This webpage is regularly updated to display the most recent final drug overdose death data published annually by NCHS. NCHS systems receive and analyze data from death certificates, including cause-of-death information reported by state and local medical examiners and coroners. Because drug overdose deaths often require lengthy investigations, data are updated as new information is received.
Methods. We used data on drug overdose deaths in the United States from 2000 to 2015 collected in the National Vital Statistics System to calculate annual rates and numbers of cocaine-related overdose deaths overall and deaths both involving and not involving opioids. We assessed statistically significant changes in trends with joinpoint regression.
Crack Cocaine Related Deaths In 2013
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The percentage of cocaine-related overdose deaths involving any opioid increased from 29.4% in 2000 to 63.0% in 2015 (Table A, available as a supplement to the online version of this article at ). Among these deaths, heroin or synthetic opioids have been increasingly contributing to these deaths since 2010, contributing to 81.5% of these deaths in 2015.
The public health and public safety response to increasing cocaine-related overdose deaths should be comprehensive and informed by the role opioids play. This is particularly important given the rapid increase in cocaine-related deaths involving synthetic opioids such as fentanyl and its highly potent analogs.
Expanding the provision of medication-assisted treatment with methadone, buprenorphine, or naltrexone in combination with behavioral health services is also crucial to treat co-occurring opioid and cocaine use disorders. For persons who use opioids, regardless of whether they also use cocaine, such medical treatments are essential for reducing substance use and improving health and social outcomes. In addition, the use of contingency management has been found to be particularly useful to reduce cocaine use (for additional references on these interventions, see Table B, available as a supplement to the online version of this article at ).
The overdose epidemic has grown increasingly complex by co-involvement of prescription and illicit drugs. For example, synthetic opioids (primarily IMFs) were involved in 23.7% of deaths involving prescription opioids, 37.4% involving heroin, and 40.3% involving cocaine in 2016.3
Recent data indicate that the involvement of opioids in stimulant-involved deaths is increasing. Nearly three-quarters (72.7%) of cocaine-involved overdose deaths also involved an opioid in 2017.5 Previous data have indicated that synthetic opioids, in particular, appear to be driving increases in cocaine-involved overdose deaths.3 Approximately one-third of psychostimulant-involved deaths also involved synthetic opioids in 2019.6
A tranquilizer not approved for use in humans called xylazine is increasingly being found in the US illicit drug supply and linked to overdose deaths.7 Xylazine can be life threatening and is especially dangerous when combined with opioids like fentanyl.
The new data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths from synthetic opioids (primarily fentanyl), psychostimulants such as methamphetamine, and cocaine also continued to increase in 2021 compared to 2020.
The biggest percentage increase in overdose deaths in 2021 occurred in Alaska, where deaths were up 75.3%, while overdose deaths in Wyoming did not increase at all in 2021 and deaths in Hawaii declined 1.8% from the same point in 2020. The visualization includes:
NCHS releases both reported and predicted provisional drug overdose death counts each month. They represent the numbers of these deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.
To estimate the impact of cocaine use on cardiovascular and all-cause deaths, we calculated the population-attributable risk (PAR) percent [11]. PAR percent expresses the proportion of disease (cardiovascular and all-cause deaths) in the study population that is attributable to the exposure (cocaine use) and thus could be eliminated if the exposure was eliminated. The PAR percentage was calculated using the following formula: equation where PAR% indicates PAR percent, Pe represents the proportion of the population exposed to the risk factor (frequent cocaine user), and OR indicates odds ratio (multivariate adjusted).
We used the coefficients from the regression model and US life tables for 2011 to estimate the years of life lost as described previously [12]. The number of years lost was the difference in expected age according to US life table and that of a person with regular lifetime cocaine use for an average adult aged 31 years (mean age of nonusers in the analysis).
