Last year, nearly 108,000 people died of drug overdoses in the United States, representing a 15% increase from 2020 and setting another record, according to preliminary data by the Centers for Disease Control and Prevention, reported The Associated Press. That translates to nearly one death every five minutes.

The deaths increasingly involve fentanyl, an extremely potent synthetic opioid often mixed into drugs—including street versions of anti-anxiety meds, such as Xanax—without the user’s knowledge. Methamphetamine, a stimulant that has become cheaper and more lethal in recent years, also fueled the increase in overdoses.

What’s more, it’s not uncommon for people who use meth and opioids to inject the drugs. Because sharing syringes and other drug paraphernalia can transmit HIV, hepatitis B and hepatitis C, the opioid epidemic has also spurred outbreaks of the viruses in West Virginia, Boston and Indiana, to name a few examples.

Synthetic opioids like fentanyl were responsible for over 71,000 deaths in 2021. Deaths from stimulants, such as meth and cocaine, were linked to 33,000 deaths. According to the AP, this marks a 23% increase in deaths involving synthetic opioids from 2021, a 23% increase in those related to cocaine and a 34% spike for meth-related overdose deaths. 

“This is indeed a continuation of an awful trend. Rates of overdose deaths have been on an upward climb for decades now, increasing at unprecedented rates right before the beginning of the COVID-19 pandemic in the U.S.,” said Nora Volkow, MD, director of the National Institute on Drug Abuse.

Although Volkow acknowledged that the overall 15% increase in overdose deaths in 2021 was “unacceptable” and “truly staggering,” that percentage also represents a decrease in the pace reported the previous year, when overdose deaths increased by 30% from 2019 to 2020.

Although the pandemic worsened the nation’s drug crisis—lives were upended while people became isolated and were unable to receive help for addiction, for example—the fact is that overdose deaths have been steadily increasing since the 1990s. Even in the earlier decades, opioid painkillers were a major culprit, followed by illicit opioids.

However, the role of methamphetamine in overdose deaths is new. As The New York Times reports, it’s becoming more common for people who use the drugs to combine the stimulants and opioids in what are called “speedballs” and “goofballs.”

“There’s an intertwined synthetics epidemic, the likes of which we’ve never seen,” Dan Ciccarone, MD, MPH, a professor of family and community medicine at the University of California at San Francisco, told the Times. “We’ve never seen a powerful opioid such as fentanyl being mixed with such a potent methamphetamine.”

In an effort to tackle the nation’s overdose epidemic—and the related issues of addiction, mental health, HIV and hepatitis—the White House and various departments of the federal government have promoted harm reduction. This includes, for example, providing syringe services (to prevent needle sharing and reduce the risk of transmitting HIV and hepatitis) and expanding access to the overdose-reversal drug naloxone. For more about these efforts, see “Nation’s First Drug Control Strategy Calls for Expanded Harm Reduction.”

Hepatitis refers to inflammation of the liver. When untreated, it can lead to scarring of the liver (cirrhosis), liver cancer, the need for a liver transplant and death. Hepatitis can be caused by several factors, including toxins, excess alcohol use, autoimmune diseases, fat in the liver and viruses, including the three most common ones: hepatitis A, B and C. According to the “Hepatitis C Transmission and Risk,” part of Hep’s Basics of Hepatitis, hep C is most easily spread through:

  • Sharing needles and other equipment (paraphernalia) used to inject drugs

  • Blood transfusions and organ transplants before July 1992

  • Sexual contact with someone who has hep C

  • Having a mother who had hep C when you were born.

HIV, in contrast, is a virus that attacks the immune system. Over several years, the immune system becomes depleted, and the body isn’t able to fight infections, leading to an AIDS diagnosis. Although there is no cure for HIV, many safe and effective treatments—often just one pill a day—are available. The medications help people living with HIV enjoy long and healthy lives and keep them from transmitting the virus to others. For more, see the Basics of HIV/AIDS in, a sister publication of, and