Fentanyl overdose deaths surged 279% since 2016 while heroin deaths fell: CDC

Fentanyl had the highest death rates across every age and racial group.

May 3, 2023, 12:01 AM

The rate of drug overdose deaths linked to fentanyl in the United States has skyrocketed over the last five years, new federal data showed.

The rate of overdose deaths involving fentanyl spiked by 279% between 2016 and 2021 from 5.7 per 100,000 to 21.6 per 100,000, according to a report published early Wednesday by the National Center for Health Statistics' National Vital Statistics System -- which looked at death certificate records.

"We are always hoping we won't see a rise in fentanyl deaths, but this really highlights that this is continuing to be the public health problem," Merianne Spencer, a co-author of the report and a researcher at the Centers for Disease Control and Prevention, told ABC News.

Although the rate of overdose deaths linked to other drugs also saw increases, they were more modest rises and did not reach the levels of fentanyl.

Deaths linked to methamphetamine quadrupled from 2.1 per 100,000 in 2016 to 9.6 per 100,000 in 2021 and deaths due to cocaine more than doubled from 3.5 per 100,000 to 7.9 per 100,000 over the same period.

"When it comes to overdose, really the biggest driver is folks who are really struggling with addiction primarily on street drugs, which fentanyl is primarily found in terms of the street drug supply rather than a prescription medication," Dr. Allison Lin, an addiction psychiatrist at University of Michigan Medical School, who was not involved in the report, told ABC News.

"And it's primarily folks who are struggling with addiction to multiple substances, so oftentimes, folks who are using not only fentanyl, but fentanyl plus cocaine or fentanyl plus methamphetamine," she said.

Rate of Drug Overdose Deaths in the United States
National Center for Health Statistics, National Vital Statistics System

Meanwhile, drugs that used to make up the majority of overdose deaths -- heroin and oxycodone -- saw declines in their rates of death.

Rates of heroin overdose fatalities fell from 4.9 per 100,000 to 2.9 per 100,000 while oxycodone overdose death rates fell slightly from 1.9 per 100,000 to 1.5 per 100,000.

Researchers have noted there has been a marked increase in fentanyl use, and subsequently fentanyl overdoses, as heroin overdoses have fallen.

From 2019 to 2020 alone, the rate of fentanyl deaths linked to fentanyl rose by 55% and by 24.1% from 2020 to 2021, according to the report. The Department of Justice and the FBI announced on Tuesday that 300 people were arrested after a year-long operation tracking the trafficking of fentanyl and opioids on the dark web.

There has been a shift from a heroin-based market to a fentanyl-based market, according to the DOJ's Drug Enforcement Administration.

"The vast majority of our folks or patients with substance use disorders, even if they don't know it, they're primarily using the drug supply that's primarily fentanyl," Lin said. "So, the folks who were using heroin previously are the folks who are also using fentanyl now. It's just that the supply of opioids and other drugs in our communities are primarily supplies that are predominantly fentanyl because of all the characteristics of it, how inexpensive it is, how easy it is to cut with other substances, other factors."

However, the CDC said the decrease in heroin-related deaths is also linked to increased treatments for people who use heroin, as well as increased access to naloxone, which reverses opioid overdoses.

Data showed that, for all five drugs analyzed in 2021, men had higher rates of death than women. The widest gap was when it came to rates of death due to heroin with men having a rate nearly three times higher at 4.2 per 100,000 compared to 1.5 per 100,000 for women.

In 2021, among all age groups, fentanyl was the drug with the highest overdose death rates. However, rates were highest among those aged 35 to 44 at 43.5 per 100,000 and those aged 25 to 34 at 40.8 per 100,000.

For Americans between ages 45 and 64, while the rates were highest for fentanyl, the rates were similar to deaths involving cocaine and methamphetamine.

Matt Capelouto, whose daughter died from a fentanyl overdose, speaks at a news conference outside the Capitol in Sacramento, Calif., April 18, 2023.
Tran Nguyen/AP

Meanwhile, for those aged 24 younger and those aged 65 and older, death rates were highest for fentanyl but not significantly different from deaths due to methamphetamine, cocaine, heroin and oxycodone.

Similarly, while fentanyl has the highest death rate across every racial/ethnic group, some groups have been affected by different drugs.

American Indians/Alaska Natives saw a fentanyl overdose death rate of 33.1 per 100,000 in 2021, but it was closely followed by methamphetamine at 27.4 per 100,000. Black Americans had a fentanyl death rate of 31.3 per 100,000 closely followed by a cocaine rate of 20.6 per 100,000.

Drug cartels have specifically targeted Native American reservations, leading to higher use of methamphetamine among this population than any other group, according to the Department of Justice. Additionally, Black Americans and African Americans have been disproportionately affected by use of crack cocaine.

"The fact that for American Indians/Alaskan Natives, it was fentanyl followed by meth and for non-Hispanic Black Americans and African Americans it was fentanyl followed by cocaine, that's an important highlight," Spencer said. "Within each group, the drug ranking varies slightly."

Lin said this is evidence that even if fentanyl is now the primary drug of focus, the epidemic related to cocaine and meth has not disappeared.

"There are going to be different substances, different factors that affect different groups," she said. "Unfortunately, we see death rates and overdose rates rise across all of these groups, because of the factor of fentanyl."

Lin added, "It doesn't mean that we've ever addressed the crack epidemic, I would say, and we also have a rising meth epidemic in the country as well and everything is just made worse [because] these are not just single substance that people are using anymore. They're really oftentimes combined with fentanyl."