At the end of 2022, the Centers for Disease Control (CDC) released a report called “Drug Overdose Deaths in the United States, 2001–2021” that presents detailed information on fatal drug overdose during the twenty-year period that includes the entirety of what we now call the Opioid Overdose Crisis. This overdose crisis has claimed over a million lives since 1999, and rates of overdose continue to increase as we write this article.
To read about the crisis, please navigate to the blog section of our website and read this article:
The Politics of Addiction: How a Group of Cities and Counties Shaped the Federal Response to the Opioid Crisis
Over the past twenty years, the addiction treatment community and public policymakers have tried virtually everything they can to stop the yearly increases in overdose fatalities. When the crisis began, our approach to drug use and misuse was still in the 1980s “War on Drugs” mode, which did not help reduce overdose deaths. Authorities realized early on that they would not be able to “arrest their way out of this crisis.”
The first major step authorities took to address the crisis was establishing a prescription drug monitoring program. This idea was based on sound reasoning, but had an unintended consequence. To learn what happened, please read this article:
Unintended Consequences: Opioid Crisis Led to Prescription Monitoring, But Did It Help?
The next step – once the majority of policymakers agreed a punitive approach was unhelpful – was to increase the use of medication-assisted treatment (MAT) for people with opioid use disorder (OUD). With medications for opioid use disorder (MOUD), people in MAT programs experience significant improvement: rates of relapse decrease, and rates of participation in treatment and other life-affirming activities increase. To learn more about MAT programs, please navigate to our MAT page here:
Medication-Assisted Treatment
When the progress we made with increasing access to MAT was threatened by the sudden increase of the powerful synthetic opioid fentanyl in the illicit drug supply, we made another shift. This time, we realized that embracing the concept of harm reduction and putting harm reduction programs in place would give us the best chance of addressing the opioid crisis. To learn how a harm reduction approach became a cornerstone of our comprehensive approach to the overdose crisis, please read this article:
The Opioid Crisis: A New National Strategy
That article outlines how harm reduction works, including details on addressing the social determinants of health, increasing access to MAT, and including people with the lived experience of opioid or drug addiction in the policymaking process.
We need this new national strategy now more than ever. The data in this latest report from the CDC tells us that the overdose crisis is not over – and for some demographic groups, it’s getting worse.
The Overdose Crisis: Twenty Years of Increasing Fatalities
There is no way to sugarcoat the overdose crisis in the U.S. As we mention above, over a million people have died of drug overdose since 1999. While we, as a nation, were slow to identify the nature of the crisis and implement the kind of policies that could lead to real and substantive change, our goal now is to look forward, embrace the concept of harm reduction, and help individuals, families, and communities move past the dangerous cycles of drug and opioid addiction that can lead to fatal overdose.
To look forward, we need to look back at the best available data and learn more about how – and for whom – to target our treatment and harm reduction efforts. We’ll start with the big picture, and look at the overdose rates in five-year increments, beginning in 2001.
Here’s the data.
Twenty-Year Trends: Drug Overdose Deaths 2001-2021
In 2001:
- 19,394 drug overdose deaths
- Rate: 6.8 per 100,000 people
In 2006:
- 34,425 drug overdose deaths
- Rate: 11.5 per 100,000 people
5-year increase:
- 15,031 more deaths in 2006 than 2001
- 77% increase
In 2011:
- 41,340 drug overdose deaths
- Rate: 13.2 per 100,000 people
10-year increase:
- 21,946 more deaths in 2011 than 2001
- That’s a 113% increase
In 2016:
- 63,632 drug overdose deaths
- Rate: 19.8 per 100,000 people
15-year increase:
- 44,238 more deaths in 2016 than 2001
- That’s a 228% increase
In 2021:
- 106,699 drug overdose deaths
- Rate: 32.4 per 100,000 people
20-year increase:
- 87,305 more deaths in 2021 than 2001
- That’s a 450% increase
That data shows us the size and scope of the overdose epidemic over the past 20 years. The dramatic increase in overdose deaths appeared in three waves, as described by the CDC. The first wave lasted from 2001 to 2006: data shows a five-year increase of 77 percent. The second wave lasted from 2006 to 2015: data shows a ten-year increase of 82 percent. This report shows the third wave lasted from 2016 to 2021, with an increase of 70 percent.
Overall, this data shows a 22.5 percent increase in drug overdose deaths every year since 2001.
Next, we’ll look at the section of this report many treatment professionals and policymakers were most interested in: a detailed analysis of the changes in rates between 2020 and 2021. This period was tumultuous and confusing to live through. The pandemic arrived, and everything changed. Treatment professionals and public officials warned that factors associated with the pandemic – the closures, the disruptions to healthcare and treatment access, the changes in work, school, and relationships, the cumulative stress – would drive overdose numbers up.
Unfortunately, they were right. Overdose increased significantly between 2020 and 2021.
Let’s take a close look at that data. We can use this CDC report to identify which groups experienced the largest increases. Then we can tailor our treatment efforts over the next several months and years – but first, we need to know exactly what happened.
Overdose Deaths 2020-2021: How We Got Here
When we look at the big picture data, we see something that’s both encouraging and discouraging. In 2017, reports showed 70,237 overdose deaths. In 2018, reports showed 67,637 overdose deaths. That’s an overall decrease of close to four percent, and a rate decrease from 21.7 overdose deaths per 100,000 people to 20.7 per 100,000 people. Then, in 2019, reports showed 70,630 deaths. In 2020, reports showed 91,799 overdose deaths. That yearly increase of 30 percent was followed by another yearly increase of 16 percent, which means we’ve returned to a rate of increase of around 22 percent.
What happened between 2018 and 2019, between 2019 and 2020, and between 2020 and 2021?
