Drug overdose

Last updated

Drug overdose
Other namesOverdose, OD, Hotshot, Wasted, Intoxication, Gassed, Medicinal Poisoning
DrugOverdose.jpg
A photograph showing a person who had overdosed
Specialty Toxicology
Symptoms Vary depending on the drug and the amount used
Complications
Causes
Risk factors
Differential diagnosis
Treatment
Fentanyl. 2 mg (white powder to the right) is a lethal dose in most people. US penny is 19 mm (0.75 in) wide. Fentanyl. 2 mg. A lethal dose in most people.jpg
Fentanyl. 2 mg (white powder to the right) is a lethal dose in most people. US penny is 19 mm (0.75 in) wide.

A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. [2] [3] Typically it is used for cases when a risk to health will potentially result. [2] An overdose may result in a toxic state or death. [3]

Contents

Classification

Timeline of US drug overdose death rates by race and ethnicity. Rate per 100,000 population. Timeline. US drug overdose death rate by race and ethnicity.gif
Timeline of US drug overdose death rates by race and ethnicity. Rate per 100,000 population.

The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly applied only to drugs, not poisons, even though many poisons as well are harmless at a low enough dosage. Drug overdose is sometimes used as a means to commit suicide, as the result of intentional or unintentional misuse of medication. Intentional misuse leading to overdose can include using prescribed or non-prescribed drugs in excessive quantities in an attempt to produce euphoria.

Usage of illicit drugs, in large quantities, or after a period of drug abstinence can also induce overdose. Cocaine and opioid users who inject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small. [5] Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient or unwitting ingestion by children. [6] A common unintentional overdose in young children involves multivitamins containing iron.

The term 'overdose' is often misused as a descriptor for adverse drug reactions or negative drug interactions due to mixing multiple drugs simultaneously.

Signs and symptoms

Toxidrome [7]
Symptoms Blood
pressure
Heart rate Respiratory
rate
Temperature Pupils Bowel
sounds
Diaphoresis
Anticholinergic ~
[ clarification needed ]
up~updilateddowndown
Cholinergic ~~unchangedunchangedconstrictedupup
Opioid downdowndowndownconstricteddowndown
Sympathomimetic upupupupdilatedupup
Sedative-hypnotic downdowndowndown~downdown

Signs and symptoms of an overdose vary depending on the drug or exposure to toxins. The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties.

Symptoms of opioid overdoses include slow breathing, heart rate and pulse. [8] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood. A person experiencing an opioid overdose might also have muscle spasms, seizures and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.

Causes

The drugs or toxins that are most frequently involved in overdose and death (grouped by ICD-10):

Added flavoring

Masking undesired taste may impair judgement of the potency, which is a factor in overdosing. For example, lean is usually created as a drinkable mixture, the cough syrup is combined with soft drinks, especially fruit-flavored drinks such as Sprite, Mountain Dew or Fanta, and is typically served in a foam cup. [9] [10] A hard candy, usually a Jolly Rancher, may be added to give the mixture a sweeter flavor. [11]

Diagnosis

The substance that has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an altered level of consciousness, provide this information, a search of the home or questioning of friends and family may be helpful.

Examination for toxidromes, drug testing, or laboratory test may be helpful. Other laboratory test such as glucose, urea and electrolytes, paracetamol levels and salicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of suicide. [12]

Prevention

The distribution of naloxone to injection drug users and other opioid drug users decreases the risk of death from overdose. [13] The Centers for Disease Control and Prevention (CDC) estimates that U.S. programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have prevented 10,000 opioid overdose deaths. [14] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the U.S. state of North Carolina, and have been replicated in the U.S. military. [15] [16] Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers' insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose. [17] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the U.S. [18]

Supervised injection sites (also known as overdose prevention centers) have been used to help prevent drug overdoses by offering opioid reversal medications such as naloxone, medical assistance and treatment options. They also provide clean needles to help prevent the spread of diseases like HIV/AIDS and hepatitis. [19] [20] [21] [22]

Management

Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses. CharcoalPO.jpg
Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses.

