3.1 (0.22) 8,276 4.2 (0.72) 735 3.3 (0.33) 5,384 4.4 (0.92) 125 2.2 (0.43) 160 4.7 (0.98) 

k k k k k k k k k k k k Unknown 490 0.2 (0.03) 140 0.2 (0.03) 

Abbreviation: No., number. ED, emergency department. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS) and 

Nationwide Emergency Department Sample (NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded from 

hospitalizations. Persons who were hospitalized, died, or transferred to another facility were excluded from ED visits. Hospitalizations and ED visits with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

95 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3E
 Estimated numbera,b and percentage of drug poisoning-related hospitalization and emergency department visits by primary payer, all intentsc — United States, 2016 

CONTINUED 

Poisonings by other opioidsh Cocaine poisoningsi Methamphetamine poisoningsjHospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits 

No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) 

Total 65,110 72,065 20,090 8,617 17,725 16,341 

Primary Payer 

Medicare 29,300 45.0 (0.49) 14,657 20.3 (0.56) 3,455 17.2 (0.61) 650 7.5 (0.67) 2,315 13.1 (0.62) 957 5.9 (0.43) 

Medicaid 16,190 24.9 (0.45) 24,296 33.7 (1.16) 9,260 46.1 (1.21) 3,340 38.8 (2.12) 7,790 43.9 (1.11) 6,660 40.8 (1.42) 

Private 12,885 19.8 (0.40) 16,147 22.4 (0.70) 2,735 13.6 (0.71) 1,528 17.7 (1.06) 3,080 17.4 (0.76) 3,751 23.0 (1.12) 

Uninsured 4,655 7.1 (0.26) 14,058 19.5 (0.91) 3,870 19.3 (1.00) 2,692 31.2 (1.94) 3,705 20.9 (0.91) 4,094 25.1 (0.97) 

Other 1,995 3.1 (0.25) 2,785 3.9 (0.45) 725 3.6 (0.56) 387 4.5 (0.85) 770 4.3 (0.41) 791 4.8 (0.63) 

k k k k k k k k Unknown 85 0.1 (0.03) 65 0.4 (0.10) 

Abbreviation: No., number. ED, emergency department. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS) and 

Nationwide Emergency Department Sample (NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded from 

hospitalizations. Persons who were hospitalized, died, or transferred to another facility were excluded from ED visits. Hospitalizations and ED visits with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those 

attributable to intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

96 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 3F
 Estimated numbera,b and percentage of drug poisoning-related hospitalization and emergency department visits by primary payer, unintentional and undetermined intentsc — United States, 2016 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf Methadone poisoningsg

Hospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) 

Total 193,150 435,983 73,650 183,147 19,325 119,465 4,810 3,038 Primary Payer 

Medicare 72,960 37.8 (0.35) 67,302 15.4 (0.38) 28,775 39.1 (0.49) 20,670 11.3 (0.46) 2,045 10.6 (0.50) 6,843 5.7 (0.33) 1,515 31.5 (1.60) 606 20.0 (1.82) 

Medicaid 58,820 30.5 (0.43) 165,796 38.0 (1.09) 22,385 30.4 (0.53) 74,743 40.8 (1.98) 9,120 47.2 (1.00) 52,858 44.2 (2.50) 2,000 41.6 (1.79) 1,418 46.7 (2.82) Private 35,770 18.5 (0.32) 103,330 23.7 (0.67) 13,155 17.9 (0.40) 31,815 17.4 (0.75) 4,055 21.0 (0.82) 18,916 15.8 (0.84) 715 14.9 (1.23) 405 13.3 (1.62) Uninsured 19,570 10.1 (0.27) 81,511 18.7 (0.99) 7,195 9.8 (0.32) 48,141 26.3 (1.77) 3,455 17.9 (0.77) 35,560 29.8 (2.22) 485 10.1 (1.02) 467 15.4 (2.30) Other 5,760 3.0 (0.16) 17,332 4.0 (0.44) 2,025 2.7 (0.19) 7,552 4.1 (0.74) 605 3.1 (0.32) 5,146 4.3 (0.91) 85 1.8 (0.42) 137 4.5 (0.98) 

k k k k k k k k k k k k Unknown 270 0.1 (0.03) 115 0.2 (0.04) 

Abbreviation: No., number. ED, emergency department. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS) and 

Nationwide Emergency Department Sample (NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded from 

hospitalizations. Persons who were hospitalized, died, or transferred to another facility were excluded from ED visits. Hospitalizations and ED visits with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

97 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

Estimated numbera,b and percent of drug poisoning-related hospitalization and emergency department visits by primary payer, unintentional and TABLE 3F undetermined intentsc — United States, 2016 

CONTINUED 

Poisonings by other opioidsh Cocaine poisoningsi Methamphetamine poisoningsj

Hospitalizations ED visits Hospitalizations ED visits Hospitalizations ED visits 

No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) No. % (SE) 

Total 50,515 61,318 17,620 7,399 14,005 13,131 

Primary Payer 

Medicare 25,195 49.9 (0.55) 13,149 21.4 (0.67) 3,045 17.3 (0.65) 533 7.2 (0.74) 1,945 13.9 (0.72) 765 5.8 (0.49) 

Medicaid 11,795 23.3 (0.50) 20,781 33.9 (1.28) 8,205 46.6 (1.28) 2,907 39.3 (2.25) 6,395 45.7 (1.23) 5,537 42.2 (1.50) Private 8,630 17.1 (0.43) 12,561 20.5 (0.70) 2,370 13.5 (0.74) 1,297 17.5 (1.14) 2,040 14.6 (0.80) 2,729 20.8 (1.13) Uninsured 3,485 6.9 (0.28) 12,433 20.3 (1.02) 3,365 19.1 (1.06) 2,352 31.8 (2.10) 3,000 21.4 (1.00) 3,409 26.0 (1.08) Other 1,340 2.7 (0.20) 2,305 3.8 (0.49) 595 3.4 (0.59) 302 4.1 (0.82) 565 4.0 (0.44) 619 4.7 (0.65) 

k k k k k k k k Unknown 70 0.1 (0.04) 60 0.4 (0.12) 

Abbreviation: No., number. ED, emergency department. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS) and 

Nationwide Emergency Department Sample (NEDS), 2016, Agency for Healthcare Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded from 

hospitalizations. Persons who were hospitalized, died, or transferred to another facility were excluded from ED visits. Hospitalizations and ED visits with missing age and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings 

attributable to intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kBecause the relative standard error was > 30% or the standard error = 0, the value of the 

estimate was considered unreliable and was not reported. 

98 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

TABLE 4A
 

Number and age-adjusted ratesa per 100,000 population of overall drug overdose 

deathsb and drug overdose deaths involving any type of opioid, by sex, age group, 

race/ethnicity, census region, urbanization, and intent — United States, 2017 

Socio-demographic characteristic 

Drug overdose deaths, overall 

Drug overdose deaths 

involving any opioidc

Number Rate SE Number Rate SE 

All 70,237 21.7 0.084 47,600 14.9 0.069 

Sex

 Male 46,552 29.1 0.137 32,337 20.4 0.115

 Female 23,685 14.4 0.096 15,263 9.4 0.077 

Age group (years)

 0–14 147 0.2 0.020 79 0.1 0.015

 15–19 822 3.9 0.136 507 2.4 0.107

 20–24 4,633 20.9 0.308 3,587 16.2 0.271

 25–34 17,400 38.4 0.291 13,181 29.1 0.253

 35–44 15,949 39.0 0.309 11,149 27.3 0.258

 45–54 15,996 37.7 0.298 10,207 24.1 0.238

 55–64 11,747 28.0 0.258 7,153 17.0 0.201

≥ 65 3,529 6.9 0.117 1,724 3.4 0.082 

Race/ethnicityd

White, non-Hispanic 53,516 27.5 0.123 37,113 19.4 0.104

 Black, non-Hispanic 8,832 20.6 0.223 5,513 12.9 0.177 

Asian/Pacific Islander, non-Hispanic 756 3.5 0.129 348 1.6 0.086 

American Indian/Alaska Native, 672 25.7 1.012 408 15.7 0.792 non-Hispanic 

Hispanic 5,988 10.6 0.139 3,932 6.8 0.111 

U.S. Census region of residencee

 Northeast 16,579 29.8 0.237 11,784 21.3 0.201

 Midwest 16,679 25.4 0.201 12,483 19.1 0.175

 South 25,272 20.7 0.132 16,999 14.1 0.110 

West 11,707 14.7 0.138 6,334 8.0 0.102 

Source: National Vital Statistics System, Mortality File. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. 

standard population using the vintage year population of the 

data year. Rates are suppressed when based on <20 deaths. 