Without looking at this new report, we can identify two things that had a direct impact on overdose rates between 2018 and 2020. The first was the influx of the powerful fentanyl into the illicit drug supply in the U.S., which caused a spike in opioid overdose deaths. The second was the COVID-19 pandemic, which was associated with an increase in overdose deaths, characterized by the presence of fentanyl and the phenomenon of polysubstance misuse and co-occurring disorders.
That accounts for 2018 to 2020. Now, with this new report, we can drill down on the data for 2020 to 2021.
Overdose Deaths 2020-2021: A Close Analysis
The previous set of data told the broad story of the overdose crisis until 2021. This set of data reveals the details on rates of overdose between 2020 and 2021. It’s important to focus on the change from 2020 to 2021, because the year 2020 brought change to the nation on a variety of levels. We increased access to MAT during the pandemic, made harm reduction a national priority, and doubled down on the importance of comprehensive, integrated treatment.
With these policies in place, we need detailed data – as below – in order to best prioritize our approach to the overdose crisis in the coming months and years.
Let’s take a look at the data.
Drug Overdose Deaths, 2020-2021
By Age Group (rate per 100,000)
- 15-24:
- 2020: 16.7
- 2021: 17.2
- 3% increase
- 25-34:
- 2020: 47.3
- 2021: 52.9
- 12% increase
- 35-44:
- 2020: 53.9
- 2021: 62.0
- 15% increase
- 45-54:
- 2020: 46.9
- 2021: 53.8
- 15% increase
- 55-64:
- 2020: 37.3
- 2021: 45.3
- 21% increase
- 65+:
- 2020: 9.4
- 2021: 12.0
- 27% increase
Seniors age 65+ showed the largest increase in overdose rates between 2020 and 2021.
By Gender (rate per 100,000)
- Male:
- 2020: 39.5
- 2021: 45.1
- 14% increase
- Female:
- 2020: 17.1
- 2021: 19.6
- 15% increase
The overdose rate for males increased by 14%, while the overdose rate for females increased by 15%. That’s the first time since 2001 that overdose rate for females increased more than overdose rate for males.
By Race/Ethnicity (rate per 100,000)
- Non-Hispanic American Indian or Alaskan Native:
- 2020: 42.5
- 2021: 56.6
- 33% increase
- Non-Hispanic Black:
- 2020: 35.8
- 2021: 44.2
- 23% increase
- Non-Hispanic White:
- 2020: 33.1
- 2021: 36.8
- 11% increase
- Hispanic:
- 2020: 17.6
- 2021: 21.1
- 20% increase
- Non-Hispanic Native Hawaiian or Pacific Islander:
- 2020: 13.7
- 2021: 20.1
- 47% increase
- Non-Hispanic Asian:
- 2020: 4.6
- 2021: 4.7
- 2% increase
Researchers observed the largest increases among Non-Hispanic Native Hawaiian or Pacific Islanders, the second largest increases among Non-Hispanic American Indian or Alaskan Natives, and the smallest increases among Non-Hispanic Asian people.
By Type of Drug (rate per 100,000)
- Any Opioid:
- 2020: 21.4
- 2021: 24.7
- 15% increase
- Heroin:
- 2020: 4.1
- 2021: 2.8
- 32% decrease
- Methadone:
- 2020: 1.1
- 2021: 1.1
- No change
- Synthetic Opioids (other than methadone, e.g., fentanyl)
- 2020: 17.8
- 2021: 21.8
- 22% increase
- Cocaine:
- 2020: 6.0
- 2021: 7.3
- 22% increase
- Psychostimulants (e.g., methamphetamine):
- 2020: 7.4
- 2021: 10.0
- 35% increase
Rates of overdose increased the most for psychostimulants, such as methamphetamine, and decreased for heroin. This aligns with what we know about this phase of the overdose crisis: it’s driven by a combination of the presence of fentanyl in stimulants and other drugs and an increase in polysubstance misuse.
That’s a complete summary of the key findings from the CDC report, with embedded commentary to help explain what the numbers mean. We’ll discuss this data further, below.
Overdose in the U.S. 2001-2021: Looking Back to Move Forward
As we mention above and describe in detail in several articles on our blog, we’ve embraced the concept of harm reduction. That means we – as a nation – are poised to offer lifesaving treatment and support where it’s needed most.
We’ll point out one data point that’s encouraging – rates of heroin overdose decreased – and one that discouraging – rates of psychostimulant overdose increased. Those findings, while meaningful, are not as impactful as the findings related to various demographic groups.
The data tells us that several demographic groups experienced significant increases in overdose rates from 2020 to 2021. Therefore, over the next several months, we’ll brainstorm – and initiate – the best ways to support the following groups:
- Older Adults, 65+:
- Senior adults showed larger increases in overdose than any other age group.
- Non-Hispanic American Indian or Alaskan Native:
- This racial/ethnic group showed the second largest increase in overdose in the country, with a 33% increase from 2020-2021
- Non-Hispanic Native Hawaiian or Pacific Islander:
- This racial/ethnic group showed the largest increase in overdose in the country, with a 47% increase from 2020-2021
- Women:
- For the first time since the beginning of the overdose crisis, rates of overdose in women increased more in a single year than rates of overdose for men
Those are the people we’ll focus on: seniors, Non-Hispanic American Indian or Alaskan Native, and Non-Hispanic Native Hawaiian or Pacific Islanders. We have the resources and the programs in place: now, it’s a matter of follow-through. If we stay the course, and remain committed to harm reduction, we’re confident we can change lives for the better. With comprehensive support and integrated treatment, we’re also confident we can make that change last, and help people begin their journey to healing and recovery.