Objectives—Using literal text from the National Vital Statistics System, this report provides national drug overdose death rates involving fentanyl, methamphetamine, cocaine, heroin, and oxycodone by sex, age, race and Hispanic origin, and public health region.

Methods—The study analyzed literal text from the National Vital Statistics System mortality data for deaths occurring in the United States among U.S. residents. Drug overdose deaths were limited to those with International Classification of Diseases, 10th Revision (ICD–10) underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent). Specific drugs were identified using enhanced methods for searching literal text from death certificates. Trends from 2016 through 2021 were examined, as well as sex, age, race and Hispanic origin, and region-specific estimates for 2021.

Results—From 2016 through 2021, age-adjusted drug overdose death rates involving fentanyl, methamphetamine, and cocaine increased, while drug overdose death rates involving oxycodone decreased. In 2021, the age-adjusted death rates for males were higher than the rates for females for all drugs analyzed. Among those aged 25–64, the highest rate of drug overdose deaths involved fentanyl; although a similar pattern was observed among those aged 0–24 years and 65 and over, no significant differences were observed between the rates (p < 0.05). Fentanyl was also the most frequent opioid or stimulant drug involved in drug overdose deaths for the race and Hispanic-origin groups analyzed. Age-adjusted rates of drug overdose deaths varied by region. In 2021, for all regions except Regions 8 and 10, drug overdose deaths involving fentanyl were highest, while drug overdose deaths involving both fentanyl and methamphetamine were highest for Regions 8 and 10.