Drug overdose deaths have risen steadily over the past decade in the United States, with opioids at the center of the country’s addiction and overdose crisis. The overuse of prescription opioids initiated the increase in opioid use disorders, which led to the increase in illicit opioid use. In the past few years, the increase in fentanyl use has made the drug one of the most concerning illicit substances in the country. The potent opioid has been involved in thousands of opioid-related deaths. 

According to the Centers for Disease Control and Prevention (CDC), overdose deaths exceeded 100,000 in 2020. By 2021, the annual death toll to opioid addiction only increased. Opioid overdose deaths have exceeded 70,000 for two years in a row. Addiction and overdose have affected people all over the country, and some states were hit particularly hard by the crisis. Several factors in the opioid crisis have emerged over the past several years. Learn more about opioid overdose numbers and the current trends in 2021. 

Overdose Death Rates

Overdose rates have been increasing steadily—and sometimes dramatically—since the mid-2010s. However, overdose death rates reached record highs in 2020 when they exceeded 100,000. COVID-19 may have been a factor in worsening mental health and substance use disorders in 2020. The added stress caused by fear of the disease, social isolation, and economic uncertainty could have contributed to the increase in these numbers. However, opioid overdose numbers have been rising since before COVID-19 was a factor. In 2021,105,149 overdose deaths were reported by December, according to the CDC.

In the same period, the CDC reports 78,960 opioid overdose deaths in the United States. Of those, more than 69,000 involved synthetic opioids like fentanyl. Heroin is a significant problem in the United States, and it is the object of addiction for many people with opioid use disorders. However, the number of overdose deaths that involve heroin has remained relatively steady for several years. This could be partly because heroin breaks down in the body quickly, converting to morphine. However, it may also have to do with the rise of fentanyl as a commonly used recreational opioid. It may be taken on purpose or dealers could be selling it as heroin. 

Overdose rates related to other drugs have also increased. Psychostimulants like cocaine, amphetamines, and methamphetamine have risen since 2015. In 2020, stimulants were involved in more than 32,000 overdose deaths. Around 24,000 involved cocaine. Alcohol and prescription depressants continue to contribute to overdose rates. Depressants can be deadly when mixed, or when they are mixed with opioids. Xanax is a common prescription depressant often used as a recreational substance. However, counterfeit versions are cold and circulated illegally. These fake Xanax pills may contain other dangerous chemicals, including fentanyl.  

Opioid Overdose Trends and Demographics in the U.S. 

An opioid prescription spilling onto a black surface reflecting the American flag

Opioid addiction and overdose are a growing problem, despite attempts to curb addiction in the U.S. over the past several years. According to the 2020 National Survey on Drug Use and Health, drug use and addiction are high and growing higher. Some key trends are:

  • 21.4% of people aged 12 or older used illicit drugs
  • 3.4% of people aged 12 or older misused prescription or illicit opioids
  • 3.3% of people aged 12 or older misused prescription pain relievers
  • 1.2 million people started misusing prescription opioids in 2020
  • 2.7 million people reported an opioid use disorder in 2020
  • 80,000 adolescents between 12 and 17 years old had an opioid use disorder
  • 286,000 young adults between 18 and 15 years old had an opioid use disorder
  • 2.3 million adults 26 or older had an opioid use disorder

Opioid Overdose by State

The opioid overdose crisis has affected states all over the U.S., but it has hit major urban areas the hardest. The state with the most opioid overdose deaths in 2020 included California, Florida, Ohio, Pennsylvania, and New York. New England also has a significant opioid overdose problem. However, the highest age-adjusted rate of opioid overdose deaths was in West Virginia, which saw a total of 1,330 opioid overdose deaths in 2020. After West Virginia, Washington, D.C., Kentucky, Delaware, and Ohio had the highest rates of opioid overdose deaths.

In 2021, a few states experienced serious increases in drug-related deaths. Overdose deaths in Alaska rose by 73.79%. Vermont, Kansas, and South Dakota also saw significant increases. However, the U.S. as a whole has seen increasing overdose deaths consistently for several years. 

