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Blog & News
During the Pandemic, Drug Overdoses Became the Third Leading Cause of Death for U.S. Adolescents
January 06, 2025:Authors
Colin Planalp, MPA, Senior Research Fellow at SHADAC
Tyler Winkelman, MD, MSc Co-Director, Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute
Fatal overdoses involving fentanyl grew nearly 300% among adolescents
For roughly a quarter-century, U.S. drug overdoses have increased nearly every year. While this ongoing tragedy has surely harmed adolescents through the loss of parents and other loved ones, overdose deaths among U.S. adolescents remained relatively rare and changed little during most of the opioid crisis.
However, this changed when overdoses among adolescents began to increase during the COVID-19 pandemic. In this blog, we take a closer look at adolescent drug overdose deaths during the pandemic period, including examining specific substances that led to these deaths.
Drug Overdoses Third Leading Cause of Death in Adolescents in 2022
From 2019 to 2022, the rate of fatal drug overdoses among U.S. adolescents (age 13-17) more than doubled — increasing from 1.3 drug overdoses deaths per 100,000 adolescents to 3.2 drug overdose deaths per 100,000 adolescents. With that change, drug overdoses became the third leading cause of death among U.S. adolescents in 2022, following firearm injuries and transportation-related injuries (e.g., automobile collisions).
Figure 1. Top Causes of Death Among U.S. Adolescents, 2019-2022
Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.
Description of Figure 1 found in alternative text.
Fentanyl and Related Synthetic Opioids Most Common Substances in Adolescent Overdoses
We also examined the specific substances most commonly involved in fatal overdoses to understand the key drivers of this large increase in deaths among adolescents.
Fentanyl and related synthetic opioids played the largest role in growing adolescent drug overdose death rates, increasing by 293% between 2019 and 2022. Stimulants also contributed to the growing death toll: Also between 2019 and 2022, fatal overdoses involving cocaine increased by 104% during, and fatal overdoses involving methamphetamine and similar “psychostimulants” increased by 87%. Each of those increases was statistically significant.
Among the most common categories of substances involved in fatal overdoses, only natural and semi-synthetic opioids [commonly referred to as prescription opioid painkillers (e.g., oxycodone, morphine)] held statistically steady, with no significant change.
Figure 2. Most Common Substances Attributed to Fatal Overdoses Among U.S. Adolescents, 2019-2022
Source: SHADAC analysis of NVSS mortality data
* Statistically significant increase in overdose rate at 95% level.
Description of Figure 2 found in alternative text.
Adolescent Drug Overdose Deaths Warrant Attention and Solutions
The pandemic era marked an inflection point in the overdose crisis for adolescents, with drug poisonings rising to become one of the top three causes of death — more deadly than cancer. Given this development, the U.S. public health and health care systems need to urgently adopt strategies to mitigate the harm.
Effective approaches to reduce the harm of substance use and overdose among adults may not work for adolescents, whose substance use profile may differ. Interventions should be tailored to ensure adolescents aren’t overlooked by responses designed for adults. For instance, proliferation of trafficked counterfeit prescription pills, often containing fentanyl, may pose a unique risk for adolescents, who are more likely to misuse prescription medications than heroin.1
The U.S. cannot afford to neglect this new development in the opioid crisis, which is killing adolescents at a historic and growing rate.
Learn more about the Opioid Epidemic in the United States here. You can continue to learn about drug and alcohol use or child and adolescent health in some of the following SHADAC products:
- Blog - What Are Adverse Childhood Experiences (ACEs)? ACEs Definition, Data Challenges, and Resources
- Brief - Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic
- Blog - Children’s Health Insurance in 2023: Exploring Rising Uninsured Rates for Low-Income Children
[1] Friedman J, Hadland SE. The Overdose Crisis among U.S. Adolescents. NEJM. 2024;390(2):97-100. DOI: 10.1056/NEJMp2312084. https://www.nejm.org/doi/full/10.1056/NEJMp2312084
Blog & News
Research Assistant
Adult Excessive Alcohol Consumption Rate Trends in the United States
January 08, 2025:From pre-pandemic to during the pandemic, heavy alcohol use among Americans rose nearly 20%. This increase in drinking was sustained through 2022. Excessive alcohol consumption has been linked to adverse health outcomes, such as increased risk of cancer, heart disease, stroke, and mental health conditions, such as anxiety and depression.
