NCHS Data Brief ■ No. 329 ■ November 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Drug Overdose Deaths in the United States, 1999–2017

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

Key findings

Data from the National 

Vital Statistics System, 

Mortality

● In 2017, there were 70,237 

drug overdose deaths in the 

United States.

● The age-adjusted rate 

of drug overdose deaths in 

2017 (21.7 per 100,000) was 

9.6% higher than the rate in 

2016 (19.8).

● Adults aged 25–34, 35–44, 

and 45–54 had higher rates of 

drug overdose deaths in 2017 

than those aged 15–24, 55–64, 

and 65 and over.

● West Virginia (57.8 per 

100,000), Ohio (46.3), 

Pennsylvania (44.3), and the 

District of Columbia (44.0) had 

the highest age-adjusted drug 

overdose death rates in 2017.

● The age-adjusted rate of 

drug overdose deaths involving 

synthetic opioids other than 

methadone (drugs such as 

fentanyl, fentanyl analogs, and 

tramadol) increased by 45% 

between 2016 and 2017, from 

6.2 to 9.0 per 100,000.

Deaths from drug overdose continue to be a public health burden in the 

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

the National Vital Statistics System (NVSS) to update trends in drug overdose 

deaths, describe demographic and geographic patterns, and identify shifts in 

the types of drugs involved.

In 2017, the age-adjusted rate of drug overdose deaths in the 

United States was 9.6% higher than the rate in 2016.

● In 2017, there were 70,237 drug overdose deaths in the United States 

(Figure 1).

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

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

Figure 1. Age-adjusted drug overdose death rates: United States, 1999–2017

1

Significant increasing trend from 1999 through 2017 with different rates of change over time, p < 0.05. 2

Male rates were significantly higher than female rates for all years, p < 0.05.

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

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

deaths in 2017 was 70,237. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#1.

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

1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

30

25

20

15

10

5

0

Male1,2

Female1

Total1
NCHS Data Brief ■ No. 329 ■ November 2018

■  2  ■

on average by 10% per year from 1999 through 2006, by 3% per year from 2006 through 

2014, and by 16% per year from 2014 through 2017. 

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

increased from 8.2 in 1999 to 29.1 in 2017. For females, the rate increased from 3.9 in 1999 

to 14.4 in 2017.

Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had 

higher rates of drug overdose deaths in 2017 than those aged 15–24, 55–64, 

and 65 and over, while those aged 65 and over had the lowest rates.

● The rates of drug overdose deaths increased from 1999 to 2017 for all age groups studied 

(Figure 2).

● In 2017, rates were significantly higher for age groups 25–34 (38.4 per 100,000), 35–44 

(39.0), and 45–54 (37.7) than for those aged 15–24 (12.6), 55–64 (28.0), and 65 and 

over (6.9). 

● In 2017, rates were lowest for adults aged 65 and over (6.9). 

● From 1999 to 2017, the greatest percentage change in drug overdose death rates occurred 

among adults aged 55–64, increasing from 4.2 per 100,000 in 1999 to 28.0 in 2017, a more 

than 6-fold increase. 

Figure 2. Drug overdose death rates, by selected age group: United States, 1999–2017

1

Significant increasing trend from 1999 through 2017 with different rates of change over time, p < 0.005. 2

2017 rates were significantly higher for age groups 25–34, 35–44, and 45–54 than for age groups 15–24, 55–64, and 65 and over, p < 0.05. The rate for age 

group 35–44 was significantly higher than the rate for age group 45–54 and statistically the same as the rate for age group 25–34. 

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

cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#2.

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

1999 2001

45–541,2

35–441,2

25–341,2

55–641

15–241

65 and over1

2003 2005 2007 2009 2011 2013 2015 2017

40

30

20

10

0
NCHS Data Brief ■ No. 329 ■ November 2018

■  3  ■

In 2017, 20 states and the District of Columbia had age-adjusted drug 

overdose death rates that were statistically higher than the national rate.

