Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential - United States, 2003-2017

Abstract

In 2016, a total of 63,632 persons died from drug overdoses in the United States (1). Drug overdose deaths involving cocaine, psychostimulants with abuse potential (psychostimulants), or both substances combined increased 42.4% from 12,122 in 2015 to 17,258 in 2016.* Psychostimulants with abuse potential include drugs such as methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA), dextroamphetamine, levoamphetamine, methylphenidate (Ritalin), and caffeine. From 2015 to 2016, cocaine-involved and psychostimulant-involved death rates increased 52.4% and 33.3%, respectively (1). A total of 70,237 persons died from drug overdoses in the United States in 2017; approximately two thirds of these deaths involved an opioid (2). CDC analyzed 2016-2017 changes in age-adjusted death rates involving cocaine and psychostimulants by demographic characteristics, urbanization levels, U.S. Census region, 34 states, and the District of Columbia (DC). CDC also examined trends in age-adjusted cocaine-involved and psychostimulant-involved death rates from 2003 to 2017 overall, as well as with and without co-involvement of opioids. Among all 2017 drug overdose deaths, 13,942 (19.8%) involved cocaine, and 10,333 (14.7%) involved psychostimulants. Death rates increased from 2016 to 2017 for both drug categories across demographic characteristics, urbanization levels, Census regions, and states. In 2017, opioids were involved in 72.7% and 50.4% of cocaine-involved and psychostimulant-involved overdoses, respectively, and the data suggest that increases in cocaine-involved overdose deaths from 2012 to 2017 were driven primarily by synthetic opioids. Conversely, increases in psychostimulant-involved deaths from 2010 to 2017 occurred largely independent of opioids, with increased co-involvement of synthetic opioids in recent years. Provisional data from 2018 indicate that deaths involving cocaine and psychostimulants are continuing to increase.† Increases in stimulant-involved deaths are part of a growing polysubstance landscape. Increased surveillance and evidence-based multisectoral prevention and response strategies are needed to address deaths involving cocaine and psychostimulants and opioids. Enhancing linkage to care, building state and local capacity, and public health/public safety collaborations are critical components of prevention efforts.

Conflict of interest statement

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Figures

FIGURE 1

Age-adjusted rates of drug overdose deaths involving cocaine with and without synthetic opioids other than methadone (synthetic opioids) and any opioids — United States, 2003–2017, Source: National Vital Statistics System, Mortality File. https://wonder.cdc.gov/. * Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. † Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdoses are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). § Drug overdose deaths, as defined, that involve cocaine (T40.5). ¶ Drug overdose deaths, as defined, that involve any opioid (T40.0–T40.4 and T40.6) and synthetic opioids other than methadone (T40.4). ** Because deaths might involve more than one drug, some deaths are included in more than one category. In 2017, 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these deaths might have involved opioids or stimulants. †† Joinpoint regression examining changes in trends during 2003–2017 indicated that cocaine-involved overdose death rates remained stable from 2003 to 2006, then decreased annually by 10.8% (95% confidence interval [CI] = −18.1 to −3.0) from 2006 to 2012, followed by a 28.5% (CI = 19.8–37.9) annual increase from 2012 to 2017. Death rates involving cocaine and any opioid remained stable from 2003 to 2013, then increased annually by 41.6% (CI = 29.1–55.2) from 2013 to 2017. Death rates involving cocaine and synthetic opioids remained stable from 2003 to 2012, then increased annually by 114.2% (CI = 82.5–151.5) from 2012 to 2017. Death rates involving cocaine without any opioid remained stable from 2003 to 2006, then decreased annually by 13.8% (CI = −21.5 to −5.3) from 2006 to 2012, followed by a 14.9% (CI = 4.8–26.1) annual increase from 2012 to 2017. Death rates involving cocaine without synthetic opioids increased annually by 11.4% (CI = 2.1–21.6) from 2003 to 2006, then decreased annually by 14.9% (CI = −22.2 to −7.0) from 2006 to 2010, followed by a 6.9% annual increase (CI = 4.4–9.4) from 2010 to 2017.

FIGURE 2

Age-adjusted rates of drug overdose deaths involving psychostimulants with abuse potential (psychostimulants) with and without synthetic opioids other than methadone (synthetic opioids) and any opioids — United States, 2003–2017, Source: National Vital Statistics System, Mortality File. https://wonder.cdc.gov/. * Rate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. † Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD-10). Drug overdoses are identified using underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). § Drug overdose deaths, as defined, that involve psychostimulants with abuse potential (T43.6). ¶ Drug overdose deaths, as defined, that involve any opioid (T40.0-T40.4, and T40.6) and synthetic opioids other than methadone (T40.4). ** Because deaths might involve more than one drug, some deaths are included in more than one category. In 2017, 12% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some of these deaths may have involved opioids or stimulants. †† Joinpoint regression examining changes in trends during 2003–2017 indicated that psychostimulant-involved overdose death rates remained stable from 2003 to 2010, then increased annually by 28.6% (95% confidence interval [CI] = 25.5–31.8) from 2010 to 2017. Death rates involving psychostimulants and any opioid increased annually by 6.9% (CI = 1.0–13.1) from 2003 to 2010, then increased annually by 28.2% (CI = 18.2–39.1) from 2010 to 2015, followed by a 50.8% (CI = 31.6–72.8) annual increase from 2015 to 2017. Death rates involving psychostimulants and synthetic opioids were greater than zero only during 2010–2017. From 2010 to 2015, these rates increased annually by 44.7% (CI = 2.8–103.5), followed by a 142.8% (CI = 43.7–310.2) annual increase from 2015 to 2017. Death rates involving psychostimulants without any opioids remained stable from 2003 to 2008, then increased annually by 22.3% (CI = 20.6–24.0) from 2008 to 2017. Death rates involving psychostimulants without synthetic opioids remained stable from 2003 to 2008, then increased annually by 22.3% (CI = 20.7–23.9) from 2008 to 2017.