During 2020 and 2021, the first two years of the COVID-19 pandemic, data show that drug overdose deaths did not subside or plateau, but unfortunately surged alongside the rise of the coronavirus. Growing death rates were driven by a substantive change in the very foundation of the opioid crisis, transforming it from a public health threat caused by prescription painkillers to one in which overdose deaths are predominantly due to three different substances: methamphetamine, cocaine, and, most concerningly, fentanyl.

In a new brief, SHADAC researchers examine this latest shift in the long-standing crisis of opioid use in the United States. As lead author Colin Planalp notes,

Fentanyl has infiltrated other aspects of the illicit drug supply so pervasively that it was involved in most prescription opioid, methamphetamine, and cocaine overdose deaths, as well.

Using the latest available data from 2021, which also marks the 10th anniversary since the CDC first declared an opioid "epidemic" in 2011, the brief provides readers with an in-depth background on the crisis, including the explosive rise of fentanyl and how it has become the drug most often associated with overdose deaths, and an analysis of drug overdose death rates overall, across all 50 states, by demographic categories, and by drug type.

A snapshot of findings from each of these topics shows that:

• In 2021, the methamphetamine overdose death rate was double the 2019 rate before the pandemic; the fentanyl overdose death rate was nearly double; and the cocaine overdose death rate was almost 50% higher.
• Nearly all states saw statistically significant increases in rates of fentanyl and methamphetamine overdose deaths (43 and 44 states, respectively). A large majority of states also experienced statistically significant increases in cocaine overdose deaths (37 states). 
• Across drug categories, overdose death rates are consistently highest among working-age adults (25-54 years old), running contrary to the narrative that substance abuse is a problem mostly among adolescents and young adults experimenting with drugs.
• By individual drug category, fentanyl overdose deaths were highest among American Indian and Alaska Native people, Black people and White people; methamphetamine deaths were highest among American Indian and Alaska Native people and White people; and cocaine overdose deaths were highest among Black people.

Read the brief in full for more detailed findings, and see the appendix for the full range of data on drug overdose deaths across all 50 states, including by drug type and comparing trends from 2019 to 2021. Additionally, if you’d like to learn more about related SHADAC work on opioids, you can:

Check out our comprehensive resource page – “The Opioid Epidemic in the United States”
Read our latest blog post – “Charting Two Decades of the Opioid Crisis”
Investigate the data on State Health Compare by topic – “Opioid-Related and Other Drug Poisoning Deaths” and “Sales of Opioid Painkillers”