Stabilization of the person's airway, breathing, and circulation (ABCs) is the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxic. Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, pulse, respiratory rate, blood pressure, urine output, electrocardiography (ECG) and O2 saturation. [23] Poison control centers and medical toxicologists are available in many areas to provide guidance in overdoses both to physicians and to the general public.

Antidotes

Specific antidotes are available for certain overdoses. For example, naloxone is the antidote for opiates such as heroin or morphine. Similarly, benzodiazepine overdoses may be effectively reversed with flumazenil. As a nonspecific antidote, activated charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant. [24] Gastric lavage, syrup of ipecac, and whole bowel irrigation are rarely used. [24]

Epidemiology and statistics

A two milligram dose of fentanyl powder (on pencil tip) is a lethal amount for most people. 2 milligrams of fentanyl on pencil tip. A lethal dose for most people. US Drug Enforcement Administration.jpg
A two  milligram dose of fentanyl powder (on pencil tip) is a lethal amount for most people.

The UN gives a figure of 300,000 deaths per year in the world through drug overdose.

1,015,060 US residents died from drug overdoses from 1968 to 2019. 22 people out of every 100,000 died from drug overdoses in 2019 in the US. [26] From 1999 to Feb 2019 in the United States, more than 770,000 people have died from drug overdoses. [27]

In the US around 107,500 people died in the 12-month period ending August 31, 2022, at a rate of 294 deaths per day. [28] 70,630 people died from drug overdoses in 2019. [29] The U.S. drug overdose death rate has gone from 2.5 per 100,000 people in 1968 to 21.5 per 100,000 in 2019. [26]

The National Center for Health Statistics reports that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (eight deaths per 100,000 population). [30]

In 2008 testimony before a Senate subcommittee, Leonard J. Paulozzi, [31] a medical epidemiologist at the Centers for Disease Control and Prevention said that in 2005 more than 22,000 American people died due to overdoses, and the number is growing rapidly. Paulozzi also testified that all available evidence suggests unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers. [32] However, the vast majority of overdoses are also attributable to alcohol. It is very rare for a victim of an overdose to have consumed just one drug. Most overdoses occur when drugs are ingested in combination with alcohol. [33]

Drug overdose was the leading cause of injury death in 2013. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes. There were 43,982 drug overdose deaths in the United States in 2013. Of these, 22,767 (51.8%) were related to prescription drugs. [34]

The 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines. Drug misuse and abuse caused about 2.5 million emergency department (ED) visits in 2011. Of these, more than 1.4 million ED visits were related to prescription drugs. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics. [35]

See also

Related Research Articles

<span class="mw-page-title-main">Oxycodone</span> Opioid medication

Oxycodone, sold under various brand names such as Roxicodone and OxyContin, is a semi-synthetic opioid used medically for treatment of moderate to severe pain. It is highly addictive and is a commonly abused drug. It is usually taken by mouth, and is available in immediate-release and controlled-release formulations. Onset of pain relief typically begins within fifteen minutes and lasts for up to six hours with the immediate-release formulation. In the United Kingdom, it is available by injection. Combination products are also available with paracetamol (acetaminophen), ibuprofen, naloxone, naltrexone, and aspirin.

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Fentanyl</span> Opioid medication

Fentanyl is a potent synthetic piperidine opioid primarily used as an analgesic. It is 50 times more potent than heroin and 100 times more potent than morphine; its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic and Sublimaze, among others.

<span class="mw-page-title-main">Naloxone</span> Opioid receptor antagonist

Naloxone is an opioid antagonist: a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. Effects begin within two minutes when given intravenously, five minutes when injected into a muscle, and ten minutes as a nasal spray. Naloxone blocks the effects of opioids for 30 to 90 minutes.