To understand the current trends of excessive alcohol consumption at the national and state-levels in the United States, we used SHADAC’s State Health Compare tool to analyze data on the measure, “Percent of Adults Reporting Excessive Alcohol Consumption in the Past 30 Days”.
Continue reading to learn more about these general trends, along with drinking trends amongst various subpopulations.
A Note on Methods
In May of 2024, SHADAC changed the way we measure risky drinking behaviors, pivoting from measuring only "binge drinking" to measuring "excessive alcohol consumption", which encompasses both binge drinking and heavy drinking. Below, you can see the definitions between these drinking terms are similar, but the 'excessive alcohol consumption' definition is the most comprehensive.
To identify any significant changes in excessive alcohol consumption patterns or trends, SHADAC researchers conducted statistical testing to compare 2023 rates to 2022 rates of excessive alcohol consumption at both the national and state level, as well as an analysis by race and ethnicity.
National Excessive Alcohol Consumption Rates 2019-2023
In 2023, the United States experienced its lowest rate of excessive alcohol consumption in the last five years. 16.4% of U.S. adults reported binge and/or heavy drinking in 2023, significantly lower than the 2022 rate of 17.9%.
Figure 1. National Adult Excessive Alcohol Consumption Rate Over Time, 2019-2023
Long description of Figure 1 found in “National Excessive Alcohol Consumption Rates 2019-2023” section of this blog.
Excessive Alcohol Consumption by Race and Ethnicity
At the national level, excessive alcohol consumption rates decreased for all available racial and ethnic groups - African American/Black, Hispanic/Latino, Other/Multiple Races, and White - from 2022 to 2023.
Note: these racial/ethnic groups were selected based on available data. State Health Compare does not have available data for some racial/ethnic groups, due to low response rates. However, SHADAC is hopeful this data gap will be addressed in the future in order to conduct equitable analyses. Learn more in SHADAC’s presentation on demographic data collection to advance health equity.
Rates of excessive alcohol consumption were significantly lower for Hispanic/Latino, Other/Multiple Races, and White adults in 2023 compared to 2022.
17.1% of Hispanic/Latino adults reported excessive alcohol consumption in 2023, a decrease from 19.8% in 2022. The rate for individuals of Other/Multiple Races decreased from 14.9% in 2022 to 13.1% in 2023. White adults reported a decrease in excessive alcohol consumption from 18.8% in 2022 to 17.6% in 2023.
The rate for African American/Black adults was statistically unchanged from 2022 to 2023, with a reported rate of 13.7% in 2022 and 13.3% in 2023.
This breakdown also follows the national trend of an overall reduction in reported excessive alcohol consumption.
Figure 2. National Adult Excessive Alcohol Consumption Rate by Race / Ethnicity Over Time, 2019-2023
Long description of Figure 2 found in “Excessive Alcohol Consumption by Race and Ethnicity” section of this blog.
Geographic Region Highlight: Excessive Alcohol Consumption in the Midwest
Midwest states, such as Iowa, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin, have had historically higher rates of binge or heavy drinking compared to other states. From 2022 to 2023, though, nearly all midwestern states, except South Dakota, saw a decrease in their reported excessive alcohol consumption.
Minnesota and Wisconsin had significantly lower rates of excessive alcohol consumption in 2023 compared to 2022 (18.1% compared to 21.0% in Minnesota and 19.6% compared to 21.4% in Wisconsin).
The rate in Iowa decreased from 22.5% in 2022 to 21.2% in 2023. Nebraska’s rate decreased from 20.3% in 2022 to 19.9% in 2023. North Dakota reported a 1.6 percentage-point decrease from 2022 to 2023, with 23.8% in 2022 and 22.2% in 2023. Finally, South Dakota saw an increase in excessive alcohol consumption with 20.1% reporting in 2022 and 21.2% reporting in 2023.
Although all of these states reported higher rates of excessive alcohol consumption than the national rate, it is still promising to note that nearly all are following the national trend of an overall reduction in excessive alcohol consumption from years prior. And, while some of the midwestern reductions were not significant decreases, the overall lower levels of excessive alcohol consumption in a region with historically high drinking rates could reflect an overall shift in drinking trends in the U.S.
