Illicit Drug Abuse and Overdose

A drug addiction and overdose epidemic has gripped the country over the past decade, particularly due to prescription painkiller and heroin misuse. According to the Center for Disease Control, fatal overdoses are the leading cause of death among people under the age of 50 and claimed 70,630 lives in 2019 alone (Hedegaard et al., 2020; Center for Disease Control & Prevention [CDC], 2020). This translates to a rate of about 21.6 per 100,000 people. Between 1999 and 2019, the rate of death from drug overdose has increased 3.5 times and claimed over 841,000 lives (CDC, 2020). Political leaders and medical professionals have sounded alarms on the “opioid epidemic,” often characterizing high rates of addiction, misuse, overdose, crime, and death as a “national emergency” (HHS, 2017). 

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This report takes a closer look at fatal overdoses by drug type, year, and race, as well as substance abuse in adolescents and young adults across the country through 2019. This was done by consulting datasets from the National Center for Health Statistics (NCHS) at the Center for Disease Control and Prevention (CDC), which collects annual data on reported fatal overdoses by drug type, race, gender, and age between 1999 and 2019. The rate of drug overdose deaths is calculated by weighting the number of deaths by the national population, and multiplying it by 100,000. The adolescent and young adult drug use rates were derived from data provided by the 2018-2019 National Survey on Drug Use and Health, administered annually by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2020). This dataset provided estimates of reported use of several drug types by state. I created a rate of substance use for select drug types by summing data for the adolescent age group (12-17 year olds), which is primarily collected in school health classes, and for the young adult age group, which includes 18-25 year olds. Then, I divided these summed estimates by each state population using data from the 2019 U.S. Census Bureau, and multiplied by 100,000. This was done for use of heroin, cocaine, marijuana, and methamphetamine, as well as substance abuse disorder and alcohol use disorder.

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Nationwide overdose death rates have skyrocketed since 1999. The leading culprits of fatal drug overdoses (ODs) are opioids, which are drugs derived from opium poppy plants commonly used for pain relief and euphoria. Opioids involved in drug ODs are often prescribed pain-killers, such as oxycodone; illicit street-drugs such as heroin; or synthetic narcotics such as fentanyl, which can be over 50x more potent than morphine (Butanis, 2018). Many drug ODs occur via a dependency on prescription pain-killers after a medical surgery and induced by ingesting more than the prescribed amount, or by injecting, smoking, or snorting heroin that can be potentially laced with fentanyl once the user loses access to legally prescribed pills (Mayo Clinic, 2018). Since the turn of the century, opioid overdose deaths have increased by 434%. In 2019, nearly 50,000 people were killed by an overdose involving any type of opioid, 36,000 of which were from synthetic opioids (CDC, 2020). Synthetic opioid use has experienced a 38-fold increase since 1999, most of which can be attributed to illicitly-manufactured fentanyl (IMF) which is often used to “cut” heroin products sold to unsuspecting users (CDC Injury Prevention Center, 2020). Public health experts warn that lucrative pharmaceutical contracts and heavy-handed prescriptions from doctors — more than 191 million opioid prescriptions in 2017 alone — have led to dependence, particularly in vulnerable populations such as low-income residents in Appalachian states (Kessler et al., 2018; Park, 2016).

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Further, fatal drug overdoses are most prevalent in Native American, Black, and White populations. Asian and Pacific Islander populations experience relatively low overdose death rates. More specifically, fatal meth overdoses are most prevalent in Native Americans (12.90 in 2019) compared to the national rate of 5 per 100,000. Black populations have surpassed White populations in fentanyl deaths since 2015, increasing from a rate of 2.4 to 14.2 in 2019 (national rate: 9). Black populations also have the highest cocaine OD death rate (CDC, 2020). 

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Another key issue is illicit drug use and substance abuse in young populations aged 12 to 25. While the most prevalent type of substance misuse in adolescents and young adults is alcohol and marijuana, “hard” drugs have also infiltrated the lives of younger Americans, leading to an increased susceptibility to overdose (Johnson et al., 2020). Young people are also more likely to experiment with hallucinogens and “club drugs,” particularly in high school and college (O’Connor, 2021). Further, states with the highest rates of substance abuse disorders per 100,000 are Colorado (2,600), Vermont (2,563), and North Dakota (2,374). The national rate was 1,822 in 2019 (SAMHSA, 2020).

There are external costs to illicit drug usage beyond lives lost, amounting to $200 billion annually through medical costs, lost work productivity, and crime (Simeone, 2011). For example, in 2014, 1.25 million emergency room visits involved illicit drugs and 21% of state prisoners reported that their prosecuted offense was in order to obtain drugs or money for drugs (Wooten, 2021). Social policies for mitigating illicit drug use are complex and may vary based on supply- or demand-side interventions. According to Narconomics, supply-side interventions such as destroying raw material crops or subsidizing new crops to raise prices and reduce supply may not be effective, because price markups for cocaine final goods can reach over 30,000% in consumer markets (Wainwright, 2016). Thus, demand-side interventions that raise prices or alter sanctions may be more effective, alongside improving education or subsidizing treatment (Wooten, 2021). 

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