“The rise in opioid overdose deaths is shown in three waves, with a slight decrease from 2022 to 2023.

From 1999-2023, approximately 806,000 people died from an opioid overdose. This includes overdose deaths involving prescription and illegal opioids.2

This rise in opioid overdose deaths can be outlined in three distinct waves.

First wave

The first wave began with increased prescribing of opioids in the 1990s. Overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increased starting around 19993 but have declined in recent years.1

Second wave

The second wave began in 2010, with rapid increases in overdose deaths involving heroin.4 However, in recent years, heroin overdose deaths have been declining.1

Third wave

The third wave began in 2013, with substantial increases in overdose deaths involving synthetic opioids, particularly those involving illegally made fentanyl and fentanyl analogs (IMFs).567 IMFs have largely saturated the illegal drug supply. They are often found in powder form or pressed into counterfeit pills and can have other drugs mixed into them. More recently, non-opioid sedatives, such as xylazine, have been found mixed into IMFs.8 From 2022 to 2023, the rate of overdose deaths involving synthetic opioids decreased approximately 2%.1

In the current landscape, many opioid overdose deaths also involve other drugs. In 2023, among a sub-set of jurisdictions, nearly 47% of drug overdose deaths involved both opioids and stimulants.”

Center for Disease Control and Prevention – CDC (Understanding the Opioid Overdose Epidemic | Overdose Prevention | CDC)