OBJECTIVE: This report identifies the specific drugs most frequently involved in drug overdose deaths in the United States from 2017 through 2023.

METHODS: Data from the 2017-2023 National Vital Statistics System mortality files were linked to literal text data from death certificates. Drug overdose deaths were identified using the underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. Specific drugs were identified by searching three literal text fields of the death certificate: the causes of death from Part I, significant conditions contributing to death from Part II, and the description of how the injury occurred. Contextual information was used to determine drug involvement in the death. Descriptive statistics were calculated for the most frequently mentioned drugs involved in drug overdose deaths. Deaths involving multiple drugs were counted in all relevant drug categories.

RESULTS: Among drug overdose deaths with mention of at least one specific drug, the most frequently mentioned drugs during 2017-2023 included: fentanyl, heroin, oxycodone, morphine, methadone, hydrocodone, alprazolam, diphenhydramine, cocaine, methamphetamine, amphetamine, gabapentin, and xylazine. Fentanyl ranked first across all years and was the most common concomitant drug found with other top drugs, ranging from 99.0% of xylazine-involved drug overdose deaths to 48.3% of oxycodone-involved drug overdose deaths. Cocaine and methamphetamine were also frequent concomitant drugs. Trends in age-adjusted rates across the 2017 to 2023 period varied by drug, but notably the rate for heroin-involved deaths sharply declined, while the rate for fentanyl-involved deaths increased and then stabilized between 2022 and 2023. In 2023, the most frequently mentioned drugs in unintentional drug overdose deaths were fentanyl, methamphetamine, and cocaine, while the most frequently mentioned drugs for suicide-related drug overdoses were diphenhydramine, oxycodone, and bupropion.

CONCLUSIONS: This report identifies patterns in the specific drugs most frequently involved in drug overdose deaths from 2017 through 2023.