What Is Causing the Opioid Overdose Crisis?

There are several contributing factors in the opioid overdose crisis of the last several years. According to the CDC, the first wave of the opioid crisis began in the 1990s. At that time, opioid overprescription largely fueled opioid addiction. Prescription opioids like oxycodone were marketed as less-addictive pain relievers than other opioids like morphine. However, oxycodone and other semi-synthetic opioids can be addictive, especially with long-term use and abuse. Opioids can be used safely and effectively when treating short-term pain. However, risks of chemical dependence and addiction increase with long-term use. 

The overuse or abuse of prescription opioids can lead to the use of illicit opioids. People who become dependent on prescription drugs may try to get pills from their doctor or engage in doctor shopping to find someone that will prescribe the medication. However, prescriptions can be expensive. Plus, if your doctor finds out that you are overusing the drugs, they may not continue to prescribe them. When the pills become too challenging to afford or obtain, some opioid-addicted people turn to other options. 

Illicit heroin is cheaper than prescription opioids, and it’s among the most prevalent illicit drugs in the United States after marijuana. Heroin significantly contributed to the second wave of opioid overdose that began in 2010. During that period, heroin use was 19 times higher among people who had previously used prescription opioids. 

The third wave of opioid addiction began in 2013 and was largely linked to fentanyl. Fentanyl is a powerful synthetic opioid that’s used to treat severe pain symptoms. However, fentanyl overdoses are usually caused by illicit fentanyl that comes from outside of the country. Since fentanyl is so powerful, it can be made and shipped in small but profitable packages that are hard to detect. However, fentanyl is often mixed into heroin and other substances, making it much more powerful. Many overdoses occur in people who didn’t know they were taking fentanyl. 

According to the DEAs 2020 National Drug Threat Assessment, Mexican transnational criminal organizations are the greatest drug trafficking threat to the United States. In addition to other drugs–like heroin, methamphetamine, and cocaine–fentanyl is trafficked into the United States after it is made in illegal foreign laboratories. The drug is mixed into other powder drugs, but it may also be pressed into counterfeit pills that look like prescription drugs. 

Addiction Risk Factors

With the increasing problem of opioid addiction, it’s important to prevent substance use problems as much as possible. Several risk factors can lead to opioid addiction. There is usually no single cause. Rather, several factors may work together to lead to a substance use disorder. These factors may include:

Personal Beliefs and Expectations 

Someone’s personal beliefs and expectations about addictive substances can play a role in when and how much they engage with them. Take alcohol, for example. Teenagers who are led to believe that alcohol has more positive effects than negative may be more likely to start drinking earlier. On the other hand, those who grow up without experiencing a drinking culture may be less likely to start drinking earlier. 

Research suggests that people begin to develop beliefs and expectations about alcohol in early childhood. Children age 9 and under tend to have a negative view of alcohol. They often dislike the taste and smell and are taught that it can have bad effects. However, expectations begin to change around age 13. 

This is where they start to learn the positive effects of alcohol and may begin to develop a taste for it. Teens who start to drink at an early age often ignore the risks and focus on the positive effects they feel. This positive view of alcohol may make them more open to using drugs down the road.


Genetics can greatly impact a person’s risk of developing an addiction. Many physiological and behavioral factors surrounding addiction are all influenced by genetics. For example, if you have a parent or grandparent with an addiction, you are at a much greater risk of developing one yourself. Your genetics may even make you less resistant to substances such as drugs or alcohol, and you may like addictive substances more than others.

However, having a close relative with an addiction doesn’t automatically mean that you will develop one too. If you have a family history of addiction or struggle with one yourself, you may need to monitor your children’s relationship with alcohol and other addictive substances.

Environmental Factors 

While genetics contribute significantly to someone’s risk for addiction, they’re only one part of the equation. For example, twins who share the same genetic makeup can have different experiences with drugs or alcohol. One may develop an addiction, but the other may not. This is where environmental factors, such as your home life or friend group, make an impact. For example, teens who are raised by adults who drink heavily or spend time with friends who do drugs are at greater risk of developing an addiction.

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