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Opioid Death Rates Everything You Need to Know in 2023

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 13, 2023 • 10 cited sources

In 2021, a record-breaking number of people died of an opioid overdose in the United States. A total of 98,268 people died of drug overdoses in 2021, and most of them took opioids.[1]

While opioid death rates are rising, they’re not inevitable. Researchers have a clear understanding of overdose risks, and they know which treatment approaches work best to reduce or eliminate that risk. Digging into that data could help you learn how to support someone you love who is struggling with opioid use disorder (OUD). 

Opioid Death Rates in 2023

Overdoses sparked by any type of drug rose to an all-time high in 2021.[2] To put the numbers in context, about 52,000 people died of overdoses in 2015. Now that this number has roughly doubled, experts are incredibly worried. 

Researchers examined death rates by state in 2021 and presented the numbers as death rates per 100,000 people. States with the highest rates include the following:[3]

  • West Virginia: 77.2 
  • District of Columbia: 48.9
  • Delaware: 48.1
  • Tennessee: 45.5
  • Kentucky: 44.8

States with the lowest rates include the following:

  • South Dakota: 5.7
  • Nebraska: 6
  • Hawaii: 6.1
  • Iowa: 8.6
  • Texas: 9.4

Living in a state with low death rates isn’t protective. You can take too much of an opioid drug and die no matter where you live. But these regional discrepancies suggest that some states are struggling with drugs tainted with substances that increase overdose risks. They also reflect regional differences in environmental and socioeconomic factors that can affect how many people use opioids.

What Increases the Likelihood of Fatal Overdose?

Anyone who uses opioids faces the risk of an opioid overdose, but some factors can raise your risk even higher. These are the characteristics researchers have identified that increase the likelihood of fatal opioid overdose:

Fentanyl Exposure 

Opioids grow increasingly dangerous as the doses get stronger. The synthetic opioid fentanyl is among the strongest medications available, capable of causing an overdose when people take very small amounts. 

In 2021, more than 70,000 people died due to overdoses of synthetic opioids, primarily fentanyl.[2] Researchers say most of these deaths aren’t linked to prescriptions. Instead, they’re caused by fentanyl made in illicit labs mixed into counterfeit pills.[4] 

Far too many people head to street dealers to buy a familiar medication (like Vicodin) and get a stronger drug like fentanyl instead. They have no idea that fentanyl is in the batch they bought. A dose that seems safe could cause an overdose instead.

Race or Ethnicity 

Researchers say people who identify as non-Hispanic American Indian or Alaska Native have higher overdose death rates than other racial or ethnic groups.[5] 

It’s not entirely clear why race or ethnicity would raise the risk of overdose, and it’s possible that an underlying issue, such as a lack of access to medical care, could be responsible. But this statistic suggests that some people face higher dangers, so it’s something to be aware of. 

Lack of Health Insurance

People without health insurance are at an increased risk of fatal opioid overdose.[5] Many other issues could contribute. 

People without health insurance might buy painkillers from dealers instead of visiting a doctor to get medications. Without insurance, people might not get the evidence-based treatment they need when they do develop an OUD, and that could also lead to an escalation of use and an overdose. 

Doctor Prescribing Choices

Anyone can develop opioid physical dependence within a few days. As many as one person in four using prescription opioids develops an OUD.[6] 

But the way a doctor prescribes medications could raise the risk too. People taking doses higher than 100 morphine milligram equivalents have an overdose risk that is two times greater than those taking lower doses.[6] 

Using opioids for a long period can raise the risks too. As physical dependence increases, people need stronger doses for pain relief. The same dose just doesn’t provide the same level of relief over time. 

As they take more, they can overwhelm their bodies and suppress breathing rates. An overdose takes hold, and like any opioid overdose, it could be fatal. The longer you take opioids, the higher this risk. 

Mixing Opioids With Other Drugs 

Using opioid drugs alongside other substances (like alcohol or benzodiazepines) can raise overdose risks substantially. Depressant substances work together, suppressing the central nervous system. The more you add to the body, the higher the risk. 

How Is Opioid Overdose Treated?

Experts call opioid overdoses “preventable deaths.”[1] With proper, quick treatment, people in the middle of an overdose can recover very quickly. But the key is that treatment has to come quickly.

The medication that can reverse opioid overdoses is naloxone, available in pharmacies without a prescription in most states. It’s designed for anyone to administer. A quick blast of medicine into the nose can render opioids inactive and bring a person back to consciousness quickly. 

Researchers say this medication is between 75% and 100% effective when administered by untrained professionals.[7] Anyone can save a life by administering naloxone. But a person revived with this drug should go to an emergency room for monitoring afterward. The overdose could return once the naloxone wears off.

That person also needs ongoing care to treat OUD. Without effective treatment, they will likely return to opioid misuse and overdose again. 

What Can Bring Overdose Death Rates Down?

Treatment can help people with OUD both achieve and maintain sobriety. But close to 87% of people with an OUD don’t get the evidence-based care they need.[8] 

Researchers and lawmakers know that far too few people get treatment for OUD. States like South Dakota, North Dakota, and Alaska have increased their rates of treatment in Medication for Addiction Treatment (MAT) programs.[9] But multiple gaps remain. 

The best way to ensure that overdose rates drop and stay down is to ensure that people with OUD get the care they need to recover. That means more enrollment in MAT programs. Increasing access to MAT programs and reducing stigma associated with this kind of care can go a long way into ensuring more people get the help they need.  

OUD Treatment Options

MAT programs combine prescription medications with therapy to help address chemical imbalances and drug-taking habits. People enrolled in these programs get full-person treatments to help address chemical imbalances that cause OUD while building a new life that doesn’t include drugs. 

Researchers say buprenorphine/naloxone combinations (like Suboxone) are effective in treating OUD.[10] You can use this medication at home rather than visiting a clinic every day like you have to with methadone treatment. 

You likely won’t feel high while using Suboxone. This medication doesn’t typically have that effect on people who are not opioid naïve. 

Instead, you’ll feel focused and capable of participating in therapy. This makes it possible to focus on the work you’re doing in therapy, allowing you to build a strong base in recovery. When you aren’t distracted by withdrawal symptoms and cravings, you can make significant gains.

If you’re struggling with OUD, MAT could be the solution you’ve been looking for. Without this kind of care, recovery can seem impossible. But with this level of support, it seems within reach and can become a reality.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Drug Overdoses. National Safety Council. Accessed March 2023.
  2. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed March 2023.
  3. Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted). Kaiser Family Foundation. Accessed March 2023.
  4. Reported Law Enforcement Encounters Testing Positive for Fentanyl Increase Across U.S. Centers for Disease Control and Prevention. August 2021. Accessed March 2023.
  5. Overdose Prevention Strategy. U.S. Department of Health and Human Services. Accessed March 2023.
  6. Risk Factors for Opioid Misuse, Addiction, and Overdose. U.S. Department of Labor. Accessed March 2023.
  7. Naloxone Dosage for Opioid Reversal: Current Evidence and Clinical Implications. Therapeutic Advances in Drug Safety December 2017. Accessed March 2023.
  8. Has the Treatment Gap for Opioid Use Disorder Narrowed in the U.S.? A Yearly Assessment from 2010 to 2019. International Journal of Drug Policy. December 2022. Accessed March 2023.
  9. Nearly 90% of Patients with Opioid Use Disorder Lack Medication Access. TechTarget. August 2023. Accessed March 2023.
  10. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. November 2016. Accessed March 2023.

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