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Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020 (



What is already known about this topic?

Drug overdose deaths increased 30% in the United States from 2019 to 2020. Known health disparities exist in overdose mortality rates, particularly among certain racial/ethnic minority populations.

What is added by this report?

From 2019 to 2020, overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native persons, respectively. As county-level income inequality increased, overdose rates increased, particularly among Black persons. Evidence of previous substance use treatment was lowest for Black decedents (8.3%).

What are the implications for public health practice?

Implementation of an evidence-based, culturally responsive, multisectoral approach is critical to reducing disparities in overdose rates. This includes addressing structural barriers and enhancing efforts such as linkage to care and harm reduction services.


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.

To access the full report, please click here.

Authors: Mbabazi Kariisa, PhD1; Nicole L. Davis, PhD1; Sagar Kumar, MPH1; Puja Seth, PhD1; Christine L. Mattson, PhD1; Farnaz Chowdhury2; Christopher M. Jones, PharmD, DrPH3 (View author affiliations)

Suggested citation for this article: Kariisa M, Davis NL, Kumar S, et al. Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:940–947. DOI:

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