While the number of heroin overdose deaths in the United States saw a significant 33% decrease in 2021, claiming 14,716 lives, the relentless toll of this crisis over the past decade reveals a complex and devastating epidemic that demands our continued attention.
Key Takeaways
- In 2021, there were 14,716 overdose deaths involving heroin in the United States, representing a 33.0% decrease from 2020.
- The age-adjusted rate of heroin-involved overdose deaths in the US was 4.4 per 100,000 in 2021.
- From 2010 to 2021, heroin overdose deaths in the US increased from 3,039 to a peak before declining to 14,716.
- Past-year heroin use among US adults aged 12+ was 0.3% or 828,000 people in 2021.
- In 2019, 0.2% of US population aged 12+ used heroin in past year, about 580,000.
- Heroin initiation among 12-17 year olds: 15,000 in 2020.
- Emergency department visits for heroin: 352,616 in 2019 DAWN.
- Heroin-related ED visits increased 145% from 2008-2019.
- In 2011, 258,482 ED visits involved heroin use.
- Heroin overdose deaths in males aged 25-44: 8.5 per 100,000 in 2021.
- Females accounted for 25% of heroin overdose deaths in 2021 US.
- Non-Hispanic whites: 75% of heroin OD deaths 2019.
- Heroin overdose deaths increased 500% from 2010 to 2017.
- From 2017 peak, heroin deaths fell 50% by 2022 provisional.
- Heroin use past year declined 25% 2015-2021 NSDUH.
Heroin overdose deaths fell by a third after peaking in recent years.
Demographics
- Heroin overdose deaths in males aged 25-44: 8.5 per 100,000 in 2021.
- Females accounted for 25% of heroin overdose deaths in 2021 US.
- Non-Hispanic whites: 75% of heroin OD deaths 2019.
- Ages 25-34: 35% of all heroin overdose deaths in 2020.
- Males aged 25-44 had heroin OD rate 12.1 per 100k 2021.
- In Appalachia states, 50% higher heroin death rates among 18-25.
- Black/African Americans: heroin OD rate 2.1 per 100k 2021.
- Urban areas: 60% of heroin deaths, rate 4.0 per 100k 2019.
- Ages 35-44: second highest heroin OD group, 28% in 2021.
- Hispanics: 10% of heroin OD deaths, rate 1.8 per 100k 2021.
- Rural residents: heroin OD rate 5.5 per 100k vs urban 3.8 2019.
- Males 18-24: heroin death rate 6.2 per 100k 2020.
- Non-Hispanic whites males: 90% of male heroin deaths 2019.
- Ages 45-54: 15% heroin ODs, declining group 2021.
- American Indian/Alaska Native: highest heroin rate 7.3 per 100k 2021.
- Females 25-34: rate 4.5 per 100k heroin deaths 2021.
- Northeast US: 40% heroin deaths despite 17% population 2019.
- Low-income (<$20k): 50% higher heroin OD risk 2018.
- Veterans: 20% of heroin deaths in military age group 2020.
- Pregnant women heroin ODs: 0.3 per 100k births 2020.
- Uninsured: 2x heroin OD rate vs insured 2019.
- Midwest: peak heroin deaths per capita 2017-2019.
- Males >65: rare, 0.5% of heroin deaths 2021.
- Asian/Pacific Islanders: lowest rate 0.4 per 100k 2021.
- Homeless: 30% of urban heroin deaths 2019 study.
- High school non-grads: 3x OD rate 18-25 group.
- West Virginia whites: 80% heroin deaths 2019.
- Females rural: 35% higher increase in heroin ODs 2015-2019.
- Ages 18-24 males: fastest rising group pre-2017.
- Blacks in Northeast: rising heroin deaths 10% annual 2018-2021.
Demographics Interpretation
This is not a faceless crisis, but a deeply human one ruthlessly targeting young, white, working-class men in the forgotten corners of America, while also betraying our veterans, exploiting poverty, and creeping into every demographic with the same lethal indifference.
