Vital Signs

Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics

25 States and the District of Columbia, 2019-2020

Mbabazi Kariisa, PhD; Nicole L. Davis, PhD; Sagar Kumar, MPH; Puja Seth, PhD; Christine L. Mattson, PhD; Farnaz Chowdhury; Christopher M. Jones, PharmD, DrPH


Morbidity and Mortality Weekly Report. 2022;71(29):940-947. 

In This Article

Abstract and Introduction


Introduction: Drug overdose deaths increased approximately 30% from 2019 to 2020 in the United States. Examining rates by demographic and social determinants of health characteristics can identify disproportionately affected populations and inform strategies to reduce drug overdose deaths.

Methods: Data from the State Unintentional Drug Overdose Reporting System (SUDORS) were used to analyze overdose death rates from 2019 to 2020 in 25 states and the District of Columbia. Rates were examined by race and ethnicity and county-level social determinants of health (e.g., income inequality and treatment provider availability).

Results: From 2019 to 2020, drug overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons, respectively. Significant disparities were found across sex, age, and racial and ethnic subgroups. In particular, the rate in 2020 among Black males aged ≥65 years (52.6 per 100,000) was nearly seven times that of non-Hispanic White males aged ≥65 years (7.7). A history of substance use was frequently reported. Evidence of previous substance use treatment was lowest for Black persons (8.3%). Disparities in overdose deaths, particularly among Black persons, were larger in counties with greater income inequality. Opioid overdose rates in 2020 were higher in areas with more opioid treatment program availability compared with areas with lower opioid treatment availability, particularly among Black (34.3 versus 16.6) and AI/AN (33.4 versus 16.2) persons.

Conclusions and Implications for Public Health Practice: Health disparities in overdose rates continue to worsen, particularly among Black and AI/AN persons; social determinants of health, such as income inequality, exacerbate these inequities. Implementation of available, evidence-based, culturally responsive overdose prevention and response efforts that address health disparities impacting disproportionately affected populations are urgently needed.


The 91,799 drug overdose deaths that occurred in the United States in 2020 represent an approximately 30% increase from 2019.[1] The COVID-19 pandemic and disruption in access to prevention, treatment, and harm reduction services have likely contributed to this increase.[2] Recent increases in drug overdose deaths were largely driven by illicitly manufactured fentanyl and fentanyl analogs (collectively referred to as IMFs).[1,3,4] Deaths involving stimulants, such as cocaine and psychostimulants with abuse potential, (e.g., methamphetamine) also increased in recent years and often co-occurred with opioids;[1,3,5,6] some racial and ethnic minority groups were disproportionately affected.[6]

Disparities in overdose mortality rates are not fully explained by substance use patterns[7,8] and might result from unequal access to substance use treatment services,[9] socioeconomic inequities, and social determinants of health.[10] Non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native (AI/AN) persons report barriers to accessing mental health services and substance use treatment.[9] However, the impact of treatment access and income inequality on drug overdose mortality has not been fully explored, particularly during the COVID-19 pandemic, which exacerbated disparities.[11]

This report describes changes in drug overdose death rates from 2019 to 2020, stratified by sex, age group, and race and ethnicity. In addition, it examines differences in circumstances surrounding drug overdose, and assesses differences in overdose death rates by county-level income inequality and availability of mental health treatment providers and providers of medications for opioid use disorder.