Number of U.S. overdose deaths involving kratom 2016-2017, by co-occurring substance

* Twenty-seven states reported data for the period July 2016–December 2017. Eleven states reported deaths that occurred during the entire period: Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, West Virginia, and Wisconsin. Sixteen additional states only reported deaths that occurred during July–December 2017: Alaska, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Utah, Vermont, Virginia, and Washington. Data were current as of January 22, 2019.

Identified as a cause of death by a medical examiner or coroner. Multiple substances could be listed as a cause of death; therefore, the substances are not mutually exclusive.

** Substances coded as heroin were heroin and 6-monoacetylmorphine. In addition, morphine and codeine were coded as heroin if the scene or other evidence indicated their presence as a result of consumption in conjunction with evidence of heroin use, injection, or illicit drug use, and no evidence of prescribed morphine or codeine.

*** Substances coded as prescription opioids were oxycodone, oxymorphone, hydrocodone, hydromorphone, tramadol, buprenorphine, methadone, meperidine, tapentadol, dextrorphan, levorphanol, propoxyphene, pentazocine, and phenacetin. Also coded as prescription opioids were brand names (e.g., Opana), metabolites (e.g., nortramadol) for these substances, and these substances in combination with nonopioids (e.g., acetaminophenoxycodone). Morphine and codeine were coded as prescription opioids if the scene or other evidence indicated their presence as a result of consumption of prescription morphine or codeine, rather than as a result of metabolism of or impurities of heroin, respectively. Fentanyl was coded as a prescription opioid if the scene or other evidence indicated likely consumption of prescription fentanyl rather than illicitly manufactured fentanyl. Decedents might have tested positive for other nonopioid substances. This analysis does not distinguish between prescription drugs prescribed to the decedent and those that were diverted.