Mortality Rates
- In 2021, there were 14,716 overdose deaths involving heroin in the United States, representing a 33.0% decrease from 2020.
- The age-adjusted rate of heroin-involved overdose deaths in the US was 4.4 per 100,000 in 2021.
- From 2010 to 2021, heroin overdose deaths in the US increased from 3,039 to a peak before declining to 14,716.
- In 2019, heroin was involved in 15,482 overdose deaths in the US.
- Heroin overdose deaths accounted for 14% of all drug overdose deaths in the US in 2017.
- The rate of heroin overdose deaths among males was 7.1 per 100,000 in 2018.
- In West Virginia, heroin overdose deaths reached 465 in 2017, highest per capita.
- Heroin-involved deaths decreased by 4.0% from 2019 to 2020 nationally.
- In 2020, 13,177 people died from heroin overdoses in the US.
- Heroin overdose mortality rate was 3.7 per 100,000 in 2020.
- From 1999-2020, heroin deaths rose from 1,960 to 13,177 cumulatively tracked.
- In 2016, heroin was implicated in 15,469 overdose deaths.
- Age-adjusted heroin death rate for ages 25-34 was 18.5 per 100,000 in 2017.
- Heroin deaths in Ohio totaled 1,014 in 2017.
- National heroin overdose deaths peaked at 15,482 in 2019.
- In 2022 provisional data, heroin deaths were 13,302.
- Heroin involved in 2.1% of all US drug overdoses in 2021.
- From 2015-2019, average annual heroin deaths: 14,000+.
- Heroin death rate for non-Hispanic whites: 4.2 per 100,000 in 2019.
- In Maryland, 1,456 heroin deaths in 2017.
- US heroin overdose deaths declined 35.6% from 2017 to 2021.
- In 2018, 14,996 heroin overdose deaths occurred.
- Heroin deaths among females: 2.8 per 100,000 in 2019.
- Pennsylvania reported 1,216 heroin deaths in 2018.
- Provisional 2021 heroin deaths: down 7% from 2020.
- Heroin accounted for 15% of opioid deaths in 2016.
- In 2020, ages 35-44 had 3,500 heroin deaths.
- Heroin death rate in rural areas: 5.2 per 100,000 in 2017.
- Kentucky heroin deaths: 859 in 2017.
- Total heroin deaths 2010-2020: over 130,000.
- In 2021, heroin overdose deaths were estimated at 10,980 by some provisional counts.
- Heroin overdose deaths per 100,000 users estimated 25-50 annually.
- Case-fatality rate for heroin overdose: 1 in 68 nonfatal ODs lead to death.
- Fentanyl adulterated heroin increases fatality 10-fold.
- Naloxone reverses 75% of heroin overdoses if given timely.
- Heroin purity average 20-40% contributes to higher fatality.
- Polydrug use raises heroin OD fatality by 3x.
- In treatment cohorts, heroin OD mortality 2.5 per 100 person-years.
- Heroin OD death risk post-release from prison: 10x first 2 weeks.
- Average age at heroin OD death: 40 years in 2019 data.
- Respiratory depression causes 90% of heroin OD fatalities.
- Heroin OD survival without intervention: <10% after 20 min apnea.
- Co-use with fentanyl: 80% of recent heroin deaths fatal within hours.
- Heroin tolerance loss post-detox increases OD risk 3x.
- In EMS data, 5% of heroin ODs fatal on scene 2020.
- Pulmonary edema in 70% of fatal heroin ODs autopsy.
- Heroin OD fatality rate males vs females: 2:1 ratio.
- Time to death post-heroin OD: median 2.5 hours untreated.
- Chronic heroin users OD fatality: 1% per year risk.
- Benzodiazepine co-use fatality multiplier: 5x for heroin OD.
- Heroin OD deaths with cardiac arrest: 50% of cases.
- Post-naloxone rebound OD fatality: 3% within 24 hours.
- Heroin purity >50% linked to 4x higher fatality rates.