● In 2017, 20 states and the District of Columbia had drug overdose death rates that were 

higher than the national rate (21.7 per 100,000); 8 states had rates that were comparable to 

the national rate; and 22 states had lower rates (Figure 3).

● West Virginia (57.8), Ohio (46.3), and Pennsylvania (44.3) were the three states with the 

highest observed age-adjusted drug overdose death rates in 2017. The District of Columbia 

had a rate of 44.0 per 100,000. 

● Texas (10.5), North Dakota (9.2), South Dakota (8.5), and Nebraska (8.1) were the four 

states with the lowest observed age-adjusted drug overdose death rates in 2017.

OR

CA

AZ

AK

HI

NM

TX LA

MS AL GA

OH

FL

AR

MO

TN

KY

NE

OK

KS

NV

UT

CO

WA

ID

MT ND

WY

SD WI

MI

ME

NH MA

CT RI

NJ

DE

VT

NY

PA

WV VA MD

NC

SC

IL IN

MN

IA

DC

Figure 3. Age-adjusted drug overdose death rates, by state: United States, 2017

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

cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#3.

SOURCE: NCHS, National Vital Statistics System, Mortality.

Statistically higher than U.S. rate

Statistically lower than U.S. rate

Statistically the same as U.S. rate

U.S. rate is 21.7 per 100,000 standard population.
NCHS Data Brief ■ No. 329 ■ November 2018

■  4  ■

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

other than methadone increased by 45% from 2016 to 2017.

● The rate of drug overdose deaths involving synthetic opioids other than methadone, which 

include drugs such as fentanyl, fentanyl analogs, and tramadol, increased from 0.3 per 

100,000 in 1999 to 1.0 in 2013, 1.8 in 2014, 3.1 in 2015, 6.2 in 2016, and 9.0 in 2017 

(Figure 4). The rate increased on average by 8% per year from 1999 through 2013 and by 

71% per year from 2013 through 2017.

● The rate of drug overdose deaths involving heroin increased from 0.7 in 1999 to 1.0 in 2008 

to 4.9 in 2016. The rate in 2017 was the same as in 2016 (4.9).

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

drugs such as oxycodone and hydrocodone, increased from 1.0 in 1999 to 4.4 in 2016. The 

rate in 2017 was the same as in 2016 (4.4).

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

2006, then declined to 1.0 in 2016. The rate in 2017 was the same as in 2016 (1.0).

Figure 4. Age-adjusted drug overdose death rates, by opioid category: United States, 1999–2017

1

Significant increasing trend from 1999 through 2017 with different rates of change over time, p < 0.05. 2

Significant increasing trend from 1999 through 2006, then decreasing trend from 2006 through 2017, p < 0.05. 

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

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

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

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

The percentage of drug overdose deaths that identified the specific drugs involved varied by year, with ranges of 75%–79% from 1999 through 2013 and 

81%–88% from 2014 through 2017. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#4.

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

1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

10

8

6

4

2

0

Natural and semisynthetic opioids1

Heroin1

Synthetic opioids 

other than methadone1 

Methadone2
NCHS Data Brief ■ No. 329 ■ November 2018

■  5  ■

Summary

This report updates statistics on deaths from drug overdoses in the United States and includes 

information on trends since 1999 as well as key statistics for 2017. 

Rates of drug overdose deaths continued to increase. In 2017, the age-adjusted rate of drug 

overdose deaths (21.7 per 100,000) was 3.6 times the rate in 1999 (6.1). Rates increased for both 

males (from 8.2 in 1999 to 29.1 in 2017) and females (from 3.9 in 1999 to 14.4 in 2017). Rates 

also increased for all age groups studied. In 2017, among persons aged 15 and over, rates were 

highest for adults aged 25–34 and 35–44 at 38.4 and 39.0 per 100,000, respectively. In 2017, 

20 states and the District of Columbia had age-adjusted drug overdose death rates that were 

statistically higher than the national rate, 8 states had rates that were comparable to the national 

rate, and 22 states had lower rates.