Continued monitoring of these trends in coming years will help to understand whether these reductions in the Midwest, and nationally, reflect a change in trend trajectory or whether they represent an anomaly amongst the historic trends.
Figure 3. Adult Excessive Alcohol Consumption by State, Midwest Region, 2019-2023
Long description of Figure 3 found in “Geographic Region Highlight: Excessive Alcohol Consumption in the Midwest” section of this blog.
Excessive Alcohol Consumption: Looking Forward
As trends of excessive alcohol consumption at both the national and state-level are decreasing, this is a promising step in the right direction for public health. Less alcohol consumption can improve overall health, quality of life, and safety. Reducing alcohol consumption also may lead to a reduction in alcohol-related deaths, as there are more than 178,000 deaths attributable to excessive alcohol consumption.
However, as we mentioned earlier, it will be important to continue to monitor these trends to answer important questions, like:
- Is this current trend of decreasing excessive alcohol consumption one that will continue?
- Will historic regional trends continue despite national reductions?
- What other subpopulations could benefit from disaggregated data analysis?
- How are varied demographic subpopulations rates of drinking different from the national and/or state-level rates? How can we target interventions specifically to reduce drinking in communities that have higher rates of excessive drinking?
Continue to monitor the data on State Health Compare and check out some related measures like Adult Smoking and Opioid Related and Other Drug Poisoning Deaths.
You can also read one of our latest SHADAC briefs for insight into alcohol-related deaths.
Publication
Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic
Alcohol has long been one of the few legal mind-altering substances in the United States. While legal, messaging around its use – and misuse – has often been mixed. Moderate levels of drinking, such as a glass of wine or beer with dinner, were once recommended as a way to promote better heart health and to help control blood sugar and cholesterol levels.1,2
Lately, however, the public health sphere has become awakened to the fact that even a small amount of alcohol can lead to negative health consequences, increasing risks for a number of chronic diseases and different types of cancer.3 These risks are even more pronounced for women who, biologically, process alcohol differently than men, and face higher odds of developing chronic health conditions, disease, and even increased risk of death from alcohol-induced causes.4,5
Using vital statistics data from the CDC’s WONDER system, a new brief from SHADAC researchers examines the concerning rise in alcohol-attributable deaths among women, which underscore larger patterns of growth seen across the U.S. We also examine differences in alcohol-attributable deaths between demographic groups, including by age, race and ethnicity, and geographic location during the COVID-19 pandemic period (2019-2022).
Key findings from our analysis of alcohol-attributable deaths during this time include:
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While men have traditionally seen high rates of alcohol-attributable deaths, women saw a 33% increase in alcohol-attributable deaths from 2019 to 2022 – an acceleration over the 28% growth in the rates of their male counterparts.
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Alcohol-attributable death rates for American Indian and Alaska native people, already at historic highs, surged by over 20 percentage points (from 54.0 deaths per 100,000 people in 2019 to 78.4 per 100,000 people in 2022) – well over the rate for the overall U.S. population (13.5 deaths per 100,000 people).
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Rates also increased for people living in non-metro (i.e., rural) areas during the pandemic, rising by 36% from 14.5 per 100,000 people in 2019 to 19.6 per 100,000 people in 2022.
Each of these individual trends make up an alarming larger pattern of accelerating alcohol-attributable death rates reaching all the way back to 2006, the year that the data for alcohol-attributable deaths first revealed any increase. While rates for years prior to 2006 remained generally stable, rates began steadily rising from 2006 onward, growing by nearly 30% from 7.4 alcohol-attributable deaths per 100,000 people to 10.4 per 100,000 people just prior to the COVID-19 pandemic in 2019. During the pandemic, this rate grew again by 30% from 10.4 deaths per 100,000 people to 13.5 death per 100,000 in 2022 in just three years – a worrying acceleration.
To learn more about alcohol-related deaths and our analysis of these trends, read the full brief, "Sobering Statistics: Acceleration of Alcohol-Attributable Deaths Across the United States During the COVID-19 Pandemic".
SHADAC has also built an interactive map that shows rates of alcohol-attributable deaths for the U.S. and the states from 2006 to 2022 for you to explore the data yourself. Start exploring below.