Relationship between cocaine use and all-cause deaths in persons aged 18 to 45 years (Cox proportional hazards analysis): Third National Health and Nutrition Examination survey mortality follow-up study
Relationship between cocaine use and cardiovascular deaths in persons aged 18 to 45 years (Cox proportional hazards analysis): Third National Health and Nutrition Examination survey mortality follow-up study
There is evidence that patients with cocaine related acute coronary syndromes have low rates of complications and mortality which may explain the lack of relationship between cardiovascular mortality and cocaine use. A retrospective cohort study at 29 hospital centers of 136 MI events related to cocaine use [18], found no events that led to in-hospital death. Complications including congestive heart failure (n = 9), and ventricular tachycardia (n = 23), were transient and infrequent after the first 12 h. The Cocaine Associated Chest Pain (COCHPA) Study Group reported two deaths in 246 patients presenting with cocaine related chest pain [19]. Elevation in cardiac enzyme, arrhythmias, and congestive heart failure were seen in
Another study involving ascertainment of mortality among 20,983 adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use found that those persons whose lifetime cocaine use had a significantly higher rate of death associated with human immunodeficiency virus diseases [5]. The unadjusted rates of deaths from diseases of the heart were 37 and 31 per 100,000 person years among nonusers and lifetime cocaine users, respectively. Further studies would be required to identify reasons, particularly preventable reasons, for death among cocaine users.
U.S. deaths from overdoses of cocaine totaled 14,666 in 2018, according to a new report from the Centers for Disease Control and Prevention. The rate of overdose deaths remained stable from 2009 through 2013, the report found, but then headed upward at about 27 percent each year from 2013 through 2018. Approximately 80% of overdose deaths involved opioids, and three of four opioid overdose deaths involved illicitly manufactured fentanyls (IMFs). The supply of fentanyl and overdose deaths involving synthetic opioids are projected to have increased for the seventh straight year in 2019. Fentanyl, heroin, cocaine, or methamphetamine (alone or in combination) were involved in nearly 85% of overdose deaths. The CDC report suggests the combination of drugs complicates intervention and treatment efforts; one-half of these deaths involved two or more of these four drugs.
The CDC report says that the rate of overdose deaths from cocaine was higher among men than women and more common among middle-aged people (35 to 44 years old), those living in urban rather than rural areas, and people residing in the Northeast region. In addition, the rate of overdose deaths attributed to cocaine laced with a synthetic opioid such as fentanyl increased faster in recent years than did overdose deaths from purely cocaine.
The CDC research indicates that more than three in five overdose deaths (62.7%) had evidence of at least one potential opportunity for intervention. Approximately one in ten opioid overdose deaths had evidence of past-month institutional release (10.7% with stimulants; 10.8% without stimulants) or previous overdose (10.9%; 12.1%). Mental health diagnoses were documented for one quarter (25.8%) of overdose deaths. Evidence of current or past substance use disorder treatment was more common among opioid overdose deaths (18.6% with stimulants; 19.1% without stimulants) than nonopioid overdose deaths (
4,859 deaths related to drug poisoning were registered in 2021 in England and Wales, equivalent to a rate of 84.4 deaths per million people; this is 6.2% higher than the rate recorded in 2020 (79.5 deaths per million).
The North East continues to have the highest rate of deaths relating to drug poisoning and drug misuse (163.4 deaths per million people and 104.1 per million, respectively); London had the lowest rate for drug poisonings (47.6 deaths per million people), and the East of England had the lowest rate for drug misuse (27.4 per million).
4,859 deaths related to drug poisoning were registered in England and Wales in 2021; this is the highest number since records began in 1993 and 6.5% higher than in 2020 (4,561 registered deaths). The rate of drug poisoning deaths registered in 2021 (84.4 deaths per million) is statistically significantly higher, by 6.2%, than the rate in 2020 (79.5 deaths per million).
The rate of drug poisoning deaths was 81.1% higher in 2021 (84.4 deaths per million) than it was in 2012 (46.6 per million people). The rate has increased every year since 2012 after remaining relatively stable over the preceding two decades.
The government has set a target, as part of the 10-year drugs plan for England, to have "prevented nearly 1,000 deaths, reversing the upward trend in drug deaths for the first time in a decade" by the end of 2024 to 2025.
Of the 4,859 registered drug poisoning deaths in 2021, 3,060 were identified as drug misuse. This represents 63.0% of drug poisonings. If we exclude deaths where no information was available on the drug(s) involved (1,219 deaths), then 84.1% of drug poisoning deaths were drug misuse. be457b7860
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