The pattern of drugs involved in drug overdose deaths has changed in recent years. The rate of 

drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, 

fentanyl analogs, and tramadol) increased 45% from 6.2 per 100,000 in 2016 to 9.0 in 2017. 

The rates of drug overdose deaths involving heroin (4.9 per 100,000), natural and semisynthetic 

opioids (4.4), and methadone (1.0) were the same in 2016 and 2017.

Definitions

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

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

inadvertently. 

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

oxycodone. 

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

and tramadol.
NCHS Data Brief ■ No. 329 ■ November 2018

■  6  ■

Data source and methods

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

(overdose) deaths were defined as having an International Classification of Diseases, 10th 

Revision (ICD–10) underlying-cause-of-death code of X40–X44 (unintentional), X60–X64 

(suicide), X85 (homicide), or Y10–Y14 (undetermined intent). Of the drug overdose deaths in 

2017, 87% were unintentional, 7% were suicides, 5% were of undetermined intent, and less than 

1% were homicides. The type of drug(s) involved are indicated by ICD–10 multiple-cause-ofdeath codes: heroin (T40.1); natural and semisynthetic opioids (T40.2); methadone (T40.3); and 

synthetic opioids other than methadone (T40.4).

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

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

Regression Program (Version 4.3.1.0) (8). Joinpoint software fitted weighted least-squares 

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

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

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

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

overall alpha level of 0.05 (9). Differences between national and state estimates were evaluated 

using two-sided significance tests at the 0.05 level, with the national rate treated as a fixed 

parameter. References to rates being higher or lower indicate that differences are statistically 

significant at the 0.05 level. References to rates being similar or not different indicate a lack of 

statistical significance even though rates may appear to differ (7). 

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

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

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

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

of drug overdose deaths for which at least one specific drug was identified as being involved 

varied by year, ranging from 75%–79% from 1999 through 2013 and from 81%–88% from 2014 

through 2017. 

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

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

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

in both the rate of drug overdose deaths involving heroin and the rate of drug overdose deaths 

involving synthetic opioids other than methadone.

About the authors

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

Epidemiology. Arialdi Miniño and Margaret Warner are with NCHS, Division of Vital Statistics. 
NCHS Data Brief ■ No. 329 ■ November 2018

■  7  ■

References

1. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. 

NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017. Available 

from: https://www.cdc.gov/nchs/data/databriefs/db294.pdf.

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

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

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

3. Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and 

psychostimulants—United States, 2015–2016. MMWR Morb Mortal Wkly Rep 67(12);349–58. 

2017. Available from: https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm. 

4. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose 

deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep 65(50–51):1445–52. 2016. 

Available from: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm.

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

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

2015. Available from: https://www.cdc.gov/nchs/data/databriefs/db190.pdf. 

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

2017. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm#Mortality_

Multiple.

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

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

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

8. National Cancer Institute. Joinpoint Regression Program (Version 4.3.1.0) [computer 

software]. 2016.

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

Center for Health Statistics Guidelines for Analysis of Trends. National Center for Health 

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

sr_02/sr02_179.pdf.
NCHS Data Brief ■ No. 329 ■ November 2018

Suggested citation

Hedegaard H, Miniño AM, Warner M. 

Drug overdose deaths in the United States, 

1999–2017. NCHS Data Brief, no 329. 

Hyattsville, MD: National Center for Health 

Statistics. 2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

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

Jennifer H. Madans, Ph.D., Associate Director for 

Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Irma E. Arispe, Ph.D., Acting Associate Director 

for Science

Division of Vital Statistics

Steven Schwartz, Ph.D., Director

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

Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

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

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

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

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

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2019–1209

CS298756 

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

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

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

Keywords: poisoning • opioids • heroin • National Vital Statistics System 

Mortality File