In 2013, deaths involving synthetic opioids other than methadone, mostly illicitly made fentanyl, totaled 3,105 in the United States. By 2023 the figure was 72,776. That is an increase of more than 23 times in about a decade, according to a USAFacts analysis of CDC data.
Deaths then turned. The CDC’s NCHS reported that the overall drug overdose death rate fell from 31.3 per 100,000 people in 2023 to 23.1 in 2024, a 26.2 percent drop and the largest single-year decline in the 2014-2024 period. Synthetic opioid deaths fell furthest of any opioid type, down 35.6 percent in rate. Provisional data shows the decline continuing into 2025.
How much of the toll is fentanyl
In 2023, about 69 percent of all drug overdose deaths involved synthetic opioids, the CDC reports. They were involved in nearly 92 percent of opioid overdose deaths. NIDA data shows fentanyl in 80 percent of heroin-involved deaths in 2022, and in nearly 70 percent of stimulant-involved and benzodiazepine-involved deaths in 2023.
Overdose remains the leading cause of death for Americans aged 18 to 44.
Who and where
Adults aged 35 to 44 accounted for 28 percent of fentanyl overdose deaths in 2023, and those aged 25 to 34 for 23 percent. The two groups make up roughly 27 percent of the population but more than half of the deaths.
The racial gap has flipped from earlier in the epidemic. Fentanyl overdose death rates in 2023 were 35.0 per 100,000 for Black Americans and 28.5 for American Indian and Alaska Native people. White Americans stood at 21.9, against a national average of 22.2.
West Virginia had the highest state rate at 69.2 per 100,000 and Nebraska the lowest at 3.3. California recorded the most deaths, 7,203, followed by New York with 4,936 and Florida with 4,593. Those counts reflect population as much as risk.
KFF found that opioid overdose death rates fell in every state from 2023 to 2024. Virginia, Wisconsin and West Virginia saw drops of roughly 44 to 46 percent. About half of states were still above their 2019 levels, and Alaska and Oregon posted the largest increases against 2019.
Supply and treatment
The DEA has seized fentanyl-xylazine mixtures in 48 of 50 states. Its 2023 lab testing found that seven in 10 fentanyl-laced counterfeit pills held a potentially lethal dose, up from four in 10 in 2021 and six in 10 in 2022.
About 54,000 Americans died of opioid overdoses in 2024. In 2023, an estimated 54.2 million people aged 12 and older needed treatment for substance use disorder. Only 12.8 million got it.
