Overdose Deaths Declined but Remained Near Record Levels During the First Nine Months of 2022 as States Cope with Synthetic Opioids

Drug overdose deaths spiked after the start of the COVID-19 pandemic and during 2020 and 2021 claimed nearly 200,000 lives.

This surge has occurred alongside a rapidly changing U.S. drug supply. More potent synthetic opioids like fentanyl are now playing a role in nearly 70 percent of deaths.

In this post, we build on past tracking analyses and use provisional federal mortality data to assess the level of overdose mortality during the first nine months of 2022 compared to previous years, the impact of synthetic opioids on overdose rates, and how trends varied by state.

Overdose Mortality Declined During the First Nine Months of 2022

New federal provisional data suggest that drug overdose deaths dropped modestly in the first nine months of 2022, compared to the same period in 2021. In 2021, a record 106,699 lives were lost.

An estimated 79,117 Americans died from drug overdoses between January and September 2022, fewer than the 81,155 people who died during the first nine months of 2021, but still 50 percent higher than pre-2020 levels.

Provisional estimates suggest that during the first nine months of 2022, 30 states had fewer overdose deaths than during the same period in 2021. In that year, nearly every state experienced a record number of overdose deaths. There were notable decreases in West Virginia, Kentucky, and Ohio, which have experienced some of the highest overdose mortality rates in the country.

But many states experienced higher mortality rates, including South Carolina, Texas, and Washington State. During the first nine months of 2022, nearly every state had overdose mortality at least 20 percent higher than the same nine-month period in 2019. In 25 states, it was at least 60 percent higher.

Synthetic Opioids a Major Driver of Overdose Deaths Across the Country

Potent synthetic opioids, like fentanyl, which significantly increase the risk of overdose and death have been a critical factor in the recent rise in overdose mortality. Synthetic opioids are more likely to be illicitly manufactured and can be used intentionally or unintentionally — and unknowingly — combined with other drugs.

In 2012, synthetic opioids were involved in 6 percent of 41,502 overdose deaths. That figure quickly climbed to 18 percent of 52,404 deaths in 2015, 51 percent of 70,630 deaths in 2019, and then 66 percent of 106,699 deaths in 2021. Provisional data suggest this will edge even higher for 2022.

The impact of synthetic opioids did not hit all regions of the U.S. at the same time. In 2015, synthetic opioids were involved in at least 25 percent of overdose deaths in 11 states. By 2018, that number had grown to 28 states, with the impact concentrated in the Northeast, Appalachian, and Midwestern regions. Western states were less affected.

But synthetic opioid–related deaths have quickly spread throughout other regions in the past three years. By 2021 they were involved in at least 50 percent of all overdose deaths in 36 states, including many in the West (i.e., Washington State, California, Arizona, New Mexico, and Colorado).

Looking Forward

Overdose deaths declined during the first nine months of 2022, but the nationwide impact of synthetic opioids and the sustained high level of mortality underscores the need for comprehensive, people-centered policies to help save lives.

Our past work has focused on poor access to addiction treatment in the U.S. and the regulatory and delivery system barriers that hinder people from receiving needed care. But the evolving and unstable nature of the U.S. drug supply also demands a broader set of harm-reduction strategies that prioritize near-term safety for people using increasingly potent drugs.

Key policy options for state and federal policymakers to consider include:

• Improving access to the overdose reversal drug naloxone by increasing insurance coverage (e.g., implementing a federal fallback option tofill the Medicaid coverage gap), expanding community and health facility distribution of the drug, removing administrative barriers (e.g., over-the-counter purchasing), and lowering costs.
• Improving access to safe drug-use supplies by decriminalizing the use of fentanyl testing strips and supporting syringe service programs.
• Investing in centralized drug-supply testing surveillance to identify the potency of drugs within local areas or hotspots and alert community members who use them.
• Offering supervised consumption sites with medical assistance and connection to treatment services, as piloted in New York City and planned in Rhode Island.
• Strengthening and updating “Good Samaritan” liability laws that provide legal protection to people reporting emergency overdose situations.

The Biden administration has highlighted some of these priorities in its past two budget proposals, including requesting additional funding for overdose surveillance data, syringe-service programs, and harm-reduction services.

States and localities will have near-term opportunities to fund policies and programs as opioid settlement funds begin to arrive. Their willingness and creativity in deploying those resources and reforming policy can play a meaningful role in saving lives and slowing the overdose crisis.