Rates for age groups are crude rates (deaths per 100,000 

population). 

b

Deaths are classified using the International Classification of 

Diseases, Tenth Revision (ICD–10). Drug overdose deaths are 

identified using underlying cause-of-death codes X40–X44 

(unintentional), X60–X64 (suicide), X85 (homicide), and 

Y10–Y14 (undetermined). Because deaths might involve 

more than one drug, some deaths are included in more than 

one category. On death certificates, the specificity of drugs 

involved with deaths varies over time. In 2017, approximately 

12% of drug overdose deaths did not include information on 

the specific type of drug(s) involved. 

c

Drug overdose deaths, as defined using ICD-10 codes, that 

involve opium (T40.0), heroin (T40.1), natural and semisynthetic opioids (T40.2), methadone (T40.3), synthetic 

opioids other than methadone (T40.4) and other and 

unspecified narcotics (T40.6). 

d

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. Potential race misclassification might lead 

to underestimates for certain categories, primarily American 

Indian/Alaska Native non-Hispanic and Asian/Pacific Islander 

non-Hispanic decedents. https://www.cdc.gov/nchs/data/ 

series/sr_02/sr02_172.pdf. e

Census regions are defined by the following jurisdictions: 

Region 1 (Northeast): Connecticut, Maine, Massachusetts, 

New Hampshire, New Jersey, New York, Pennsylvania, Rhode 

Island, and Vermont; Region 2 (Midwest): Illinois, Indiana, 

Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North 

Dakota, Ohio, South Dakota, and Wisconsin; Region 3 (South): 

Alabama, Arkansas, Delaware, District of Columbia, Florida, 

Georgia, Kentucky, Louisiana, Maryland, Mississippi, North 

Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, 

and West Virginia; Region 4 (West): Alaska, Arizona, California, 

Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, 

Oregon, Utah, Washington, and Wyoming. 

f

Categories of 2013 NCHS Urban-Rural Classification Scheme 

for Counties. 

99 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

TABLE 4A 

Number and age-adjusted ratesa per 100,000 population of overall drug overdose 

deathsb and drug overdose deaths involving any type of opioid, by sex, age group, 

race/ethnicity, census region, urbanization, and intent — United States, 2017 

CONTINUED 

Socio-demographic characteristic 

Drug overdose deaths, overall 

Drug overdose deaths 

involving any opioidc 

Number Rate SE Number Rate SE 

2013 Urbanizationf

 Large central metropolitan 21,219 20.2 0.141 14,518 13.9 0.117

 Large fringe metropolitan 18,897 23.7 0.175 13,594 17.2 0.150

 Medium metropolitan 15,875 24.1 0.196 10,561 16.2 0.161

 Small metropolitan 5,721 20.5 0.279 3,560 12.9 0.222

 Micropolitan 5,386 21.3 0.298 3,462 13.9 0.243

 Noncore 3,139 18.2 0.337 1,905 11.2 0.265 

Intent

 Unintentional 61,311 19.1 0.078 43,036 13.5 0.066

 Undetermined 3,687 1.1 0.019 2,586 0.8 0.016

 Suicide 5,097 1.5 0.021 1,884 0.5 0.012 

Source: National Vital Statistics System, Mortality File. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. 

standard population using the vintage year population of 

the data year. Rates are suppressed when based on <20 

deaths. Rates for age groups are crude rates (deaths per 

100,000 population). 

b

Deaths are classified using the International Classification 

of Diseases, Tenth Revision (ICD–10). Drug overdose 

deaths are identified using underlying cause-of-death 

codes X40–X44 (unintentional), X60–X64 (suicide), X85 

(homicide), and Y10–Y14 (undetermined). Because deaths 

might involve more than one drug, some deaths are 

included in more than one category. On death certificates, 

the specificity of drugs involved with deaths varies over 

time. In 2017, approximately 12% of drug overdose deaths 

did not include information on the specific type of drug(s) 

involved. 

c

Drug overdose deaths, as defined using ICD-10 codes, that 

involve opium (T40.0), heroin (T40.1), natural and semisynthetic opioids (T40.2), methadone (T40.3), synthetic 

opioids other than methadone (T40.4) and other and 

unspecified narcotics (T40.6). 

d

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. Potential race misclassification might 

lead to underestimates for certain categories, primarily 

American Indian/Alaska Native non-Hispanic and Asian/ 

Pacific Islander non-Hispanic decedents. https://www.cdc. 

gov/nchs/data/series/sr_02/sr02_172.pdf. e

Census regions are defined by the following jurisdictions: 

Region 1 (Northeast): Connecticut, Maine, Massachusetts, 

New Hampshire, New Jersey, New York, Pennsylvania, 

Rhode Island, and Vermont; Region 2 (Midwest): Illinois, 

Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, 

Nebraska, North Dakota, Ohio, South Dakota, and 

Wisconsin; Region 3 (South): Alabama, Arkansas, Delaware, 

District of Columbia, Florida, Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North Carolina, Oklahoma, South 

Carolina, Tennessee, Texas, Virginia, and West Virginia; 

Region 4 (West): Alaska, Arizona, California, Colorado, 

Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, 

Utah, Washington, and Wyoming. 

f

Categories of 2013 NCHS Urban-Rural Classification Scheme 

for Counties. 

100 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 4B
 Number and age-adjusted ratesa per 100,000 population of drug overdose deathsb involving selected opioids by sex, age group, race/ethnicity, census 

region, urbanization, and intent — United States, 2017 

Prescription opioidsc

Natural and semi-synthetic opioidsd Methadonee Heroinf

Synthetic opioids other than methadoneg

Number Rate SE Number Rate SE Number Rate SE Number Rate SE Number Rate SE 

All 17,029 5.2 0.041 14,495 4.4 0.037 3,194 1.0 0.018 15,482 4.9 0.040 28,466 9.0 0.054 

Sex 

Male 9,873 6.1 0.063 8,398 5.2 0.058 1,867 1.1 0.027 11,596 7.3 0.069 20,524 13.0 0.092 

Female 7,156 4.2 0.052 6,097 3.6 0.047 1,327 0.8 0.022 3,886 2.5 0.040 7,942 5.0 0.057 

Age group (years) 

h h h 0–14 50 0.1 0.012 36 0.1 0.010 16 33 0.1 0.009 

15–19 154 0.7 0.059 124 0.6 0.053 33 0.2 0.027 140 0.7 0.056 312 1.5 0.084 

20–24 896 4.1 0.135 786 3.6 0.127 132 0.6 0.052 1,314 5.9 0.164 2,343 10.6 0.219 

25–34 3,408 7.5 0.129 2,854 6.3 0.118 665 1.5 0.057 4,890 10.8 0.154 8,825 19.5 0.207 

35–44 3,714 9.1 0.149 3,129 7.7 0.137 743 1.8 0.067 3,713 9.1 0.149 7,084 17.3 0.206 45–54 4,238 10.0 0.154 3,659 8.6 0.143 746 1.8 0.064 3,043 7.2 0.130 5,762 13.6 0.179 55–64 3,509 8.4 0.141 2,965 7.1 0.130 710 1.7 0.063 2,005 4.8 0.107 3,481 8.3 0.140 ≥ 65 1,055 2.1 0.064 937 1.8 0.060 149 0.3 0.024 368 0.7 0.038 620 1.2 0.049 

Race/ethnicityi

White, non-Hispanic 13,900 6.9 0.061 11,921 5.9 0.056 2,488 1.2 0.026 11,293 6.1 0.059 21,956 11.9 0.082 

Black, non-Hispanic 1,508 3.5 0.093 1,247 2.9 0.084 330 0.7 0.042 2,140 4.9 0.109 3,832 9.0 0.147 

Asian/Pacific Islander, non-Hispanic 130 0.6 0.052 117 0.5 0.050 17 h 119 0.5 0.050 189 0.8 0.062 

American Indian/Alaska Native, non-Hispanic 187 7.2 0.540 147 5.7 0.483 47 1.8 0.261 136 5.2 0.458 171 6.5 0.507 

Hispanic 1,211 2.2 0.063 994 1.8 0.057 284 0.5 0.031 1,669 2.9 0.072 2,152 3.7 0.081 

Source: National Vital Statistics System, Mortality File. Abbreviation: SE, standard error. aRate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year 

population of the data year. Rates are suppressed when based on <20 deaths. Rates for age groups are crude rates (deaths per 100,000 population). 

bDeaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug 

overdose deaths are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Because deaths might involve more than one drug, some deaths are included in more than one category. On death certificates, the specificity of drugs involved with deaths varies over time. In 2017, approximately 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. 

cDrug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) and methadone 

(T40.3). 

dDrug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2). eDrug overdose deaths, as defined, that involve methadone (T40.3). fDrug overdose deaths, as defined, that involve heroin (T40.1). 

gDrug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). hCells with nine or fewer deaths are not reported. Rates based on <20 deaths are not considered reliable and 

not reported. 

iData 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. Potential race and ethnicity misclassification might lead to underestimates for certain categories, primarily American Indian/Alaska Native, non-Hispanic and Asian/Pacific Islander non-Hispanic decedents. https://www.cdc. gov/nchs/data/series/sr_02/sr02_172.pdf. 

jCensus regions are defined by the following jurisdictions: Region 1 (Northeast): Connecticut, Maine, 

Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Region 2 (Midwest): Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Region 3 (South): Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; Region 4 (West): Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 

kCategories of 2013 NCHS Urban-Rural Classification Scheme for Counties 

101 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

TABLE 4B
 Number and age-adjusted ratesa per 100,000 population of drug overdose deathsb involving selected opioids by sex, age group, race/ethnicity, census 

region, urbanization, and intent — United States, 2017 

CONTINUED 

Prescription opioidsc 

Natural and semi-synthetic opioidsd Methadonee Heroinf 

Synthetic opioids other than methadoneg 

Number Rate SE Number Rate SE Number Rate SE Number Rate SE Number Rate SE 

 Census region of residence U.S. j

Northeast 3,047 5.3 0.099 2,478 4.3 0.089 692 1.2 0.046 4,310 7.8 0.122 8,861 16.2 0.176 

Midwest 3,702 5.5 0.093 3,175 4.7 0.086 641 1.0 0.039 4,228 6.5 0.102 8,234 12.8 0.143 

South 6,929 5.6 0.069 6,032 4.9 0.064 1,148 0.9 0.028 4,776 4.0 0.059 9,906 8.3 0.085 

West 3,351 4.1 0.073 2,810 3.5 0.067 713 0.9 0.034 2,168 2.8 0.061 1,465 1.9 0.050 

2013 Urbanizationk

Large central metropolitan 4,945 4.7 0.068 4,029 3.8 0.061 1,123 1.1 0.032 5,820 5.6 0.074 8,511 8.2 0.090 

Large fringe metropolitan 4,273 5.2 0.082 3,669 4.5 0.075 782 1.0 0.035 4,526 5.8 0.088 8,991 11.6 0.124 

Medium metropolitan 3,951 5.9 0.096 3,384 5.0 0.089 688 1.0 0.040 2,973 4.6 0.087 6,254 9.8 0.126 

Small metropolitan 1,479 5.2 0.140 1,287 4.5 0.130 249 0.9 0.060 972 3.6 0.117 1,878 7.0 0.164 

Micropolitan 1,440 5.6 0.152 1,296 5.0 0.144 204 0.8 0.060 801 3.3 0.118 1,860 7.7 0.181 

Noncore 941 5.3 0.179 830 4.6 0.167 148 0.9 0.074 390 2.4 0.126 972 6.0 0.196 

Intent 

Unintentional 14,502 4.4 0.038 12,255 3.8 0.035 2,831 0.9 0.016 14,762 4.6 0.039 26,211 8.3 0.052 

Undetermined 1,076 0.3 0.010 869 0.3 0.009 265 0.1 0.005 573 0.2 0.007 1,707 0.5 0.013 

Suicide 1,425 0.4 0.010 1,349 0.4 0.010 93 0.01 0.002 121 0.03 0.004 484 0.2 0.007 

Source: National Vital Statistics System, Mortality File. Abbreviation: SE, standard error. aRate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year 

population of the data year. Rates are suppressed when based on <20 deaths. Rates for age groups are crude rates (deaths per 100,000 population). 

bDeaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug 

overdose deaths are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Because deaths might involve more than one drug, some deaths are included in more than one category. On death certificates, the specificity of drugs involved with deaths varies over time. In 2017, approximately 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. 

cDrug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) and methadone 

(T40.3). 

dDrug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2). eDrug overdose deaths, as defined, that involve methadone (T40.3). fDrug overdose deaths, as defined, that involve heroin (T40.1). 

gDrug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). hCells with nine or fewer deaths are not reported. Rates based on <20 deaths are not considered reliable and 

not reported. 

iData 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. Potential race and ethnicity misclassification might lead to underestimates for certain categories, primarily American Indian/Alaska Native, non-Hispanic and Asian/Pacific Islander non-Hispanic decedents. https://www.cdc. gov/nchs/data/series/sr_02/sr02_172.pdf. 

jCensus regions are defined by the following jurisdictions: Region 1 (Northeast): Connecticut, Maine, 

Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Region 2 (Midwest): Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Region 3 (South): Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; Region 4 (West): Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 

kCategories of 2013 NCHS Urban-Rural Classification Scheme for Counties 

102 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

 

 

 

 

 

 

 

TABLE 4C
 

Number and age-adjusted ratesa per 100,000 population of drug overdose deathsb

involving cocaine and other psychostimulants with abuse potential by sex, age group, 

race/ethnicity, census region, urbanization, and intent — United States, 2017 

Drug overdose deaths involving: 

Socio-demographic characteristic 

Cocainec Psychostimulants with abuse potentiald

Number Rate SE Number Rate SE 

All 13,942 4.3 0.037 10,333 3.2 0.032 

Sex 

Male 10,021 6.2 0.064 7,240 4.5 0.054 

Female 3,921 2.5 0.040 3,093 1.9 0.036 

Age group (years) 

e e e e 0–14 

15–19 111 0.5 0.050 108 0.5 0.049 

20–24 813 3.7 0.129 672 3.0 0.117 

25–34 3,463 7.6 0.130 2,593 5.7 0.112 

35–44 3,282 8.0 0.140 2,548 6.2 0.123 

45–54 3,497 8.3 0.140 2,477 5.8 0.117 

55–64 2,335 5.6 0.115 1,648 3.9 0.097 

≥ 65 432 0.8 0.041 278 0.5 0.033 

Race/ethnicityf

White, non-Hispanic 8,614 4.6 0.051 7,995 4.2 0.048 

Black, non-Hispanic 3,554 8.3 0.141 663 1.6 0.062 

Asian/Pacific Islander, non-Hispanic 129 0.6 0.053 218 1.0 0.068 

American Indian/Alaska Native, 65 2.4 0.311 222 8.5 0.585 non-Hispanic 

Hispanic 1,438 2.5 0.067 1,125 2.0 0.060 

Source: National Vital Statistics System, Mortality File. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. 

standard population using the vintage year population of 

the data year. Rates are suppressed when based on <20 

deaths. Rates for age groups are crude rates (deaths per 

100,000 population). 

b

Deaths are classified using the International Classification 

of Diseases, Tenth Revision (ICD–10). Drug overdose 

deaths are identified using underlying cause-of-death 

codes X40–X44 (unintentional), X60–X64 (suicide), X85 

(homicide), and Y10–Y14 (undetermined). Because deaths 

might involve more than one drug, some deaths are 

included in more than one category. On death certificates, 

the specificity of drugs involved with deaths varies over 

time. In 2017, approximately 12% of drug overdose deaths 

did not include information on the specific type of drug(s) 

involved. 

c

Drug overdose deaths, as defined, that involve cocaine 

(T40.5). 

d

Drug overdose deaths, as defined, that involve 

psychostimulants with abuse potential (T43.6). 

e

Cells with nine or fewer deaths are not reported. Rates 

based on <20 deaths are not considered reliable and not 

reported. 

f

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. Potential race and ethnicity 

misclassification might lead to underestimates for certain 

categories, primarily American Indian/Alaska Native 

non-Hispanic and Asian/Pacific Islander non-Hispanic 

decedents. https://www.cdc.gov/nchs/data/series/sr_02/ 

sr02_172.pdf. g

Census regions are defined by the following jurisdictions: 

Region 1 (Northeast): Connecticut, Maine, Massachusetts, 

New Hampshire, New Jersey, New York, Pennsylvania, 

Rhode Island, and Vermont; Region 2 (Midwest): Illinois, 

Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, 

Nebraska, North Dakota, Ohio, South Dakota, and 

Wisconsin; Region 3 (South): Alabama, Arkansas, Delaware, 

District of Columbia, Florida, Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North Carolina, Oklahoma, South 

Carolina, Tennessee, Texas, Virginia, and West Virginia; 

Region 4 (West): Alaska, Arizona, California, Colorado, 

Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, 

Utah, Washington, and Wyoming. 

h

Categories of 2013 NCHS Urban-Rural Classification Scheme 

for Counties. 

103 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

TABLE 4C 

Number and age-adjusted ratesa per 100,000 population of drug overdose deathsb 

involving cocaine and other psychostimulants with abuse potential by sex, age group, 

race/ethnicity, census region, urbanization, and intent — United States, 2017 

CONTINUED 

Drug overdose deaths involving: 

Socio-demographic characteristic 

Cocainec Psychostimulants with abuse potentiald 

Number Rate SE Number Rate SE 

U.S. Census region of residenceg

Northeast 3,860 7.0 0.115 648 1.2 0.049 

Midwest 3,711 5.6 0.095 1,959 3.1 0.071 

South 5,365 4.4 0.061 3,508 3.0 0.051 

West 1,006 1.3 0.041 4,218 5.3 0.084 

2013 Urbanizationh

Large central metropolitan 5,513 5.3 0.072 3,178 3.0 0.055 

Large fringe metropolitan 3,701 4.7 0.078 1,843 2.3 0.055 

Medium metropolitan 2,945 4.5 0.085 2,672 4.1 0.081 

Small metropolitan 777 2.9 0.106 972 3.6 0.118 

Micropolitan 740 3.0 0.113 994 4.0 0.130 

Noncore 266 1.6 0.104 674 4.1 0.162 

Intent 

Unintentional 13,253 4.1 0.037 9,786 3.1 0.032 

Undetermined 558 0.2 0.008 269 0.1 0.006 

Suicide 120 0.04 0.004 249 0.1 0.006 

Source: National Vital Statistics System, Mortality File. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. 

