In January 2020, the U.S. Centers for Disease Control and Prevention (CDC) announced that the national mortality rate from drug overdoses had declined by 4.6 percent from 2017 to 2018--dropping from about 70,200 to 67,400 deaths. Although drug overdose death rates still hovered near record highs, the improvement offers encouragement that federal, state and local efforts to fight the opioid crisis may be starting to return desired results. However, a deeper examination of the overdose data across individual drug types paints a more nuanced picture. While the United States has made progress in reducing deaths from some types of opioids, deaths from other opioids have continued to climb. In 2018, U.S. overdose death rates from natural and semi-synthetic opioids (i.e., prescription opioid painkillers) declined significantly compared with the prior year, as did those from the illicit opioid heroin. But death rates from synthetic opioids (e.g., fentanyl) again increased significantly--reaching yet another record high. Also concerning are emerging signs that the opioid crisis is increasingly broadening to encompass deaths from non-opioid illicit substances; for instance, in 2018, U.S. overdose death rates for cocaine and for psychostimulants (e.g., methamphetamine) increased significantly. Substantial evidence has recently emerged linking the growth in death rates from cocaine and psychostimulants with the opioid crisis. The CDC released research findings that indicate more than 70 percent of cocaine overdoses, and roughly 50 percent of methamphetamine overdoses, also involve opioids, and U.S. Drug Enforcement Administration (DEA) reports reveal that illicitly trafficked cocaine and methamphetamine have increasingly begun to also contain opioids. This brief examines variation and changes in opioid-related drug overdose deaths across the states, with a particular focus on changes in death rates in recent years, especially in 2018. National-level analysis can be found in the companion brief, Opioid Crisis in Transition: Changing National Trends in a Widening Drug Death Epidemic.
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