Opioid use disorder in the United States

Maybe you’ve heard about them in passing or come across news articles discussing them. Or maybe you’ve taken them at some point in your health journey. Unfortunately, it wouldn’t be a surprise if you, a family member, or someone else you know has been negatively impacted by them.

We’re talking about opioids: a class of drugs that encompasses both legal prescriptions used to treat pain, such as Vicodin and OxyContin, and illegal drugs like heroin. Some opioids (morphine and codeine, as a few examples) come from natural substances—the poppy plant opium—while other opioids are classified as semi-synthetic (oxycodone) or completely synthetic (fentanyl), or otherwise made in a lab with unnatural ingredients.

The main reason opioids are such a hot-button topic inside and outside the health community is that they’re highly addictive. In turn, when misused, they can lead to harmful or even deadly effects (i.e., opioid use disorder and fatal overdoses).

The quick and scary rise of opioid use

The first opioid public health crisis occurred in the 1990s, but it wasn’t until the 2010s that heroin overdoses popped onto the scene in alarming numbers. By 2013, synthetic opioids had further exacerbated the problem, and in 2017, the U.S. government declared opioid use a public health emergency under section 319 of the Public Health Service Act.

Today, opioid use disorder claims over 200 lives a day. Among the nearly 108,000 deaths from drug overdose in 2022, approximately 82,000 of them, or about 75%, involved opioids. According to the CDC, more than 645,000 people have died from overdoses involving opioids since it was declared an epidemic.

It’s one thing to see the statistics holistically. But to truly understand what’s happening across the country, it’s crucial to highlight the biggest trends—who is most impacted, where the crisis is headed, and what that ultimately means for healthcare providers, insurers, employers, and individuals. Below, we’ll break it all down.

4 current trends in opioid use

Here’s what we know right now about opioid use in the United States:

1. Fatal and nonfatal overdose rates are declining but remain alarmingly high

Deaths from opioids have been steadily climbing since the 1990s, with the National Institute of Drug Abuse, a part of the NIH, reporting that overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017 (a 395% increase).

Even with deaths declining after 2017, 2022 still saw 14,716 opioid overdose deaths. Drug overdose deaths involving heroin rose from 3,036 in 2010 to 15,469 in 2016 (410%), and while they’ve trended down in the last five years, the proportion of these deaths co-involving heroin and fentanyl precipitously increased to nearly 80% in 2022.

The figures for nonfatal overdoses aren’t uplifting, either. According to the Agency for Healthcare Research and Quality, there were around 290,000 hospitalizations and emergency department visits related to opioid poisoning in 2016. During the COVID-19 pandemic, overdose visit counts increased by 10.5% compared to 2018 and 2019. And an estimated 599,000 people were treated for a nonfatal overdose from January 2021 to June 2022, according to data around emergency department visits compiled by the Drug Abuse Warning Network, a nationwide public health surveillance system.

In short, while the numbers are trending down slightly in some areas, there are still a shocking number of individuals across the country impacted by opioid use disorder.

2. Synthetic opioid deaths are on the rise

Synthetic opioids such as fentanyl and heroin target the same parts of the brain that natural opioids do to provide pain and stress relief. Not every synthetic opioid is necessarily dangerous—several have been approved for medical use, including fentanyl and methadone—but when manufactured and trafficked in unregulated territories, there’s a high risk of contamination. In addition, they’re often more potent, which raises the risk of a fatal overdose. For context, synthetic fentanyl is 100 times more potent than morphine.

Synthetic opioids comprise the majority of overdose deaths in the U.S. During the COVID-19 pandemic, the CDC issued a health advisory explaining how the amount of synthetic opioid deaths increased 38.4% from 2019 to 2020 and that this increase was linked primarily to illicitly manufactured fentanyl. Their data also suggested that an increase in overdose deaths involving cocaine was primarily related to overdose deaths that involved both cocaine and synthetic opioids.

More recently, the CDC’s National Center for Health Statistics reported, synthetic opioids contributed to 71,238 deaths in the U.S. in 2021, up from 57,834 in 2020, a 23% increase.

3. Disparities have shifted from white Americans to AIAN and Black communities, while deaths are higher for young adults and men

For years, the opioid crisis has centered on white Americans, specifically in rural communities. This is for good reason: As health policy research agency KFF reports, white individuals made up the majority of opioid overdose deaths in 2021.

But what’s often overlooked is the rate at which opioid overdoses are occurring among other populations and how those rates have shifted over time.

In the past decade, for example, opioid death rates surged more than 700% among Black Americans, compared to 140% among white Americans, KFF reported in 2024. The death rate for white Americans in 2023 was around 25%, but it was almost 38% for Black Americans and nearly 50% for American Indian and Alaska Native (AIAN) populations.

Deaths dropped more significantly for white Americans between 2022 and 2023 (-14%) than for Black Americans (-6%), and the rates actually increased 2% for AIAN individuals. Consider, too, that while opioid deaths dropped in most states in the last six months of 2023, they increased 58% in Alaska.

Disparities among age groups are worth noting as well. Death rates sit highest, at around 45%, for individuals between the ages of 26 and 44, according to 2023 KFF data. However, they actually increased 9% between 2022 and 2023 among individuals over 65 years of age, largely due to a lack of education, detection, and treatment for this group.

Finally, opioid death rates are much higher for men than women—34.5% versus 13.7%.

4. There are also disparities in access to opioid treatment

Even as opioid use continues to affect certain populations more than others, our healthcare system lags behind in providing equitable, inclusive care for all. One report this year found that AIAN individuals have to travel the farthest to access opioid treatment programs and providers of buprenorphine (a synthetic opioid used to treat opioid use disorder, or OUD) when compared to other racial and ethnic groups.

Another 2023 study found that Black and other marginalized communities are less likely than white communities to receive medications to treat OUD, likely due to being too far from a provider, issues with Medicaid coverage, or choosing not to continue treatment.

Substance use treatment with Carrum Health

Access to substance use treatment matters to employees: A recent survey found that a third of the workforce experiences personal or family issues related to substance use, and over half believe employer support for substance use issues is important.

No matter your company’s size or industry, let Carrum Health be your guide in this area. Carrum partners with some of the very best substance use treatment centers—such as Hazelden Betty Ford and Meadows Behavioral Health—that meet the established criteria for high-quality substance use care. When an employee connects with Carrum through their benefits, they’ll be paired with a dedicated clinical care navigator (a licensed clinician and certified substance use counselor) who will support them throughout their treatment and beyond.

Declining opioid overdose numbers are promising—but we still have a ways to go to give everyone the support they or a loved one needs to handle or overcome substance use. As an organization or provider, you can play a vital role in keeping this crisis at bay, or maybe eradicating it completely down the line.

Learn more about Carrum’s first-of-its-kind value-based substance use treatment program here.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.