standard population using the vintage year population of 

the data year. Rates are suppressed when based on <20 

deaths. Rates for age groups are crude rates (deaths per 

100,000 population). 

b

Deaths are classified using the International Classification 

of Diseases, Tenth Revision (ICD–10). Drug overdose 

deaths are identified using underlying cause-of-death 

codes X40–X44 (unintentional), X60–X64 (suicide), X85 

(homicide), and Y10–Y14 (undetermined). Because deaths 

might involve more than one drug, some deaths are 

included in more than one category. On death certificates, 

the specificity of drugs involved with deaths varies over 

time. In 2017, approximately 12% of drug overdose deaths 

did not include information on the specific type of drug(s) 

involved. 

c

Drug overdose deaths, as defined, that involve cocaine 

(T40.5). 

d

Drug overdose deaths, as defined, that involve 

psychostimulants with abuse potential (T43.6). 

e

Cells with nine or fewer deaths are not reported. Rates 

based on <20 deaths are not considered reliable and not 

reported. 

f

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. Potential race and ethnicity 

misclassification might lead to underestimates for certain 

categories, primarily American Indian/Alaska Native 

non-Hispanic and Asian/Pacific Islander non-Hispanic 

decedents. https://www.cdc.gov/nchs/data/series/sr_02/ 

sr02_172.pdf. g

Census regions are defined by the following jurisdictions: 

Region 1 (Northeast): Connecticut, Maine, Massachusetts, 

New Hampshire, New Jersey, New York, Pennsylvania, 

Rhode Island, and Vermont; Region 2 (Midwest): Illinois, 

Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, 

Nebraska, North Dakota, Ohio, South Dakota, and 

Wisconsin; Region 3 (South): Alabama, Arkansas, Delaware, 

District of Columbia, Florida, Georgia, Kentucky, Louisiana, 

Maryland, Mississippi, North Carolina, Oklahoma, South 

Carolina, Tennessee, Texas, Virginia, and West Virginia; 

Region 4 (West): Alaska, Arizona, California, Colorado, 

Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, 

Utah, Washington, and Wyoming. 

h

Categories of 2013 NCHS Urban-Rural Classification Scheme 

for Counties. 

104 
FIGURES
 

 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

FIGURE 1A
 Trends in opioid prescriptions filled 

Rates for overall annual opioid prescriptions filled per 100 persons and for high-dosage prescriptions 

(≥ 90 morphine milligram equivalent [MME]/day)a — United States, 2006-2018 

Source: : IQVIATM Xponent 2006-2018. Data extracted in 2019. (Supplemental Table 1a). 

a

High-dosage prescriptions were defined as opioid prescriptions filled resulting in a daily dosage of ≥ 90 morphine milligram 

equivalents. 

b

Temporal trends from 2006 to 2018 were evaluated by applying joinpoint regression methodology. This modeling approach 

simultaneously identified statistically significant trends as well as shifts in trends that occurred within a time series. A maximum of 

two joinpoints were allowed, and the permutation method was used for model selection. Different line dashes correspond to year 

groupings as determined by joinpoint regression. When analyzing trends using IQVIATM data, data were compared with and without 

the IQVIATM data modification starting in 2017 and found no significant differences in our findings. 

106 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

FIGURE 1B
 Trends in opioid prescriptions filled 

Rates for overall annual opioid prescriptions filled per 100 persons rates by days of supply per 

prescription — United States, 2006-2018 

Source: IQVIATM Xponent 2006-2018. Data extracted in 2019. (Supplemental Table 1a). 

a

Temporal trends from 2006 to 2018 were evaluated by applying joinpoint regression methodology. This modeling approach 

simultaneously identified statistically significant trends as well as shifts in trends that occurred within a time series. A maximum 

of two joinpoints were allowed, and the permutation method was used for model selection. Different line dashes correspond to 

year groupings as determined by joinpoint regression. When analyzing trends using IQVIATM data, data were compared with and 

without the IQVIATM data modification starting in 2017 and found no significant differences in our findings. 

107 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

FIGURE 1C Trends in opioid prescriptions filled 

Average daily morphine milligram equivalents (MME) per opioid prescription dispensed 

— United States, 2006-2018 

Source: IQVIATM Xponent 2006-2018. Data extracted in 2019. (Supplemental Table 1a).
 

Abbreviation: MME, morphine milligram equivalents.
 

a

Temporal trends from 2006 to 2018 were evaluated by applying joinpoint regression methodology. This modeling approach
 

simultaneously identified statistically significant trends as well as shifts in trends that occurred within a time series. A maximum 

of two joinpoints were allowed, and the permutation method was used for model selection. Different line dashes correspond to 

year groupings as determined by joinpoint regression. When analyzing trends using IQVIATM data, data were compared with and 

without the IQVIATM data modification starting in 2017 and found no significant differences in our findings. 

108 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

FIGURE 1D
 Trends in opioid prescriptions filled 

Average days of supply per opioid prescription filled — United States, 2006-2018
 

Source: IQVIATM Xponent 2006-2018. Data extracted in 2019. (Supplemental Table 1a). 

a

Temporal trends from 2006 to 2018 were evaluated by applying joinpoint regression methodology. This modeling approach 

simultaneously identified statistically significant trends as well as shifts in trends that occurred within a time series. A maximum 

of two joinpoints were allowed, and the permutation method was used for model selection. Different line dashes correspond to 

year groupings as determined by joinpoint regression. When analyzing trends using IQVIATM data, data were compared with and 

without the IQVIATM data modification starting in 2017 and found no significant differences in our findings. 

109 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

FIGURE 2A
 Trends in drug overdose deaths 

Age-adjusted ratesa per 100,000 population of drug overdose deathsb and drug overdose deaths 

involving any opioidc for all intents and for unintentional intent by year — United States, 1999-2017 

Source: National Vital Statistics System, Mortality File, CDC WONDER.
 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year.
 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). All drug overdose deaths are identified using
 

underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Unintentional drug 

overdose deaths are identified using underlying cause-of-death codes X40–X44. Note that overall drug overdose deaths and opioid overdose deaths 

include deaths of any intent. In 2017, 5.2% of drug overdose deaths had undetermined intent; this is a decrease from 14.7% of drug overdose deaths 

that had an undetermined intent in 1999. Some of these deaths may be unintentional drug overdose deaths. 

c

Drug overdose deaths, as defined, that involve opium (T40.0), heroin (T40.1), natural and semi-synthetic opioids (T40.2), methadone (T40.3), other 

synthetic opioids excluding methadone (T40.4), and other and unspecified narcotics (T40.6). Specification on death certificates of drugs involved 

with deaths varies over time. In 2017, approximately 12% of drug overdose deaths did not include information on the specific type of drug(s) 

involved. Some of these deaths may have involved opioids. 

110 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

FIGURE 2B
 Trends in drug overdose deaths 

Age-adjusted ratesa per 100,000 population of drug overdose deathsb by drug or drug 

class and year — United States, 1999-2017 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. Because deaths 

might involve more than one drug, some deaths are included in more than one category. Specification on death certificates of drugs involved with 

deaths varies over time. In 2017, 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these 

deaths may have involved opioids or stimulants. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying 

cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). 

c

Drug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). 

d

Drug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3). 

e

Drug overdose deaths, as defined, that involve heroin (T40.1). 

f

Drug overdose deaths, as defined, that involve cocaine (T40.5). 

g

Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). 

111 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

FIGURE 2C
 Trends in drug overdose deaths 

Ratesa per 100,000 population of drug overdose deathsb by drug or drug class and age category 

— United States, 2017 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

a

Rate per 100,000 population using the vintage year population of the data year. Because deaths might involve more than one drug, some deaths are 

included in more than one category. Specification on death certificates of drugs involved with deaths varies over time. In 2017, approximately 12% 

of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these deaths may have involved opioids or 

stimulants. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying 

cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). 

c

Drug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3). 

d

Drug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). 

e

Drug overdose deaths, as defined, that involve heroin (T40.1). 

f

Drug overdose deaths, as defined, that involve cocaine (T40.5). 

g

Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). 

112 
 

 

 

 

 

 

 

 

 

Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

FIGURE 2D Trends in drug overdose deaths 

Age-adjusted ratesa per 100,000 population of drug overdose deathsb by state — United States, 2017 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source: National Vital Statistics System, Mortality File, CDC WONDER.
 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year.
 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified
 

using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). 