<span class="mw-page-title-main">Opioid</span> Psychoactive chemical

Opioids are a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. Opioids work in the brain to produce a variety of effects, including pain relief. As a class of substances, they act on opioid receptors to produce morphine-like effects.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Oxymorphone</span> Opioid analgesic drug

Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.

<span class="mw-page-title-main">Substance abuse prevention</span> Measures to prevent the consumption of licit and illicit drugs

Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults – especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.

<span class="mw-page-title-main">Opioid overdose</span> Medical condition

An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils, and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.

<span class="mw-page-title-main">Benzodiazepine overdose</span> Medical condition

Benzodiazepine overdose describes the ingestion of one of the drugs in the benzodiazepine class in quantities greater than are recommended or generally practiced. The most common symptoms of overdose include central nervous system (CNS) depression, impaired balance, ataxia, and slurred speech. Severe symptoms include coma and respiratory depression. Supportive care is the mainstay of treatment of benzodiazepine overdose. There is an antidote, flumazenil, but its use is controversial.

<span class="mw-page-title-main">Acetylfentanyl</span> Opioid analgesic

Acetylfentanyl is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated acetylfentanyl to be 15 times more potent than morphine, which would mean that despite being somewhat weaker than fentanyl, it is nevertheless still several times stronger than pure heroin. It has never been licensed for medical use and instead has only been sold on the illicit drug market. Acetylfentanyl was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. However, in 2013, Canadian police seized 3 kilograms of acetylfentanyl. As a μ-opioid receptor agonist, acetylfentanyl may serve as a direct substitute for oxycodone, heroin or other opioids. Common side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea and potentially fatal respiratory depression. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.

<span class="mw-page-title-main">Buprenorphine/naloxone</span> Opioid treatment

Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. It is used to treat opioid use disorder, and reduces the mortality of opioid use disorder by 50%. It relieves cravings to use and withdrawal symptoms. Buprenorphine/­naloxone is available for use in two different forms, under the tongue or in the cheek.

<span class="mw-page-title-main">Opioid epidemic in the United States</span> Ongoing overuse of opioid medication in the US

There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years.

A take-home naloxone program is a governmental program that provides naloxone drug kits to those that are at risk of an opioid overdose. Naloxone is a medication that was created to reverse opioid overdoses. As an opioid antagonist, it binds to the μ-opioid receptors blocking the opioid's effects. Naloxone quickly restores normal respiration. The ongoing opioid epidemic has caused many public health authorities to expand access to naloxone.

<span class="mw-page-title-main">Opioid epidemic</span> Deaths due to abuse of opioid drugs

The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.

<span class="mw-page-title-main">United States drug overdose death rates and totals over time</span> US public health issue

The United States Centers for Disease Control and Prevention has data on drug overdose death rates and totals. Around 1,106,900 US residents died from drug overdoses from 1968 to 2020, around 932,400 from 1999 through 2020 and around 91,800 in 2020. Of every 100,000 people in 2020 in the US, drugs killed 28. Opioids were involved in around 80,400 of the around 106,700 deaths in 2021. Synthetic opioids other than methadone were involved with 70,601 deaths in 2021.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

<span class="mw-page-title-main">Response to the Opioid Crisis in New Jersey</span> Policy

New Jersey's most recent revised policy was issued September 7, 2022 pursuant to P.L.2021, c.152 which authorized opioid antidotes to be dispensed without a prescription or fee. Its goal is to make opioid antidotes widely available, reducing mortality from overdose while decreasing morbidity in conjunction with sterile needle access, fentanyl test strips, and substance use treatment programs. A $67 million grant provided by the Department of Health and Human Services provides funding for naloxone as well as recovery services. This policy enables any person to distribute an opioid antidote to someone they deem at risk of an opioid overdose, alongside information regarding: opioid overdose prevention and recognition, the administration of naloxone, circumstances that warrant calling 911 for assistance with an opioid overdose, and contraindications of naloxone. Instructions on how to perform resuscitation and the appropriate care of an overdose victim after the administration of an opioid antidote should also be included. Community first aid squads, professional organizations, police departments, and emergency departments are required to "leave-behind" naloxone and information with every person who overdosed or is at risk of overdosing.

