Opioid Overdose Deaths



Why do we measure opioid overdose deaths?

Opioids are a class of drugs used to reduce pain, and they were involved in almost 70,000 overdose deaths in 2020, a rate that has tripled since 2010 and makes up 75% of all drug overdose deaths.(1,2)Key contributors to the opioid death rate include prescription painkillers (like hydrocodone, oxycodone, morphine, oxycontin, and codeine), heroin, and more recently fentanyl and synthetic opioids.(4,5)

As opioid use disorders have risen across the U.S., most demographic groups are increasingly affected.(6) Effective strategies to address the epidemic include a range of prevention approaches, such as prescription drug monitoring and increasing medication-assisted treatment and naloxone distribution and administration, among others.  

How do we measure opioid overdose deaths?

This metric includes all deaths for which opioid overdose is included as a cause of death.  

Underestimation of Congressional District-Level Opioid Overdose Death Prevalence

Previous research has identified differences in how opioid-involved overdose deaths are reported across states. Differences in reporting can underestimate opioid-involved overdose deaths. For example, variability in coding procedures regarding opioid versus “unspecified” overdose deaths and assignment of deaths to county rather than block geographies may each play a role in underestimation in some jurisdictions.(6,7) Also, recent local shifts in opioid use patterns may not be reflected in the mortality estimates presented on the Dashboard due to time lags. For these reasons, Dashboard estimates may not adequately reflect the current extent of the opioid epidemic, and users should also consult local data sources and exercise caution when using these data. Please reach out to [email protected] with any questions, comments, or concerns.

Strengths of Metric

Limitations of Metric

Opioid-involved overdose deaths are a measure of the intensity and severity of the opioid use epidemic in a city. Other measures, like rates of non-fatal overdoses, or rates of over-prescribing by physicians, or availability of effective treatment, can give valuable insights into local patterns of use and strategies for addressing it. 

Opioid-involved overdose deaths capture only the most severe outcome of opioid use and do not reflect the far greater range of use among the broader population. 

The metric does not distinguish between deaths from different types of opioids (e.g., heroin, prescription opioids).

In some districts and states, opioid deaths are undercounted on death certificates.(8) Data users should exercise caution when making comparisons between districts.


Opioid overdose deaths are calculated by the following formula:

opioid formula

This metric is age-adjusted to the 2020 U.S. age distribution and is calculated by aggregated estimates from smaller geographies to the congressional district level. For more information on the calculation, please refer to the City Health Dashboard Technical Document.  

Data Source

Estimates for this metric are from Multiple Cause of Death Data from National Vital Statistics System of the National Center for Health Statistics. 

Opioid overdose deaths are identified by International Disease Classification code (version 10) that classifies underlying causes of death. This metric uses the X40-44, X60-64, X85, Y10-14 underlying cause of death codes in combination with the T400-T404, and T406 multiple cause of death codes. 

Years of Collection

For total population, calculated by the Dashboard Team using data from 2021, 1 year estimate

For all specific demogroups, including racial/ethnic subgroups and gender subgroups, calculated by the Dashboard Team using data from 2021, 3 year estimate


  1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.

  2. National Institute on Drug Abuse. Overdose Death Rates. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Accessed November 15, 2022.3.Hedegaard H, Warner M, Minino AM. Drug Overdose Deaths in the United States, 1999-2016. NCHS data brief. 2017(294):1-8.

  3. Warner M, Trinidad JP, Bastian BA, Minino AM, Hedegaard H. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2016;65(10):1-15.

  4. Centers for Disease Control and Prevention. Opioid Overdose- Understanding the Epidemic. Updated August 30, 2017; https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed February 23, 2018.

  5. National Institute on Drug Abuse. Opioids. https://www.drugabuse.gov/drugs-abuse/opioids. Accessed February 23, 2018.

  6. King NB, Fraser V, Boikos C, Richardson R, Harper S. Determinants of Increased Opioid-Related Mortality in the United States and Canada, 1990–2013: A Systematic Review. American Journal of Public Health. 2014;104(8):e32-e42.

  7. Warner M, Hedegaard H. Identifying Opioid Overdose Deaths Using Vital Statistics Data. Am J Public Health. 2018;108(12):1587-1589.

  8. Buchanich JM, Balmert LC, Williams KE, Burke DS. The Effect of Incomplete Death Certificates on Estimates of Unintentional Opioid-Related Overdose Deaths in the United States, 1999-2015. Public Health Reports. 2018;133(4):423-431.

  9. Davis G, Warner M, Paulozzi L, Nolte K, Ls N. State variation in certifying manner of death and drugs involved in drug intoxication deaths. Vol 32013.

Last updated: February 20, 2024