113 
 

APPENDIX 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

                           

 

 

 

SUPPLEMENTAL 

TABLE 1A 

Opioid prescriptions filled and morphine milligram equivalents (MME) dispensed — 

United States, 2006–2018a

% change 

from 2006 

Opioid prescribing 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 to 2018 

Prescribing rateb

 All opioids 72.4 75.9 78.2 79.5 81.2 80.9 81.2 78.1 75.6 70.7 66.5 58.5 51.4 -29.0

 High-dosagec 11.5 11.7 11.8 11.5 11.4 8.8 8.3 7.6 7.1 6.7 6.1 5.0 3.9 -66.4

 Days of supply per Rx

 ≥ 30 days 17.6 20.1 22.1 23.9 25.9 27.1 28.0 28.3 28.4 28.2 27.3 24.6 22.0 25.0

 < 30 days 54.7 55.8 56.1 55.6 55.3 53.8 53.2 49.8 47.2 42.5 39.2 33.9 29.4 -46.3

 < 3 days 16.2 16.2 15.8 15.4 15.1 14.5 14.2 13.0 12.1 11.1 10.2 8.9 8.2 -49.4

 < 7 days 35.3 35.6 35.2 34.4 33.7 32.3 31.4 28.9 27.3 24.7 22.5 19.7 18.2 -48.6 

> 3 days and < 7 days 19.1 19.4 19.4 18.9 18.7 17.8 17.2 16.0 15.2 13.6 12.3 10.8 10.0 -47.7 

Dosage (MME) 

Average daily MME per Rx 59.7 59.1 58.7 58.1 58.0 53.9 51.8 50.2 48.9 48.1 47.1 45.3 42.9 -28.1

 Average MME per Rx 828.2 861.9 894.1 922.6 963.8 946.7 911.5 901.7 895.9 907.5 901.2 873.4 828.1 0.0

 MME per capita 599.3 653.9 699.4 733.0 782.3 765.9 740.6 704.1 896.0 641.4 599.3 511.1 424.6 -29.2 

Average days supply 13.3 13.9 14.5 15.0 15.5 16.0 16.4 16.9 17.2 17.7 18.1 18.3 18.4 37.6 per Rx filled 

Source:: IQVIATM Xponent 2006-2018. Data extracted in 2019. 

Abbreviations: MME, morphine milligram equivalents; Rx, prescription. 

a

When analyzing trends using IQVIATM data, data were compared with and without the IQVIATM data modification starting in 2017 and 

found no significant differences in our findings. 

b

Rate per 100 persons adjusted to the U.S. census population. 

c

High-dosage prescriptions were defined as opioid prescriptions resulting in a daily dosage of ≥ 90 MME. 

115 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2A 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related hospitalizations by selected substances, all 

intentsc— United States, 2016 — United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 326,200 100.9 1.27 91,840 28.4 0.43 22,360 6.9 0.19 5,675 1.8 0.06 65,110 20.1 0.31 20,090 6.2 0.25 17,725 5.5 0.17 

Sex

 Male 145,750 91.5 1.28 44,420 27.9 0.5 15,525 9.7 0.29 2,935 1.8 0.09 26,890 16.9 0.31 13,425 8.4 0.37 11,285 7.1 0.26

 Female 180,450 109.9 1.45 47,420 28.9 0.48 6,835 4.2 0.15 2,740 1.7 0.08 38,220 23.3 0.4 6,665 4.1 0.18 6,440 3.9 0.14 

Age Groups

l l l l l l l l l 0–14 9,380 15.4 0.87 640 1.0 0.11 600 1.0 0.11 410 0.7 0.08

 15–19 22,880 108.2 3.15 2,005 9.5 0.5 435 2.1 0.21 145 0.7 0.13 1,445 6.8 0.43 345 1.6 0.2 925 4.4 0.34

 20–24 26,495 118.4 2.3 6,245 27.9 0.92 3,410 15.2 0.65 300 1.3 0.18 2,685 12.0 0.55 1,395 6.2 0.39 1,855 8.3 0.47

 25–34 53,380 119.2 2.08 15,530 34.7 0.85 8,035 17.9 0.59 965 2.2 0.16 6,935 15.5 0.48 3,775 8.4 0.38 5,215 11.6 0.44

 35–44 49,265 121.5 2.12 12,840 31.7 0.8 4,195 10.3 0.45 885 2.2 0.17 8,005 19.7 0.57 3,915 9.7 0.45 4,015 9.9 0.43

 45–54 58,065 135.6 2.33 17,140 40.0 0.89 3,350 7.8 0.44 1,180 2.8 0.2 12,940 30.2 0.7 5,610 13.1 0.76 3,115 7.3 0.45

 55–64 53,780 129.7 2.07 20,205 48.7 1.01 2,400 5.8 0.34 1,440 3.5 0.23 16,575 40.0 0.85 4,115 9.9 0.62 1,715 4.1 0.29

≥ 65 52,955 107.5 1.58 17,235 35.0 0.75 530 1.1 0.11 715 1.5 0.13 15,925 32.3 0.71 885 1.8 0.16 475 1.0 0.1 

Region

 Northeast 57,355 101.8 3.27 16,945 30.1 1.11 6,440 11.4 0.59 1,260 2.2 0.21 9,575 17.0 0.64 5,750 10.2 0.97 1,195 2.1 0.14

 Midwest 77,200 113.6 2.95 21,240 31.2 1.07 6,460 9.5 0.58 1,120 1.6 0.13 14,005 20.6 0.67 3,905 5.7 0.39 3,115 4.6 0.31

 South 129,100 105.5 2.12 36,010 29.4 0.68 6,640 5.4 0.26 2,025 1.7 0.1 27,825 22.7 0.54 8,820 7.2 0.42 6,505 5.3 0.23 

West 62,545 81.6 2.14 17,645 23.0 0.72 2,820 3.7 0.2 1,270 1.7 0.11 13,705 17.9 0.6 1,615 2.1 0.18 6,910 9.0 0.53 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency for Healthcare 

Research and Quality (AHRQ). 

b In-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

c Includes poisonings of accidental (unintentional) or undetermined intent and those attributable to 

intentional self-harm and assault. 

d Includes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. e Includes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. 

f Includes ICD-10-CM/PCS code T40.1. g Includes ICD-10-CM/PCS code T40.3. h Includes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. j Includes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

m Rates cannot be calculated based on the available data. 

116 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2A 

Estimated numbera,b and rate per 100,000 population of drug poisoning-related hospitalizations by selected substances 

 United States, 2016 —

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

2013 urbanization category 

Large central metropolitan 94,070 94.4 3.27 26,270 26.4 1.01 7,360 7.4 0.44 2,040 2.0 0.13 17,380 17.4 0.68 9,095 9.1 0.66 5,075 5.1 0.31 

Large fringe metropolitan 74,645 92.7 3.2 22,665 28.1 1.07 6,710 8.3 0.43 1,120 1.4 0.11 15,140 18.8 0.72 4,265 5.3 0.35 3,065 3.8 0.23 

Medium metropolitan 75,170 111.2 5.25 21,265 31.5 1.55 4,730 7.0 0.48 1,185 1.8 0.16 15,575 23.1 1.14 3,835 5.7 0.42 4,200 6.2 0.47 

Small metropolitan 33,690 114.2 6.5 8,695 29.5 1.78 1,610 5.5 0.49 470 1.6 0.19 6,695 22.7 1.42 1,125 3.8 0.43 2,195 7.4 0.75

 Micropolitan 28,100 103.0 3.58 7,535 27.6 1.15 1,195 4.4 0.33 385 1.4 0.17 6,000 22.0 0.99 760 2.8 0.3 1,605 5.9 0.42

 Noncore 17,500 92.7 3.73 4,615 24.5 1.22 395 2.1 0.27 370 2.0 0.25 3,940 20.9 1.1 450 2.4 0.29 1,105 5.9 0.53

m m m m m m m m m m m m m m Unknown 3,025 795 360 105 380 560 480

Abbreviations: No., number; SE, standard error. 

aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency for Healthcare 

Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those attributable to 

intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. 

fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

117 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2B 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related hospitalizations by selected substances, 

unintentional and undetermined intentsc — United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 193,150 59.7 0.78 73,650 22.8 0.36 19,325 6.0 0.18 4,810 1.5 0.06 50,515 15.6 0.25 17,620 5.4 0.24 14,005 4.3 0.15 

Sex

 Male 97,320 61.1 0.94 36,880 23.2 0.44 13,525 8.5 0.26 2,595 1.6 0.08 21,545 13.5 0.26 11,975 7.5 0.35 9,450 5.9 0.24

 Female 95,830 58.4 0.79 36,770 22.4 0.4 5,800 3.5 0.14 2,215 1.3 0.07 28,970 17.6 0.33 5,645 3.4 0.17 4,555 2.8 0.11 

Age Groups

l l l l l l l l l 0–14 4,765 7.8 0.5 465 0.8 0.09 425 0.7 0.09 310 0.5 0.07

 15–19 5,190 24.5 0.93 900 4.3 0.33 370 1.7 0.2 85 0.4 0.1 455 2.2 0.24 300 1.4 0.19 430 2.0 0.23

 20–24 11,385 50.9 1.27 4,715 21.1 0.79 2,995 13.4 0.61 260 1.2 0.17 1,590 7.1 0.42 1,180 5.3 0.35 1,395 6.2 0.4

 25–34 28,030 62.6 1.26 12,040 26.9 0.72 6,805 15.2 0.52 795 1.8 0.14 4,745 10.6 0.38 3,145 7.0 0.34 4,005 8.9 0.38