In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices. These new laws fell primarily into one of the following four categories:

  1. Prescription Drug Monitoring Program (PDMP) enrollment laws: prescribers must enroll in their state's PDMP, an electronic database containing a record of all patients' controlled substance prescriptions
  2. PDMP query laws: prescribers must check the PDMP before prescribing an opioid
  3. Opioid prescribing cap laws: opioid prescriptions cannot exceed designated doses or durations
  4. Pill mill laws: pain clinics are closely regulated and monitored to minimize the prescription of opioids non-medically

References

  1. Fentanyl. Image 4 of 17. US DEA (Drug Enforcement Administration). See archive with caption: "photo illustration of 2 milligrams of fentanyl, a lethal dose in most people".
  2. 1 2 Definitions Archived February 27, 2011, at the Wayback Machine Retrieved on September 20, 2014.
  3. 1 2 "Stairway to Recovery: Glossary of Terms" Archived July 9, 2011, at the Wayback Machine . Retrieved on March 19, 2021
  4. NCHS Data Visualization Gallery—Drug Poisoning Mortality. From National Center for Health Statistics. Open the dashboard dropdown menu and pick "U.S. Trends". From the menus on the right pick all races, all ages, and both sexes. Run your cursor over the graph to see the data.
  5. Study on fatal overdose Archived January 19, 2012, at the Wayback Machine in New-York City 1990-2000, visited May 11, 2008,
  6. "What to do with leftover medicines". Medicines Talk, Winter 2005. Available at "What to do with left-over medicines: National Prescribing Service Ltd NPS". Archived from the original on October 24, 2009. Retrieved January 6, 2010.
  7. Goldfrank, Lewis R. (1998). Goldfrank's toxicologic emergencies. Norwalk, CT: Appleton & Lange. ISBN   0-8385-3148-2.
  8. Chandler, Stephanie. "Symptoms of an opiate overdose". Live Strong. Archived from the original on April 18, 2012. Retrieved May 17, 2012.
  9. "T.I. Arrest -- Sippin' on Sizzurp?". TMZ. Retrieved August 19, 2019.
  10. Melissa Leon (March 17, 2013). "Lil Wayne Hospitalization: What the Hell Is Sizzurp?". The Daily Beast.
  11. Tamara Palmer (2005). Country Fried Soul: Adventures in Dirty South Hip-hop. Outline Press Limited. p. 188.
  12. "Column—Fatal Drug-Drug Interaction As a Differential Consideration in Apparent Suicides" Archived February 23, 2008, at the Wayback Machine .
  13. Piper TM; Stancliff S; Rudenstine S; et al. (2008). "Evaluation of a naloxone distribution and administration program in New York City". Subst Use Misuse. 43 (7): 858–870. doi:10.1080/10826080701801261. hdl: 2027.42/60330 . PMID   18570021. S2CID   31367375.
  14. "Community-Based Opioid Overdose Prevention Programs Providing Naloxone—United States, 2010". Centers for Disease Control and Prevention. December 2010. Archived from the original on September 9, 2017.
  15. Albert S, Brason FW 2nd, Sanford CK, Dasgupta N, Graham J, Lovette B (June 2011). "Project Lazarus: community-based overdose prevention in rural North Carolina". Pain Medicine. 12 (Suppl 2): S77–85. doi: 10.1111/j.1526-4637.2011.01128.x . PMID   21668761.
  16. Beletsky L, Burris SC, Kral AH (2009). Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States (PDF) (Report). Temple University Beasley School of Law. SSRN   1437163. Archived (PDF) from the original on January 27, 2023 via Boonshoft School of Medicine.