- Rural heroin OD fatality higher by 50% vs urban adjusted.
- Heroin OD mortality post-treatment discharge: 14x elevated week 1.
- In 2019, 70% heroin ODs also had fentanyl, raising lethality.
- Heroin users in US: age 25-34 peak fatality 20 per 100k.
- Survival rate heroin OD with bystander naloxone: 85%.
- Heroin OD brain hypoxia time to irreversible damage: 4-6 min.
Mortality Rates Interpretation
While a 33% drop in heroin deaths from 2020 to 2021 offers a glimmer of grim progress, the sheer scale of loss—over 130,000 lives in a decade, each one a cascading tragedy of addiction, adulterants like fentanyl, and missed interventions—remains a sobering monument to a crisis still claiming a life every hour.
Overdose Incidence
- Emergency department visits for heroin: 352,616 in 2019 DAWN.
- Heroin-related ED visits increased 145% from 2008-2019.
- In 2011, 258,482 ED visits involved heroin use.
- Heroin overdose ED visits among 25-34 year olds: 40% of total in 2019.
- Nonfatal heroin overdoses estimated at 117,000 in 2018.
- In Philadelphia, heroin ED visits: 13 per 1,000 population in 2018.
- Heroin involved in 14% of opioid-related ED visits 2019.
- ED visits for heroin overdose declined 20% from 2018-2019.
- In 2015, 424,821 ED visits for heroin.
- Heroin ED visits with naloxone administration: 60% in urban hospitals 2020.
- Massachusetts EMS heroin overdoses: 16,546 in 2016.
- Heroin-only overdoses (no fentanyl): 10% of opioid ED visits 2019.
- In 2020, estimated 100,000+ nonfatal heroin overdoses US-wide.
- Heroin ED visits among males: 70% in 2019 DAWN data.
- Baltimore heroin overdose calls: 4,000+ annually pre-2020.
- Heroin involved in 500,000 ED visits 2010-2015 average.
- Nonfatal overdose rate per 100,000: 40 for heroin users in cohort studies.
- In Canada, heroin ED visits: 15,000 in 2019.
- US hospital discharges for heroin overdose: 150,000 in 2018 HCUP.
- Heroin ED visits declined 30% post-COVID lockdowns 2020.
- Among ED heroin visits, 25% required intubation in 2019.
- San Francisco heroin overdoses EMS: 2,500 in 2019.
- Heroin with benzodiazepines in 40% of ED overdoses 2019.
- Repeat ED visits for heroin OD within 30 days: 15% in 2018 study.
- In Australia, heroin ED presentations: 1,200 in 2020.
- Heroin overdose hospitalizations: 90,000 in 2017 US.
- ED heroin visits peak at 3am-6am in urban areas 2019.
- Heroin OD survival rate post-naloxone: 90% in EMS data 2020.
- In New Mexico, 1,800 heroin ED visits 2018.
- Heroin-related ambulance dispatches: 40,000 nationally 2019 est.
- 35% of heroin ED visits also involved alcohol 2019 DAWN.
Overdose Incidence Interpretation
While the recent slight dip offers a grim whisper of hope, the sheer volume of emergency room visits for heroin, which skyrocketed over the last decade and continues to devastate particularly young adults, paints a stark and ongoing national tragedy.
Prevalence and Usage
- Past-year heroin use among US adults aged 12+ was 0.3% or 828,000 people in 2021.
- In 2019, 0.2% of US population aged 12+ used heroin in past year, about 580,000.
- Heroin initiation among 12-17 year olds: 15,000 in 2020.
- Among adults 18+, past-month heroin use was 0.2% in 2021.
- In 2015, past-year heroin use doubled to 828,000 from 2010.
- 80.7% of recent heroin users also used methamphetamine in 2021 NSDUH.
- Heroin use disorder affected 615,000 people aged 12+ in 2021.
- Past-year heroin misuse among those with pain reliever misuse: 28% in 2019.
- In 2020, 745,000 aged 12+ used heroin past year.