 35–44 25,860 63.8 1.29 9,715 24.0 0.68 3,650 9.0 0.41 740 1.8 0.16 5,560 13.7 0.47 3,285 8.1 0.42 3,215 7.9 0.4

 45–54 33,935 79.3 1.63 13,125 30.7 0.78 2,865 6.7 0.41 1,010 2.4 0.18 9,495 22.2 0.59 4,995 11.7 0.73 2,645 6.2 0.42

 55–64 38,845 93.7 1.69 17,135 41.3 0.91 2,135 5.1 0.32 1,245 3.0 0.21 13,900 33.5 0.77 3,825 9.2 0.6 1,575 3.8 0.28

≥ 65 45,140 91.6 1.42 15,555 31.6 0.7 500 1.0 0.11 630 1.3 0.13 14,345 29.1 0.67 845 1.7 0.16 430 0.9 0.1 

Region

 Northeast 35,635 63.2 2.26 13,915 24.7 0.97 5,610 10.0 0.53 1,090 1.9 0.19 7,525 13.4 0.55 5,170 9.2 0.94 850 1.5 0.12

 Midwest 41,325 60.8 1.73 16,605 24.4 0.9 5,540 8.1 0.54 915 1.3 0.12 10,405 15.3 0.52 3,350 4.9 0.36 2,185 3.2 0.26

 South 78,705 64.3 1.26 29,025 23.7 0.57 5,725 4.7 0.23 1,710 1.4 0.09 21,945 17.9 0.45 7,665 6.3 0.4 5,000 4.1 0.19 

West 37,485 48.9 1.32 14,105 18.4 0.6 2,450 3.2 0.18 1,095 1.4 0.1 10,640 13.9 0.49 1,435 1.9 0.17 5,970 7.8 0.51 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency for Healthcare 

Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings attributable to 

intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. 

fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

118 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2B 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related hospitalizations by selected substances, 

unintentional and undetermined intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

2013 urbanization category 

Large central metropolitan 60,060 60.3 2.19 21,540 21.6 0.87 6,515 6.5 0.41 1,795 1.8 0.12 13,665 13.7 0.56 8,240 8.3 0.63 4,235 4.3 0.29 

Large fringe metropolitan 44,690 55.5 1.94 18,320 22.7 0.88 5,755 7.1 0.37 910 1.1 0.09 11,875 14.7 0.58 3,710 4.6 0.31 2,345 2.9 0.2 

Medium metropolitan 42,350 62.7 2.9 16,690 24.7 1.25 4,000 5.9 0.41 1,025 1.5 0.15 11,830 17.5 0.9 3,275 4.8 0.38 3,250 4.8 0.4 

Small metropolitan 17,975 61.0 3.53 6,775 23.0 1.44 1,335 4.5 0.42 385 1.3 0.17 5,095 17.3 1.13 920 3.1 0.38 1,675 5.7 0.66 

Micropolitan 15,655 57.4 2.02 5,915 21.7 0.94 1,040 3.8 0.3 300 1.1 0.15 4,605 16.9 0.81 590 2.2 0.25 1,255 4.6 0.36 

Noncore 10,350 54.9 2.4 3,705 19.6 1.05 365 1.9 0.26 295 1.6 0.22 3,115 16.5 0.94 390 2.1 0.26 825 4.4 0.44 

m m m m m m m m m m m m m m Unknown 2,070 705 315 100 330 495 420

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Inpatient Sample (NIS), 2016, Agency for Healthcare 

Research and Quality (AHRQ). 

bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings attributable to 

intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. 

fIncludes ICD-10-CM/PCS code T40.1. gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

119 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2C 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related emergency department visits by selected substances, all intentsc — United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 577,794 178.7 6.51 197,970 61.2 4.32 123,272 38.1 3.43 3,434 1.1 0.09 72,065 22.3 1.02 8,617 2.7 0.18 16,341 5.1 0.24 

Sex

 Male 290,607 182.5 7.78 124,643 78.3 5.84 84,453 53.0 4.67 1,810 1.1 0.12 38,967 24.5 1.33 5,654 3.6 0.25 10,268 6.4 0.36

 Female 287,187 174.9 5.65 73,328 44.7 2.89 38,819 23.6 2.26 1,625 1.0 0.08 33,099 20.2 0.78 2,963 1.8 0.14 6,073 3.7 0.17 

Age Groups

l l l 0–14 77,450 127.0 5.89 2,716 4.5 0.32 114 0.2 0.04 2,533 4.2 0.29 62 0.1 0.03 1,810 3.0 0.19

 15–19 63,321 299.4 10.66 6,130 29.0 1.52 2,548 12.0 1.11 80 0.4 0.09 3,497 16.5 0.85 409 1.9 0.22 1,673 7.9 0.47

 20–24 68,156 304.5 14.08 29,350 131.1 9.77 21,603 96.5 8.18 298 1.3 0.21 7,594 33.9 2.04 1,200 5.4 0.48 2,504 11.2 0.71

 25–34 133,555 298.3 16.51 71,975 160.8 13.35 53,291 119.0 11.1 802 1.8 0.19 18,324 40.9 2.59 2,828 6.3 0.51 5,219 11.7 0.66

 35–44 81,061 199.9 10.13 36,385 89.7 7.56 23,962 59.1 6.02 549 1.4 0.14 12,078 29.8 1.77 1,841 4.5 0.39 2,876 7.1 0.53

 45–54 66,409 155.1 6.41 25,939 60.6 4.41 13,799 32.2 3.32 698 1.6 0.21 11,489 26.8 1.32 1,454 3.4 0.3 1,589 3.7 0.35

 55–64 46,682 112.5 4.08 17,219 41.5 2.63 6,988 16.8 1.8 608 1.5 0.21 9,668 23.3 1.09 738 1.8 0.21 512 1.2 0.15

≥ 65 41,161 83.5 2.46 8,256 16.8 0.67 1,031 2.1 0.26 284 0.6 0.08 6,882 14.0 0.55 86 0.2 0.04 158 0.3 0.07 

Abbreviation: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample (NEDS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those attributable to 

intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

120 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2C 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related emergency department visits by selected substances, all intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

 census region of residence U.S.

 Northeast 103,639 183.9 17.05 49,338 87.5 11.4 35,202 62.5 9.22 631 1.1 0.17 13,717 24.3 2.67 1,752 3.1 0.37 1,077 1.9 0.19

 Midwest 149,216 219.5 16.72 56,896 83.7 12.07 38,858 57.2 9.48 596 0.9 0.13 17,638 25.9 2.81 1,673 2.5 0.35 3,656 5.4 0.44

 South 206,343 168.5 11.18 65,632 53.6 7.36 38,145 31.2 5.9 1,178 1.0 0.12 26,712 21.8 1.67 4,042 3.3 0.37 5,703 4.7 0.28 

West 118,597 154.7 7.64 26,105 34.1 3.08 11,067 14.4 2.04 1,029 1.3 0.27 13,999 18.3 1.13 1,150 1.5 0.28 5,906 7.7 0.81 

2013 urbanization category

 Large central metropolitan 159,308 159.9 10.78 48,726 48.9 4.92 29,267 29.4 3.72 1,322 1.3 0.21 18,318 18.4 1.43 2,752 2.8 0.35 4,795 4.8 0.51

 Large fringe metropolitan 127,661 158.5 13.55 55,351 68.7 8.67 37,490 46.5 6.86 539 0.7 0.07 17,524 21.8 2.23 1,845 2.3 0.3 2,434 3.0 0.3

 Medium metropolitan 135,762 200.9 19.93 51,675 76.5 13.62 33,899 50.2 10.74 652 1.0 0.13 17,387 25.7 3.05 2,341 3.5 0.45 3,190 4.7 0.38

 Small metropolitan 56,864 192.8 18.79 15,118 51.3 7.45 8,457 28.7 5.57 327 1.1 0.2 6,361 21.6 2.22 615 2.1 0.34 1,951 6.6 0.86

 Micropolitan 57,860 212.1 13.11 16,729 61.3 7.32 9,061 33.2 5.19 296 1.1 0.15 7,475 27.4 2.36 571 2.1 0.26 2,094 7.7 0.59

 Noncore 33,927 179.8 9.45 7,061 37.4 2.91 2,768 14.7 1.98 209 1.1 0.19 4,097 21.7 1.49 269 1.4 0.22 1,356 7.2 0.62

m m m m m m l m m m m m m l m m Unknown 6,413 3,311 2,330 903 223

Abbreviation: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample (NEDS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent and those attributable to 

intentional self-harm and assault. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

121 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2D 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related emergency department visits by selected substances, unintentional and undetermined intentsc— United States, 2016 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf

Methadone poisoningsg

Poisonings by other opioidsh Cocaine poisoningsi

Methamphetamine poisoningsj

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

All Visits 435,983 134.8 5.63 183,147 56.6 4.24 119,465 36.9 3.38 3,038 0.9 0.08 61,318 19.0 0.97 7,399 2.3 0.17 13,131 4.1 0.22 