  17. Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S (January 2007). "Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities". Journal of Urban Health. 84 (1): 126–36. doi:10.1007/s11524-006-9120-z. PMC   2078257 . PMID   17146712.
  18. Lavoie D. (April 2012). "Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands". Huffington Post. Archived from the original on May 18, 2012.
  19. Oladipo, Gloria (November 30, 2021). "New York to open supervised injection sites in bid to curb overdose deaths". The Guardian. Retrieved December 1, 2021.
  20. Kim, Lisa (November 30, 2021). "NYC Close To Opening Supervised Injection Sites To Prevent Overdoses, After Years Of Setbacks, Report Says". Forbes. Retrieved December 1, 2021.
  21. "What's The Evidence That Supervised Drug Injection Sites Save Lives?". NPR. September 7, 2018. Retrieved December 1, 2021.
  22. Ng, Jennifer; Sutherland, Christy; Kolber, Michael (November 2017). "Does evidence support supervised injection sites?". Canadian Family Physician. 63 (11): 866. PMC   5685449 . PMID   29138158.
  23. Longmore, Murray; Ian Wilkinson; Tom Turmezei; Chee Kay Cheung (2007). Oxford Handbook of Clinical Medicine. United Kingdom: Oxford. ISBN   978-0-19-856837-7.
  24. 1 2 Vanden Hoek, TL; Morrison, LJ; Shuster, M; Donnino, M; Sinz, E; Lavonas, EJ; Jeejeebhoy, FM; Gabrielli, A (November 2, 2010). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S829–61. doi: 10.1161/CIRCULATIONAHA.110.971069 . PMID   20956228.
  25. "One Pill Can Kill". US Drug Enforcement Administration . Archived from the original on November 15, 2023. Retrieved November 15, 2023.
  26. 1 2 Data is from these saved tables from CDC Wonder at the Centers for Disease Control and Prevention, National Center for Health Statistics. The tables have totals, rates, and US populations per year.
  27. STATCAST—Week of September 9, 2019. NCHS Releases New Monthly Provisional Estimates on Drug Overdose Deaths. National Center for Health Statistics.
  28. Products - Vital Statistics Rapid Release - Provisional Drug Overdose Data. Centers for Disease Control and Prevention. Hover cursor over the end of the graph in Figure 1A to get the latest number. Scroll down the page and click on the dropdown data table called "Data Table for Figure 1a. 12 Month-ending Provisional Counts of Drug Overdose Deaths". The number used is the "predicted value" for the 12 month period that is ending at the end of that month. That number changes as more info comes in. If there are problems use a different browser.
  29. 1 2 3 4 5 6 7 Overdose Death Rates. And Archived 2015-11-28 at the Wayback Machine . By National Institute on Drug Abuse.
  30. Referral Page—FASTSTATS—Accidents or Unintentional Injuries Archived July 15, 2017, at the Wayback Machine Retrieved on September 20, 2014.
  31. CDC Expert, Leonard J. Paulozzi, MD, MPH Archived February 20, 2014, at the Wayback Machine Retrieved on September 20, 2014.
  32. CDC Washington Testimony March 5, 2008 Archived July 15, 2017, at the Wayback Machine Retrieved on September 20, 2014.
  33. "The Persistent, Dangerous Myth of Heroin Overdose" Archived March 23, 2015, at the Wayback Machine .
  34. "Understanding the Epidemic | Drug Overdose | CDC Injury Center" Archived September 9, 2017, at the Wayback Machine .
  35. "Prescription Opioid Overdose Data | Drug Overdose | CDC Injury Center" Archived January 18, 2017, at the Wayback Machine .
  36. Opioid Data Analysis and Resources. Drug Overdose. CDC Injury Center. Centers for Disease Control and Prevention. Click on "Rising Rates" tab for a graph. See data table below the graph.

Further reading