More than a decade after the Centers for Disease Control and Prevention declared a national opioid epidemic in the United States, the crisis remains a grim and persistent fact of life in communities across the country. Since 2000, more than 1.1 million Americans have succumbed to drug overdoses—including over 100,000 as recently as 2022, the most recent year for which there is data tracking the crisis. And like many other areas of public health, the opioid crisis was a problem that only grew worse during the COVID-19 pandemic.

A new study from the University of Minnesota School of Public Health (SPH) tracked changes in drug overdose death rates during the pandemic, focusing on the four most common causes of drug overdose: fentanyl, prescription opioids, methamphetamine, and cocaine. The study, conducted by researchers from SPH State Health Access Data Assistance Center (SHADAC), found that between 2019 and 2022:

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  Fatal overdoses increased in most types of opioids.

  • Fatal overdoses increased 108% from methamphetamine, 99% from fentanyl, and 69% from cocaine. Fatal overdoses from prescription opioids did not change significantly.
• The crisis spread during the pandemic to age groups that had previously been less heavily impacted by it.
  • Among adolescents (age 13-17) the fentanyl overdose death rate almost quadrupled, while fatal cocaine overdoses roughly doubled and fatal methamphetamine overdoses nearly doubled.
  • Fatal fentanyl, methamphetamine and cocaine overdoses also rose significantly among elderly adults. For people aged 65-74, fentanyl overdose deaths nearly tripled, and cocaine and methamphetamine overdose death rates more than doubled.
• The toll of drug overdose deaths varied across racial and ethnic groups.
  • Fatal fentanyl overdoses were most common among American Indian and Alaska Native people, Black people, and white people. Fatal methamphetamine overdoses were most common among American Indian and Alaska Native people, Native Hawaiian and Pacific Islander people, and white people. Fatal cocaine overdoses were most common among Black people.
• Most fatal overdoses from prescription opioids, methamphetamine and cocaine also involved fentanyl.
  • Fifty-nine percent of fatal prescription opioid overdoses involved fentanyl, 65% of fatal methamphetamine overdoses involved fentanyl, and 76% of fatal cocaine overdoses involved fentanyl.

• Geographically, a majority of states experienced increases in overdose deaths, and no state experienced a decline in fentanyl, methamphetamine, or cocaine overdose death rates.
  • Fatal overdoses from fentanyl rose in 43 states, from methamphetamine increased in 44 states, and from cocaine rose in 37 states.

The researchers included data for Minnesota, which saw some of the largest increases in fatal overdose deaths among certain drug types. For example: 

• While Minnesota’s cocaine overdose death rate remained significantly lower than the U.S. average in 2022, it experienced the largest increase in cocaine overdose death rates among the states from 2019 to 2022. In those years, the state’s fatal cocaine overdose rate more than tripled, from 1.1 to 3.7 deaths per 100,000 people.

• And while Minnesota’s fatal methamphetamine and fentanyl overdose rates were also significantly lower than the U.S. average in 2022, they increased significantly from 2019 to 2022. The methamphetamine overdose death rate more than doubled between 2019 and 2022, from 4.3 to 9.4 deaths per 100,000 people; its fentanyl overdose death rate roughly tripled between 2019 and 2022, from 5.7 deaths to 17.3 deaths per 100,000 people.

“This report serves as a sobering reminder of the opioid crisis’s persistence and growing complexity,” said Colin Planalp, SPH senior research fellow and lead author. “As the report makes clear, the overdose crisis grew dramatically worse during the pandemic. While our focus shifted to COVID-19, the U.S. opioid epidemic kicked into higher gear. We saw growth in fatal overdose deaths in most states across the country, and that growth extended into age groups that had until recently been less affected by the crisis. We also saw increased disparities in fatal overdoses across racial and ethnic groups. The largest factor driving these tragic trend lines is the rapid acceleration of the availability and use of fentanyl, and its newly intertwined relationship with cocaine and methamphetamine. The report underscores the urgent need for improved public health responses that directly address not only fentanyl, but also the emerging public health threats posed by methamphetamine and cocaine.”

The report notes the need for an enhanced data infrastructure to provide more timely and precise insights into emerging trends in the opioid epidemic. Currently, the report states, data is imprecise and subject to long time lags, making it difficult to track the ongoing problem and develop timely and focused solutions.