Sex

 Male 243,504 152.9 7.22 117,939 74.1 5.75 81,874 51.4 4.61 1,612 1.0 0.12 34,941 21.9 1.29 4,867 3.1 0.23 8,532 5.4 0.34

 Female 192,479 117.2 4.24 65,208 39.7 2.81 37,591 22.9 2.22 1,426 0.9 0.07 26,377 16.1 0.69 2,532 1.5 0.13 4,600 2.8 0.14 

Age Groups

l l l 0–14 64,701 106.1 4.75 2,376 3.9 0.29 101 0.2 0.04 2,223 3.6 0.27 57 0.1 0.03 1,638 2.7 0.17

l l l 15–19 27,126 128.2 4.36 4,152 19.6 1.34 2,421 11.4 1.1 1,670 7.9 0.52 318 1.5 0.2 994 4.7 0.35

 20–24 49,091 219.3 12.12 27,254 121.8 9.55 20,910 93.4 8.01 285 1.3 0.2 6,197 27.7 1.89 1,021 4.6 0.45 2,015 9.0 0.65

 25–34 106,591 238.1 15.34 68,086 152.1 13.14 51,692 115.5 10.93 718 1.6 0.18 16,065 35.9 2.54 2,458 5.5 0.46 4,218 9.4 0.59

 35–44 61,935 152.7 9.19 33,753 83.2 7.44 23,176 57.2 5.94 446 1.1 0.12 10,299 25.4 1.7 1,570 3.9 0.36 2,330 5.7 0.48

 45–54 50,211 117.3 5.56 23,775 55.5 4.3 13,458 31.4 3.28 584 1.4 0.2 9,769 22.8 1.22 1,250 2.9 0.27 1,381 3.2 0.34

 55–64 38,332 92.4 3.58 16,017 38.6 2.57 6,765 16.3 1.77 577 1.4 0.2 8,710 21.0 1.03 652 1.6 0.2 408 1.0 0.14

≥ 65 37,997 77.1 2.29 7,734 15.7 0.65 1,009 2.0 0.26 279 0.6 0.08 6,384 13.0 0.53 72 0.1 0.04 147 0.3 0.07 

Abbreviations: No., number; SE, standard error. aWeighted national estimates from HCUP Nationwide Emergency Department Sample (NEDS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings attributable to 

intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

122 
CDC National Center for Injury Prevention and Control | 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes | United States

SUPPLEMENTAL TABLE 2D 

Estimated numbersa,b and rates (not age-adjusted) per 100,000 of drug poisoning-related emergency department visits by selected 

substances, unintentional and undetermined intentsc — United States, 2016 

CONTINUED 

Socio-demographic characteristics 

All drug poisoningsd All opioid poisoningse Heroin poisoningsf 

Methadone poisoningsg 

Poisonings by other opioidsh Cocaine poisoningsi 

Methamphetamine poisoningsj 

No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE No. Ratek SE 

 census region of residence U.S.

 Northeast 87,219 154.8 14.99 47,472 84.2 11.14 34,355 61.0 9.05 579 1.0 0.16 12,740 22.6 2.6 1,630 2.9 0.35 919 1.6 0.17

 Midwest 112,195 165.0 15.07 52,998 78.0 11.87 37,571 55.3 9.33 506 0.7 0.12 15,067 22.2 2.73 1,377 2.0 0.31 2,787 4.1 0.38

 South 156,672 128.0 9.57 60,496 49.4 7.23 37,005 30.2 5.83 1,019 0.8 0.11 22,819 18.6 1.56 3,404 2.8 0.34 4,387 3.6 0.22 

West 79,897 104.2 5.52 22,181 28.9 2.95 10,534 13.7 2.01 934 1.2 0.27 10,692 13.9 0.96 988 1.3 0.27 5,038 6.6 0.77 

2013 urbanization category

 Large central metropolitan 117,108 117.5 8.24 44,721 44.9 4.75 28,314 28.4 3.66 1,245 1.2 0.2 15,339 15.4 1.27 2,334 2.3 0.32 4,035 4.0 0.47

 Large fringe metropolitan 103,166 128.1 11.9 52,651 65.4 8.46 36,680 45.5 6.76 474 0.6 0.07 15,694 19.5 2.1 1,671 2.1 0.28 1,936 2.4 0.24

 Medium metropolitan 103,345 152.9 17.24 47,779 70.7 13.34 32,723 48.4 10.58 540 0.8 0.11 14,717 21.8 2.87 1,957 2.9 0.42 2,460 3.6 0.3

 Small metropolitan 40,973 138.9 14.1 13,576 46.0 7.11 8,161 27.7 5.42 288 1.0 0.2 5,142 17.4 1.88 520 1.8 0.3 1,461 5.0 0.73

 Micropolitan 41,966 153.8 10.98 15,107 55.4 7.16 8,708 31.9 5.06 224 0.8 0.13 6,255 22.9 2.28 505 1.9 0.24 1,721 6.3 0.53

 Noncore 24,107 127.8 6.58 6,145 32.6 2.7 2,602 13.8 1.9 179 0.9 0.17 3,355 17.8 1.24 209 1.1 0.2 1,041 5.5 0.55

m m m m m m l l l m m m m l l l Unknown 5,319 3,167 2,277 817 203

Abbreviations: No., number; SE, standard error. 

aWeighted national estimates from HCUP Nationwide Emergency Department Sample (NEDS), 2016, Agency 

for Healthcare Research and Quality (AHRQ). 

bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age 

and sex were excluded. Numbers subject to rounding error. 

cIncludes poisonings of accidental (unintentional) or undetermined intent. Poisonings attributable to 

intentional self-harm and assault were excluded. 

dIncludes ICD-10-CM/PCS codes T36-T50. See technical notes for additional information. eIncludes ICD-10-CM/PCS codes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. fIncludes ICD-10-CM/PCS code T40.1. 

gIncludes ICD-10-CM/PCS code T40.3. hIncludes ICD-10-CM/PCS codes T40.0, T40.2, T40.4, T40.6, T40.69. iIncludes ICD-10-CM/PCS code T40.5. jIncludes ICD-10-CM/PCS code T43.62. kRates calculated per 100,000 population. lBecause the relative standard error was > 30% or the standard error = 0, the value of the estimate was 

considered unreliable and was not reported. 

mRates cannot be calculated based on the available data. 

123 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

SUPPLEMENTAL 

TABLE 3A 

Trend analyses of age-adjusted ratesa per 100,000 population of drug overdose deaths by 

drug or drug class—United States, 1999-2017 

Trend 1 Trend 2 Trend 3 Trend 4 

Drug Categoryb Yearsc APC (95% CL) Yearsc APC (95% CL) Yearsc APC (95% CL) Yearsc APC (95% CL) 

Prescription opioids 1999–2006 18.7 (14.9–22.7)d 2006–2017 2.0 (1.0–3.1)d n/a n/a n/a n/a 

Heroin 1999–2004 -2.0 (-7.1–3.4) 2004–2010 9.9 (4.9–15.1)d 2010–2015 31.4 (26.0–37.1)d 2015–2017 7.2 (-1.7–16.8) 

Synthetic Opioids 1999–2013 8.4 (4.7–12.3)d 2013–2017 69.8 (56.0–84.9)d n/a n/a n/a n/a 

Cocaine 1999–2006 10.1 (6.8–13.4)d 2006–2010 -14.1 (-22.9– -4.3)d 2010–2014 6.1 (-5.2–18.7) 2014–2017 37.6 (26.9–49.2)d

Psychostimulants 1999–2005 19.2 (11.2–27.8)d 2005–2008 -7.2 (-31.7–26.1) 2008–2012 20.2 (5.2–37.3)d 2012–2017 30.1 (26.0–34.3)d

with abuse potential 

Source: National Vital Statistics System Mortality File.
 

Abbreviations: APC, annual percent change; CL, confidence limits; n/a, not applicable.
 

aRate per 100,000 persons adjusted to the U.S. census population.
 

b

 Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using
 

underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Among deaths with 

drug overdose as the underlying cause, the type of drug(s) involved are indicated by the following ICD–10 codes: prescription opioids (T40.2, T40.3); 

heroin (T40.1); synthetic opioids, excluding methadone (T40.4); cocaine (T40.5) and psychostimulants with abuse potential (T43.6). 

c Year category presented in each trend represents groupings as determined by joinpoint regression. 

d

 Indicates that the annual percent change was significantly different from 0 (p<0.05). 

