NCHS Data Brief ■ No. 294 ■ December 2017

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, 1999–2016

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

Key findings

Data from the National 

Vital Statistics System, 

Mortality

● In 2016, there were more

than 63,600 drug overdose

deaths in the United States.

● The age-adjusted rate of

drug overdose deaths in 2016

(19.8 per 100,000) was 21%

higher than the rate in 2015

(16.3).

● Among persons aged 15 and

over, adults aged 25–34, 35–44,

and 45–54 had the highest rates

of drug overdose deaths in

2016 at around 35 per 100,000.

● West Virginia (52.0 per

100,000), Ohio (39.1), New

Hampshire (39.0), the District

of Columbia (38.8), and

Pennsylvania (37.9) had the

highest observed age-adjusted

drug overdose death rates in

2016.

● The age-adjusted rate of

drug overdose deaths involving

synthetic opioids other than

methadone (drugs such as

fentanyl, fentanyl analogs, and

tramadol) doubled between

2015 and 2016, from 3.1 to 6.2

per 100,000.

Deaths from drug overdose are an increasing public health burden in the 

United States (1–4). This report uses the most recent 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.

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

Mortality File

In 2016, the age-adjusted rate of drug overdose deaths in the 

United States was more than three times the rate in 1999. 

● In 2016, there were more than 63,600 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 19.8 in 2016 (Figure 1). The rate

 

 

 

 

 

 

 

 

 

 

 

 

 

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

2014, and by 18% per year from 2014 to 2016. 

● Rates were significantly higher for males than females. For males, the rate increased from

8.2 in 1999 to 26.2 in 2016. For females, the rate increased from 3.9 in 1999 to 13.4 in 2016.

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

the highest rates of drug overdose deaths in 2016.

● The rates of drug overdose deaths increased from 1999 to 2016 for all age groups studied

(Figure 2).

● Rates in 2016 were highest for persons aged 25–34 (34.6 per 100,000), 35–44 (35.0), and

45–54 (34.5).

● From 2015 to 2016, the greatest percentage increase in the drug overdose death rates

occurred among adults aged 15–24, 25–34, and 35–44 with increases of 28%, 29%, and

24%, respectively.

● From 2015 to 2016, the drug overdose death rates for adults aged 45–54, 55–64, and 65 and

over increased 15%, 17%, and 7% respectively.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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In 2016, 22 states and the District of Columbia had age-adjusted drug 

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

● 22 states and the District of Columbia had drug overdose death rates that were higher than 

the national rate (19.8 per 100,000); 5 states had rates that were comparable to the national 

rate; and 23 states had lower rates (Figure 3).

● West Virginia (52.0), Ohio (39.1), New Hampshire (39.0), and Pennsylvania (37.9) were the 

four states with the highest observed age-adjusted drug overdose death rates. The District of 

Columbia had a rate of 38.8 per 100,000. 

● Iowa (10.6), North Dakota (10.6), Texas (10.1), South Dakota (8.4), and Nebraska (6.4) 

were the five states with the lowest observed age-adjusted drug overdose death rates.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

other than methadone doubled from 2015 to 2016.

● 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, and 6.2 in 2016 (Figure 4). The 

rate increased on average by 18% per year from 1999 to 2006, did not statistically change 

from 2006 to 2013, then increased by 88% per year from 2013 to 2016.

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

2010, to 4.9 in 2016. The rate was steady from 1999 to 2005, then increased on average by 

10% per year from 2005 to 2010, by 33% per year from 2010 to 2014, and by 19% from 

2014 to 2016. 

● 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 increased on average by 13% per year from 1999 to 2009 and by 3% per year from 

2009 to 2016. 

● 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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 294 ■ December 2017

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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 findings for 2016.

The rates of drug overdose deaths continued to increase. In 2016, the age-adjusted rate of drug 

overdose deaths (19.8 per 100,000) was more than three times the rate in 1999 (6.1). Rates 

increased for both males (from 8.2 in 1999 to 26.2 in 2016) and females (from 3.9 in 1999 to 13.4 

in 2016). Rates also increased for all age groups studied. In 2016, among persons aged 15 and 

over, rates were highest for adults aged 25–34, 35–44, and 45–54, at about 35 per 100,000. From 

2015 to 2016, drug overdose death rates increased 28% for persons aged 15–24, 29% for persons 

aged 25–34, 24% for persons aged 35–44, 15% for persons aged 45–54, 17% for persons aged 

55–64, and 7% for persons aged 65 and over. In 2016, 22 states and the District of Columbia had 

age-adjusted drug overdose death rates that were statistically higher than the national rate; 5 states 

had rates that were comparable to the national rate; and 23 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) doubled in a single year from 3.1 per 100,000 in 2015 to 6.2 in 

2016. Rates of drug overdose deaths involving heroin increased from 4.1 in 2015 to 4.9 in 2016. 

Rates of drug overdose deaths involving natural and semisynthetic opioids increased from 3.9 in 

2015 to 4.4 in 2016. 

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. 
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Data source and methods

Estimates are based on the NVSS multiple-cause-of-death mortality files (5). Drug poisoning 

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

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 

2016, 86% were unintentional, 8% were suicides, 6% 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 

standard population (6). Differences between national and state estimates were evaluated using 

two-sided significance tests at the 0.01 level, with the national rate treated as a fixed parameter. 

Trends in death rates were evaluated using the Joinpoint Regression Program (7). Unless 

otherwise stated, all comparisons described are statistically significant at the 0.05 level of 

significance. 

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 likely to affect 

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

drug overdose deaths that identified the specific drugs involved varied by year, with ranges of 

75%–79% from 1999 to 2013, and 81%–85% from 2014 to 2016. 

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. Margaret Warner and Arialdi M. Miniño are with the NCHS Division of Vital 

Statistics.
NCHS Data Brief ■ No. 294 ■ December 2017

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References

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

2015. NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics. 2017. 

Available from: https://www.cdc.gov/nchs/data/databriefs/db273.pdf.

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

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

Statistics. 2011. Available from: https://www.cdc.gov/nchs/products/databriefs/db81.htm. 

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

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

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

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 65:1445–52. 2016. 

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

5. National Center for Health Statistics. National Vital Statistics System. Mortality multiple 

cause of death files. 1999–2016. Available from: https://www.cdc.gov/nchs/nvss/dvs_data_

release.htm.

6. Murphy SL, Xu JQ, Kochanek KD, Curtin SC, Arias E. Deaths: Final data for 2015. National 

Vital Statistics Reports; vol 66 no 6. Hyattsville, MD: National Center for Health Statistics. 2017. 

Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_06.pdf. 

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

software]. 2016.
NCHS Data Brief ■ No. 294 ■ December 2017

Suggested citation

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.

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

Makram Talih, Ph.D., Associate Director for 

Science

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