John Elflein
Research expert covering health and health care
The opioid epidemic in the U.S. - Statistics & Facts
The death rate from drug overdose in the United States has risen steadily since 1999 and hit a record high in 2022. That year there were around 33 overdose deaths per 100,000 population, compared to a rate of six per 100,000 population in 1999. The vast majority of these drug overdose deaths involve opioids such as prescription opioids, heroin, or illegally manufactured synthetic opioids like fentanyl. This sharp rise in opioid abuse and overdose deaths in the United States is known as the opioid epidemic. Although the government declared the opioid epidemic a public health emergency in 2017, the epidemic has only worsened in recent years, intensifying under the shadow of the COVID-19 pandemic. The opioid epidemic has come in three distinct waves: the first was a rise in overdose deaths from prescription opioids; the second, a sharp increase in overdose deaths involving heroin; and the third, and most deadly, a substantial increase in deaths involving synthetic opioids, namely fentanyl.
For more information on the opioid epidemic please see our detailed report on the topic.
The first wave: The role of the pharmaceutical industry
The origins of the opioid epidemic began in the early 1990s, with substantial growth in the number of prescription painkillers, such as Oxycontin, which were available to patients and dispensed by physicians. Irresponsible marketing by pharmaceutical companies, a rise in dispensed prescriptions, a lack of physician-patient communication concerning the dangers of opioids, and increased social acceptability of using such medications have all been blamed in part for the current epidemic. In response to the opioid epidemic, rates of prescription opioids dispensed have decreased steadily since peaking in 2012. However, there has still not been a substantial change in overdose death rates involving prescription opioids. In 2021, around 16,700 people in the United States lost their life to prescription opioid overdose, the third highest number reported since the opioid epidemic began. In recent years, thousands of civil lawsuits have been filed against pharmaceutical companies, such as Purdue Pharma, Johnson & Johnson, McKesson, and Cardinal Health, for their role in contributing to the epidemic and billions of U.S. dollars have been paid to settle these suits. However, most companies still deny any wrongdoing and many people believe the financial penalties these companies have been forced to pay do not do justice to the harm, pain, and death they have caused.The second wave: The persistent problem of heroin
Heroin has been a problem in the United States for decades, but beginning around 2010, there was a sharp increase in overdose deaths involving this addictive drug. This rise in heroin overdose deaths is considered the second wave of the opioid epidemic. The reasons for this increase include wider availability of cheap and easily accessible heroin and the similarities between heroin and prescription opioids: heroin and prescription opioids share similar physiological effects and chemical properties, making heroin a practical substitute for prescription opioids when such medications are no longer available or easily obtained. The death rate due to heroin overdose peaked in 2015 and 2016 and has since seen a steady decline, but there were still almost 9,200 overdose deaths involving heroin in 2021. The states with the highest death rates due to heroin include Delaware, New Mexico, and West Virginia.The third wave: Fentanyl
The third wave of the epidemic has been a significant increase in the number of overdose deaths involving illegally manufactured synthetic opioids, in particular fentanyl, which began in 2013. Fentanyl is extremely potent, making it highly addictive and greatly increasing the risk of accidental overdose. It is often mixed with other drugs such as heroin or cocaine, sometimes without the user’s knowledge. The majority of overdose deaths in the United States now involve fentanyl or one of its analogues. In 2021, there were around 70,600 overdose deaths from fentanyl, compared to just 3,100 in the year 2013. Although some steps have been taken to address the issue of overprescribing opioids, the rise of fentanyl has added a new dimension to the opioid epidemic and it will take the effort of all parties i.e. government, law enforcement, users, patients, physicians, and pharmaceutical companies, if a timely and effective solution is to be found.Who has been most impacted by the epidemic?
Since the start of the opioid epidemic, opioid overdose deaths have increased for both men and women, as well as almost every racial/ethnic group, age, and U.S. state. However, although everyone is susceptible to opioid abuse and overdose, some groups have been more affected than others. For example, the death rate for opioid overdose among men was twice as high as that of women in 2021. Furthermore, the opioid epidemic has historically impacted non-Hispanic whites and American Indians or Alaska Natives more than any other racial or ethnic group. However, in 2020 the opioid overdose death rate among non-Hispanic Black people was higher than that of whites for the first time since the year 2000. Rural areas of the United States have been some of the hardest hit by the epidemic, but every state has seen increases in opioid overdoses. In fact, from 2019 to 2020, only three states reported decreases in overall drug overdose deaths with the largest increases found in the states of Mississippi, West Virginia, and South Carolina. In 2021, the states with the highest rates of opioid overdose death were West Virginia, Delaware, and Tennessee, while South Dakota and Nebraska reported the lowest rates.For more information on the opioid epidemic please see our detailed report on the topic.