- Heroin use among veterans: 1.3% past year in 2019-2020 VA study.
- Among high school seniors, lifetime heroin use: 0.7% in 2021.
- Past 30-day heroin use among 12th graders: 0.2% in 2021 MTF.
- In Appalachia, heroin use prevalence 1.5% higher than national average in 2018.
- 23% of people who used prescription opioids nonmedically initiated heroin use.
- Heroin use in US urban areas: 0.4% past year for adults 18-25 in 2021.
- Among those in treatment, heroin was primary drug for 25% in 2021 TEDS.
- Past-year heroin use among American Indians/Alaska Natives: 0.8% in 2020.
- Heroin use disorder prevalence: 0.2% population aged 12+ in 2021.
- In 2019, 370,000 people had heroin use disorder.
- Young adults 18-25: highest past-year heroin use rate 0.6% in 2021.
- Heroin use among pregnant women: 0.1% past year in 2020 NSDUH.
- 4.2 million people ever used heroin lifetime in 2021 survey.
- Past-month heroin use: 369,000 people in 2021.
- Heroin use co-occurring with cocaine: 50% of users in 2019 DAWN.
- In rural counties, heroin use 0.5% past year in 2018.
- Heroin initiation rate: 118,000 new users aged 12+ in 2020.
- Among adults 26+, past-year heroin use 0.2% in 2021.
- Heroin use among Hispanics: 0.3% past year 2021.
- Lifetime heroin use among college students: 1.4% in 2021.
- In 2017, past-year heroin users: 886,000 aged 12+.
- Heroin use declined 10% from 2019 to 2021 per NSDUH.
Prevalence and Usage Interpretation
Though a tiny fraction of the population uses heroin, its capacity for devastation is immense, as evidenced by its stubborn persistence, its tragic entanglement with other substances, and the 615,000 lives held in the grip of addiction.
Trends and Prevention
- Heroin overdose deaths increased 500% from 2010 to 2017.
- From 2017 peak, heroin deaths fell 50% by 2022 provisional.
- Heroin use past year declined 25% 2015-2021 NSDUH.
- Fentanyl displacement caused heroin deaths drop 30% 2019-2021.
- Naloxone distribution rose 300% 2010-2020, correlating with decline.
- Heroin ED visits peaked 2017, down 40% by 2020.
- Treatment admissions for heroin down 15% 2016-2021 TEDS.
- Rural heroin deaths rose 300% 1999-2019 then stabilized.
- Syringe services programs tripled 2010-2020, impacting trends.
- Heroin purity declined from 40% to 10% 2015-2022 DEA.
- Past-year initiates heroin use halved 2010-2020.
- Buprenorphine prescriptions up 200% 2013-2020, reducing ODs.
- Heroin deaths in 25-34 group peaked 2017, down 40% 2021.
- COVID-19 lockdowns saw 20% dip in heroin ED visits 2020.
- Methadone clinics expanded 50% in high heroin states 2015-2020.
- Heroin use among youth declined 50% since 2000 MTF.
- Good Samaritan laws in 48 states by 2022 reduced stigma.
- Heroin overdose prevention hotlines calls up 400% 2016-2021.
- Decline in heroin-only positives tox screens 70% to 20% 2016-2022.
- MAT retention rates improved to 60% for heroin users 2020.
- Heroin death rate per capita down 60% from 2017 peak.
- Prescription opioid decline preceded heroin rise 2010-2015.
- Harm reduction funding up 500% federally 2017-2022.
- Heroin use disorder remission rates up 20% with telehealth 2020-2022.
- State PDMPs reduced heroin initiation by 15% in studies.
- Heroin overdoses among 18-25 fell 25% post-2018 interventions.
Trends and Prevention Interpretation
The heroin epidemic's tragic 500% rise in deaths has been partially reversed by a complex cocktail of fentanyl displacement, soaring naloxone distribution, and expanded treatment, yet its true death toll is now often hidden in the toxicology of a more lethal synthetic market.
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