124 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

SUPPLEMENTAL DATA 

SUPPORTING FIGURE 2A 

Age-adjusted ratesa per 100,000 population of drug overdose 

deathsb and drug overdose deaths involving any opioidc for all 

intents and for unintentional intent by year — United States, 

1999-2017 

Drug overdose deaths Unintentional drug 

Drug overdose deaths Unintentional drug involving any opioid overdose deaths 

(of all intents) overdose deaths (of all intents) involving any opioid 

Year Rate SE Rate SE Rate SE Rate SE 

1999 6.1 0.047 4.0 0.038 2.9 0.032 2.1 0.028 

2000 6.2 0.047 4.1 0.038 3.0 0.033 2.2 0.028 

2001 6.8 0.049 4.6 0.040 3.3 0.034 2.4 0.029 

2002 8.2 0.053 5.7 0.045 4.1 0.038 3.1 0.033 

2003 8.9 0.055 6.3 0.047 4.5 0.039 3.4 0.034 

2004 9.4 0.057 6.8 0.048 4.7 0.040 3.6 0.035 

2005 10.1 0.059 7.6 0.051 5.1 0.042 4.0 0.037 

2006 11.5 0.062 8.8 0.055 5.9 0.045 4.8 0.040 

2007 11.9 0.063 9.1 0.055 6.1 0.045 5.0 0.041 

2008 11.9 0.063 9.2 0.055 6.4 0.046 5.3 0.042 

2009 11.9 0.063 9.4 0.056 6.6 0.047 5.5 0.043 

2010 12.3 0.064 9.7 0.057 6.8 0.047 5.7 0.044 

2011 13.2 0.066 10.6 0.059 7.3 0.049 6.3 0.045 

2012 13.1 0.065 10.6 0.059 7.4 0.049 6.4 0.046 

2013 13.8 0.067 11.3 0.061 7.9 0.051 6.9 0.048 

2014 14.7 0.069 12.1 0.063 9.0 0.054 7.9 0.051 

2015 16.3 0.072 13.8 0.067 10.4 0.058 9.3 0.055 

2016 19.8 0.080 17.1 0.075 13.3 0.066 11.9 0.062 

2017 21.7 0.084 19.1 0.078 14.9 0.069 13.5 0.066 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the 

data year. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). All drug overdose deaths 

are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and 

Y10–Y14 (undetermined). Unintentional drug overdose deaths are identified using underlying cause-of-death codes 

X40–X44. Note that 5.2% of drug overdose deaths in 2017 had undetermined intent; this is a decrease from 14.7% of 

drug overdose deaths that had undetermined intent in 1999. Some of these deaths may be unintentional drug overdose 

deaths. 

c

Drug overdose deaths, as defined, that involve opium (T40.0), heroin (T40.1), natural and semi-synthetic opioids (T40.2), 

methadone (T40.3), other synthetic opioids excluding methadone (T40.4), and other and unspecified narcotics (T40.6). 

125 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

SUPPLEMENTAL DATA 

SUPPORTING FIGURE 2B 

Age-adjusted ratesa per 100,000 population of drug overdose deathsb

by drug or drug class and year — United States, 1999-2017 

Prescription 

opioidsc

Synthetic opioids 

other than 

methadoned Heroine Cocainef

Psychostimulants with 

abuse potentialg

Year Rate SE Rate SE Rate SE Rate SE Rate SE 

1999 1.2 0.021 0.3 0.009 0.7 0.016 1.4 0.022 0.2 0.009 

2000 1.3 0.022 0.3 0.010 0.7 0.015 1.3 0.021 0.2 0.009 

2001 1.7 0.024 0.3 0.011 0.6 0.015 1.3 0.022 0.2 0.009 

2002 2.3 0.028 0.4 0.012 0.7 0.016 1.6 0.023 0.3 0.011 

2003 2.6 0.030 0.5 0.013 0.7 0.016 1.8 0.025 0.4 0.012 

2004 2.9 0.032 0.6 0.014 0.6 0.015 1.9 0.025 0.4 0.012 

2005 3.2 0.033 0.6 0.014 0.7 0.015 2.1 0.027 0.5 0.013 

2006 3.9 0.036 0.9 0.017 0.7 0.016 2.5 0.029 0.5 0.013 

2007 4.2 0.038 0.7 0.015 0.8 0.016 2.2 0.027 0.4 0.012 

2008 4.3 0.038 0.8 0.016 1.0 0.018 1.7 0.024 0.4 0.012 

2009 4.4 0.038 1.0 0.018 1.1 0.019 1.4 0.022 0.5 0.013 

2010 4.7 0.039 1.0 0.018 1.0 0.018 1.3 0.021 0.6 0.014 

2011 4.9 0.040 0.8 0.017 1.4 0.022 1.5 0.022 0.7 0.016 

2012 4.5 0.038 0.8 0.017 1.9 0.025 1.4 0.022 0.8 0.017 

2013 4.4 0.038 1.0 0.018 2.7 0.030 1.6 0.023 1.2 0.020 

2014 4.6 0.038 1.8 0.024 3.4 0.034 1.7 0.024 1.4 0.021 

2015 4.7 0.039 3.1 0.032 4.1 0.037 2.1 0.026 1.8 0.024 

2016 5.2 0.041 6.2 0.045 4.9 0.040 3.2 0.032 2.4 0.028 

2017 5.2 0.041 9.0 0.054 4.9 0.040 4.3 0.037 3.2 0.032 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. Because deaths 

might involve more than one drug, some deaths are included in more than one category. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using underlying 

cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). 

c

Drug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3). 

d

Drug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). 

e

Drug overdose deaths, as defined, that involve heroin (T40.1). 

f

Drug overdose deaths, as defined, that involve cocaine (T40.5). 

g

Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). Psychostimulants with abuse potential include drugs 

such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), 

and caffeine. 

126 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

 

 

 

 

 

                 

SUPPLEMENTAL DATA 

SUPPORTING FIGURE 2C 

Ratesa per 100,000 population of drug overdose deathsb by drug or drug 

class and age category — United States, 2017 

Prescription 

opioidsc

Synthetic opioids 

other than 

methadoned Heroine Cocainef

Psychostimulants with 

abuse potentialg

Year Rate SE Rate SE Rate SE Rate SE Rate SE 

Age group (years) 

h h h h h h 0–14 0.1 0.012 0.1 0.009 

15–24 2.4 0.075 6.1 0.119 3.4 0.088 2.1 0.070 1.8 0.065 

25–34 7.5 0.129 19.5 0.207 10.8 0.154 7.6 0.130 5.7 0.112 

35–44 9.1 0.149 17.3 0.206 9.1 0.149 8.0 0.140 6.2 0.123 

45–54 10.0 0.154 13.6 0.179 7.2 0.130 8.3 0.140 5.8 0.117 

55–64 8.4 0.141 8.3 0.140 4.8 0.107 5.6 0.115 3.9 0.097 

≥65 2.1 0.064 1.2 0.049 0.7 0.038 0.8 0.041 0.5 0.033 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population using the vintage year population of the data year. Because deaths might involve more than one drug, some deaths 

are included in more than one category. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are identified using 

underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). 

c

Drug overdose deaths, as defined, that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3). 

d

Drug overdose deaths, as defined, that involve synthetic opioids other than methadone (T40.4). 

e

Drug overdose deaths, as defined, that involve heroin (T40.1). 

f

Drug overdose deaths, as defined, that involve cocaine (T40.5). 

g

Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). Psychostimulants with abuse potential include drugs 

such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), 

and caffeine. 

h

Rates are suppressed when based on <20 deaths. 

127 
Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2019

 

 

SUPPLEMENTAL DATA 

SUPPORTING FIGURE 2D 

Age-adjusted ratesa per 100,000 population of drug overdose 

deathsb by state — United States, 2017 

State of residence Age-adjusted rate SE State of residence Age-adjusted rate SE 

Alabama 18.0 0.636 Montana 11.7 1.111 

Alaska 20.2 1.704 Nebraska 8.1 0.674 

Arizona 22.2 0.581 Nevada 21.6 0.847 

Arkansas 15.5 0.749 New Hampshire 37.0 1.762 

California 11.7 0.170 New Jersey 30.0 0.590 

Colorado 17.6 0.561 New Mexico 24.8 1.147 

Connecticut 30.9 0.973 New York 19.4 0.318 

Delaware 37.0 2.072 North Carolina 24.1 0.499 

District of Columbia 44.0 2.553 North Dakota 9.2 1.152 

Florida 25.1 0.361 Ohio 46.3 0.664 

Georgia 14.7 0.380 Oklahoma 20.1 0.738 

Hawaii 13.8 0.998 Oregon 12.4 0.550 

Idaho 14.4 0.953 Pennsylvania 44.3 0.620 

Illinois 21.6 0.418 Rhode Island 31.0 1.786 

Indiana 29.4 0.696 South Carolina 20.5 0.662 

Iowa 11.5 0.638 South Dakota 8.5 1.019 

Kansas 11.8 0.660 Tennessee 26.6 0.645 

Kentucky 37.2 0.959 Texas 10.5 0.195 

Louisiana 24.5 0.752 Utah 22.3 0.886 

Maine 34.4 1.728 Vermont 23.2 2.075 

Maryland 36.3 0.782 Virginia 17.9 0.468 

Massachusetts 31.8 0.699 Washington 15.2 0.453 

Michigan 27.8 0.551 West Virginia 57.8 1.901 

Minnesota 13.3 0.502 Wisconsin 21.2 0.633 

Mississippi 12.2 0.662 Wyoming 12.2 1.513 

Missouri 23.4 0.647 

Source: National Vital Statistics System, Mortality File, CDC WONDER. 

Abbreviation: SE, standard error. 

a

Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data 

year. 

b

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug overdose deaths are 

identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 

(undetermined). 

128