Home / Health / Articles / Are fentanyl overdose deaths rising in the US?

In 2022, 73,654 people died from a fentanyl overdose[1] in the US, more than double the amount of deaths from three years prior in 2019. Fentanyl deaths have increased every year for the past decade, but 2022 marked the smallest year-over-year growth at 4.3%.

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What is fentanyl and why is it so dangerous?

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Like other opioids, fentanyl use can lead to dependency and addiction. Most illicit fentanyl is made in labs outside the country and smuggled across the US-Mexico border.

Early in the opioid epidemic, overdose deaths were largely driven by a flood of prescriptions for drugs such as Hydrocodone, Oxycodone, Oxymorphone, and Morphine. Pharmaceutical fentanyl was approved by the Food and Drug Administration as a pain reliever in 1998 and was typically prescribed to patients with severe or chronic pain. As prescriptions for these drugs fell, heroin, and eventually illegally made fentanyl, became the main cause of opioid overdose deaths.

Drug dealers may mix fentanyl with other drugs such as heroin, cocaine, meth, and MDMA to increase the drugs’ effects — sometimes without the user’s knowledge.

Lethal dose of fentanyl

Because fentanyl is significantly stronger than other opioids, doses as small as two milligrams can be lethal. And with users unaware of how much fentanyl they are using, it’s an especially dangerous combination. The DEA found that 6 out of 10 fentanyl-laced fake prescription pills contain a potentially lethal dose of fentanyl.

Can naloxone reverse a fentanyl overdose?

In recent years, many first responders and some civilians have started to carry naloxone (also known by the brand name Narcan), a drug that can rapidly reverse an opioid overdose. While there isn’t data available on how many overdoses have been reversed by naloxone, the Centers for Disease Control and Prevention (CDC) says that bystanders are present in 46% of overdose deaths and could potentially save lives by carrying and administering naloxone.

When did fentanyl deaths begin to rise?

Fentanyl overdose deaths began to rise significantly in 2013, at the beginning of what the CDC calls the third wave of the opioid epidemic. That year, 3,105 people died from a synthetic opioid overdose. In 2022, fentanyl was responsible for 23 times more deaths.

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In recent years, deaths from fentanyl overdose rose sharply, overtaking deaths from prescription opioids and heroin.

Why are fentanyl deaths rising?

The increase in fentanyl overdose deaths may be related to a decline in opioid prescription rates and reformulations to drugs such as Oxycontin aimed at curbing abuse, along with the growing rate at which illegally made fentanyl is combined with other illicit drugs.

From 2010 to 2020, the rate of opioid prescriptions dispensed per 100 people dropped from 81.32 to 43.3, a decline of nearly 47%. In West Virginia — the state with the highest rate of opioid prescriptions in 2010  — prescription rates fell by 62%. Despite the waning availability of prescription opioids, total overdose deaths involving any opioid more than tripled during the same period.

With deaths from prescription opioids[2] and heroin falling, fentanyl overdoses have made up an increasingly large share of drug deaths. Since 2019, fentanyl has been involved in over half of all drug overdose deaths. By 2022, it was the underlying cause of nearly 70% of drug overdose deaths.

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Which states have the most fentanyl deaths?

When adjusted for population, West Virginia had the highest rate of fentanyl overdose deaths in the country in 2022. West Virginia had 60.8 deaths per 100,000 people due to fentanyl overdoses, which is about 34% higher than Delaware, the state with the second-highest rate.[3]

South Dakota had the lowest rate of fentanyl overdose deaths among states in 2022, with 4.2 deaths per 100,000 residents.

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California had the most total deaths from fentanyl in 2022 with 6,453. Florida (5,083) and New York (4,950) had the second and third most total deaths. In general, states with higher populations have more total fentanyl overdose deaths.

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In addition to having the lowest rate of fentanyl overdose deaths in 2022, South Dakota also had the fewest total deaths with 38.

Where does this data come from?

The CDC tracks drug overdose data with the International Classification of Diseases, 10th Revision (ICD-10), which records fentanyl overdose deaths together with those caused by other synthetic opioids. However, they note that fentanyl accounts for most synthetic opioid deaths. Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one ICD-10 category when describing the number of drug overdose deaths involving specific drugs.

How to seek treatment for an opioid addiction

If you or someone you know is experiencing substance use disorders, call the SAMHSA National Helpline, 1-800-662HELP (4357), a free, confidential, 24/7, year-round treatment referral and information service for individuals and families facing mental and/or substance use disorders.

Learn more about the top causes of death in the US, the history of the opioid epidemic, and get the data directly in your inbox by subscribing to our weekly newsletter.

Provisional Multiple Cause of Death Data
Last updated
September 8, 2023
Understanding the Opioid Overdose Epidemic
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Drug Overdose Death Rates
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Fentanyl deaths are defined as drug overdoses listed as accidents, suicides, homicides, or of undetermined intent that involved synthetic opioids other than methadone.


Prescription opioid deaths are defined as overdose deaths involving methadone or other prescription opioids.


Delaware had the second-highest among states, but Washington, DC, had a higher rate of fentanyl overdose deaths at 46.3 per 100,000 people.