Notes and Citations
1. Callahan, A. (2024, February 17). How Red Wine Lost Its Health Halo. The New York Times. https://www.nytimes.com/2024/02/17/well/eat/red-wine-heart-health.html
2. Richardson, C. (2023, February 10). Is beer healthy? How much should people drink? Medical News Today. https://www.medicalnewstoday.com/articles/is-beer-healthy
3. National Cancer Institute. (2021, July 14). Alcohol and Cancer Risk. National Institutes of Health. https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet
4. Centers for Disease Control and Prevention (2024, September 19). Sex and Gender Considerations on Alcohol Use and Health. https://www.cdc.gov/alcohol/about-alcohol-use/alcohol-and-gender-considerations.html
5. Zhao, J., Stockwell, T., Naimi, T., Churchill, S., Clay, J., & Sherk, A. (2023, March 31). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open, 6(3), e236185. doi:10.1001/jamanetworkopen.2023.6185
Publication
PRESENTATION: Trends and Patterns in Fatal Drug Overdoses Since the COVID-19 Pandemic
SHADAC Senior Research Fellow Colin Planalp presented at the APHA Annual Meeting in October 2024. In this presentation, Mr. Planalp reviews trends and patterns in fatal drug overdoses since the COVID-19 pandemic, including the increase in fentanyl related overdose deaths, which significantly increased from 11.4 deaths per 100,000 in 2019 to 22.7 deaths per 100,000 in 2022.
Click the image below to view the slides from this presentation in a PDF format. If you would like to view the presentation in a different format, please contact us.
Are you interested in learning more about the opioid epidemic? You can view all of our latest opioid crisis resources on our Opioid Epidemic in the United States page.
Publication
Changing Dynamics in the Opioid Crisis Since the COVID-19 Pandemic
Soaring rates of fatal fentanyl, methamphetamine, and cocaine overdoses have worsened and spread to previously insulated groups, including teenagers and the elderly
It has been more than a decade since the U.S. Centers for Disease Control and Prevention (CDC) declared a national opioid “epidemic,” also known as the opioid crisis. In that time, hundreds of thousands of people have died, with the impact rippling out amongst friends, family, and communities: One in three U.S. adults know someone who has died of an overdose.1
Despite knowledge of this crisis and efforts to reduce fatal overdoses and impacts of substance use disorder, we have seen the opioid epidemic continually worsen and evolve. Evidence suggests that increased regulations on prescription opioids pushed many to illicit alternatives.2 The COVID-19 pandemic coincided with a huge increase in overdose deaths. Fentanyl, a once lesser-known contributor to the epidemic, has skyrocketed in its impact. Once insulated groups, like adolescents and the elderly, have seen overdose rates rise.
In this new brief from SHADAC, we examine changes in drug overdose death rates, and the types of drugs that cause these fatal overdoses, during the pandemic period (2019-2022). We also look at the history of the opioid epidemic: its beginnings, factors that influenced its evolution, and what it looks like now.
With this brief focusing on the four most common causes of drug overdoses — fentanyl, prescription opioids, methamphetamine, and cocaine — just some of the findings from this pandemic period include:
- Fatal overdoses from fentanyl increased 99%
- Fatal overdoses from methamphetamine increased 108%, and
- Fatal overdoses from cocaine increased 69%
While overdose death rates generally increased across all the measured racial and ethnic groups, “we […] found evidence of dramatic and growing disparities across racial and ethnic groups in rates of fatal overdoses, with the crisis increasingly harming American Indian and Alaska Native people and Black people during the pandemic era,” lead author and Senior Researcher Colin Planalp says.
In this brief, we explore these findings and more, including looking deeper at the impacts of the opioid crisis on different communities, demographics, and states. Click here to read the brief in full. The appendix for this piece is available here.
[1] Kennedy-Hendricks, A., Ettman, C. K., Gollust, S. E., Bandara, S. N., Abdalla, S. M., Castrucci, B. C., & Galea, S. (2024). Experience of Personal Loss Due to Drug Overdose Among US Adults. JAMA health forum, 5(5), e241262. https://pubmed.ncbi.nlm.nih.gov/38819798/
[2] Pitt, A.L., Humphreys, K., & Brandeau, M.L. (2018). Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. American Journal of Public Health, 108(10), 1394-1400. https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2018.304590
