While drug overdose deaths in the U.S. have been increasing over the last several years, they reached a grim milestone last year when overdose deaths hit an all-time high. Over 90,000 Americans died of a drug overdose in the 12-month period ending in December 2020, an increase of almost 30% over the prior year, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics.

Most states experienced a dramatic increase in drug-related deaths last year, with only North Dakota and New Hampshire seeing a downward trend. Some of the states with the greatest percent increases over the previous year were Arkansas (42%), California (46%), Kentucky (54%), Louisiana (48%), Nebraska (43%), South Carolina (52%), Tennessee (44%), Vermont (58%), Virginia (42%), and West Virginia (49%).

Opioids contribute to the majority of overdose deaths, according to the CDC. The latest report shows that more than 70% of the 2020 drug-related deaths were from some form of opioid. Opioids are a class of drug used to manage pain. Some of these drugs come from natural sources (e.g., codeine, morphine and heroin), some are semi-synthetic (e.g., hydrocodone, oxycodone, also known as Oxycontin), and others are synthetic (e.g., fentanyl). Although some opioids are available by prescription, they can be misused, and some are manufactured and sold illegally.

Trends in the types of opioids causing deaths have shifted over the last several years. Deaths from prescription opioids like morphine and oxycodone predominated in the late 1990’s. At that time, drug manufacturers assured healthcare providers that these drugs were not addictive. As providers prescribed opioids to more of their patients to manage pain, misuse of the drugs rose. Some prescribed opioids were diverted–they were given or sold to people who did not have a prescription for them. A greater number of people became addicted before it was fully understood that prescription opioids are highly addictive. By 2010, however, heroin became the deadliest opioid and by 2013, the synthetic drug fentanyl ranked highest in causing overdose deaths.

Fentanyl is a powerful opioid that is 50 to 100 times more potent than morphine. It is intended to treat patients experiencing severe pain. In recent years, illegally manufactured fentanyl has been sold in illicit drug markets and has been added as an ingredient to other street drugs like cocaine, sometimes without the drug user’s knowledge. Synthetic opioids, especially illegally made fentanyl, were primary drivers of last year’s steep rise in opioid deaths.

Several other factors related to the COVID-19 pandemic may have worsened opioid misuse and the overdose death rate, including:

  • Treatment centers closing and people with addictions unable to access services or support groups
  • Stay-at-home orders leading to isolation, which can worsen depression and anxiety
  • Using drugs in isolation, which results in no bystander available to aid in case of an overdose
  • Stress from job losses, accumulating debts and possible home evictions
  • Disruption in illegal drug supplies, resulting in increased availability of potent drugs in place of less potent ones

Although the U.S. continues to grapple with the COVID-19 pandemic, there has been some restoration of addiction support groups, outreach, education and treatment services. The CDC calls for implementing other strategies that have shown promise in combating this serious public health issue, including:

  • Expanding distribution of naloxone, a medication that reverses the effects of an opioid overdose
  • Using medications to treat opioid use disorder
  • Routinely screening for fentanyl
  • Making it easier for people to call 911 in the event of a suspected overdose without fear of criminal charges related to illegal drug use
  • Establishing programs within communities that can help people get treatment for opioid misuse

For more information and resources, visit the Substance Abuse and Mental Health Services Administration website.


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