Fentanyl By State: Report

Fentanyl fatalities more than doubled in 30 states in just two years, and more than tripled in 15. In six states, fentanyl fatalities increased almost five fold.*

Summary

• Fentanyl fatalities doubled in 30 states in just two years; tripled in 15 and increased nearly five-fold in six: Alaska, Colorado, Louisiana, Mississippi, California and Texas. The per capita rate of fentanyl deaths was highest in West Virginia last year, with a staggering 64.4 fentanyl deaths per 100,000 West Virginians. Florida had the highest total number of fentanyl deaths in 2021, 5,161, followed closely by California with a total of 5,123 fentanyl deaths last year. Fentanyl deaths have been highest in Florida since 2018; before 2018 Ohio consistently experienced the highest number of fentanyl deaths.

• Fentanyl killed 209,491 Americans in just six years. Ohio alone lost 18,929 people to illicit fentanyl poisoning - more than the bottom twenty states combined which lost a total of 12,699 people since 2015. 

• Fentanyl fatalities have increased by more than 100% since 2015 in almost every single state. In Louisiana, fentanyl deaths have increased 2,363% since 2015 or 24.6x. Fentanyl deaths in Arizona and California similarly increased by more than 2,000% since 2015. 

• Methodology

  1. All of the findings of this report were taken directly from the CDC Wonder database at the beginning of December 2021. Data for 2020 and 2021 were both considered “provisional” at the time of analysis, but according to the CDC should align closely to the final numbers and therefore can be used for health statistical reporting. When analyzing deaths caused by, or indirectly tied to, COVID-19, our research team used “year-to-date” data; meaning deaths that occurred between January 2021 and late November 2021. COVID-19 fatality data rapidly changes within the CDC database, whereas the number of deaths caused by fentanyl, cancer, suicide or car accidents, remains relatively the same throughout the year. For that reason, we relied on year-end May 2021 data for all other causes of death as that was considered to be the most accurate data by the CDC.

  2. In order to ascertain the total number of fentanyl deaths in 2021 - we used the “Provisional Multiple Cause of Death Data” request form and filtered the results by “underlying cause of death (UCD) - Drug/Alcohol Induced” and “multiple cause of death (MCD) - ICD-10 113 Cause List.” Then we selected our “time period of death” - so for fentanyl, suicide, car accidents etc. we highlighted June 2020 through May 2021. Finally, we selected “Drug-induced causes” under the section entitled, “Select underlying cause of death,” and code T40.4 (Other Synthetic Narcotics) after clicking the MCD - ICD-10 Codes option. The same method was used to gather the total number of fatalities caused by suicide, car accidents, cancers etc that occurred between June 2020 and May 2021 with slightly different UCD and MCD selections based on cause. COVID-19 death totals during 2021 were gathered using the same form but by selecting the months of January 2021 through November 2021, and altering the UCD and MCD selections to “COVID-19 U07.1” and “*U07.1 (COVID-19)” respectively. All of our UCD and MCD selections were based on CDC recommendations and the data we present in our reports adheres to CDC standards. When filtering fatalities by age - we simply added an additional filter at the top of the form “Singe-Year Ages” and selected our chosen age range. The same process was used when filtering fentanyl deaths by race and/or state - we simply added a new filter at the top ie. “Single Race 6” or “Occurrence State” and left the remainder of the form the same.

  3. Fatality data for all years preceding 2020 was gathered using CDC Wonder’s “Current Final Multiple Cause of Death Data” request form and replicating the process outlined above. However, it should be noted that the forms within this category do not distinguish between occurrence vs. resident states and only allows one to filter by “State.” Additionally, for years preceding 2018, the CDC database only has one filter for the race subsection - and that section only has four racial demographics: “American Indian or Alaska Native, Asian or Pacific Islander, Black or African American and White.” Compared to the three available race filters (Single Race 6, Single Race 15 or Single/Multi Race 31) for 2018 and beyond, and the 31 multi/single race options available within those filters.

  4. When making comparisons in order to contextualize the data, we relied both on the total number of deaths within each category and on the per capita rate of deaths per 100,000 people of that group, or “crude rate.” To calculate the crude rate of Black Americans who died from fentanyl in the year-end May 2021 we divided the total number of fentanyl deaths among Black Americans during that time period by the population of the Black community and multiplied the answer by 100,000. The crude rate gives a sense of what communities are most heavily affected by fentanyl. For example, while more White people died of fentanyl poisoning than Black people in 2021, the Black community was disproportionately impacted because the per capita rate of fentanyl deaths was higher in the Black community: 26.6 fentanyl deaths per 100,000 Black people vs. 19.2 fentanyl deaths per 100,000 White people. In order to calculate the crude rate of fentanyl deaths per state, for example, we used the same calculation as described above, but used the total number of fentanyl deaths of each state during a given period and then divided that by the corresponding population of that state during the same period, and multiplied the result by 100,000.