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National Vital Statistics Reports
Volume 67, Number 9 December 12, 2018

Drugs Most Frequently Involved in Drug Overdose

Deaths: United States, 2011–2016
by Holly Hedegaard, M.D., M.S.P.H., and Brigham A. Bastian, B.S., National Center for Health Statistics;
James P. Trinidad, M.P.H., M.S., U.S. Food and Drug Administration; Merianne Spencer, M.P.H., and
Margaret Warner, Ph.D., National Center for Health Statistics


Objective—This report identifies the specific drugs involved most frequently in drug overdose deaths in the United States from 2011 through 2016.
Methods—Record-level data from the 2011–2016 National
Vital Statistics System–Mortality files were linked to electronic files containing literal text information from death certificates.
Drug overdose deaths were identified using the International

Classification of Diseases, Tenth Revision underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Drug
mentions were identified by searching the literal text in three fields of the death certificate: the causes of death from Part I,
significant conditions contributing to death from Part II, and a description of how the injury occurred. Contextual information
was used to determine drug involvement in the death. Descriptive statistics were calculated for drug overdose deaths involving the
10 most frequently mentioned drugs. Deaths involving more than one drug (e.g., a death involving both heroin and cocaine)were counted in all relevant drug categories (e.g., the same death was included in counts of heroin deaths and in counts of cocaine deaths).

Results—Among drug overdose deaths that mentioned at least one specific drug, the 10 most frequently mentioned drugs during 2011–2016 included fentanyl, heroin, hydrocodone,methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine. Oxycodone ranked first in 2011, heroin during 2012–2015, and fentanyl in 2016.

During the study period, cocaine consistently ranked second or third. From 2011 through 2016, the age-adjusted rate of drug overdose deathsinvolving heroin more than tripled, as did the rate of drugoverdose deaths involving methamphetamine. The rate of drug
overdose deaths involving fentanyl and fentanyl analogs doubled each year from 2013 through 2016, from 0.6 per 100,000 in 2013 to 1.3 in 2014, 2.6 in 2015, and 5.9 in 2016. The rate of overdose deaths involving methadone decreased from 1.4 per 100,000 in 2011 to 1.1 in 2016. The 10 most frequently mentioned drugs often were found in combination with each other. The drugs most frequently mentioned varied by the intent of the drug overdose death. In 2016, the drugs most frequently mentioned in unintentional drug overdose deaths were fentanyl,
heroin, and cocaine, while the drugs most frequently mentioned in suicides by drug overdose were oxycodone, diphenhydramine, hydrocodone, and alprazolam.

Conclusions—This report identifies patterns in the specific drugs most frequently involved in drug overdose deaths from 2011 through 2016 and highlights the importance of complete and accurate reporting in the literal text on death certificates.

Keywords: opioid • fentanyl • heroin • cocaine • National Vital

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