US overdose deaths remain significantly higher than other countries

Based on provisional data, there were more than 100,000 deaths from drug overdoses in the United States in 2023 — a 50% increase from the number of overdose deaths in 2019. This was also the third consecutive year that U.S. drug overdose deaths reached over 100,000.

Compared to other countries, the United States continues to have the highest rate of overdose deaths in the world. For the report, the Commonwealth Fund analyzed the latest mortality data from 2022 and found that the United States had an overdose rate of 324 deaths per 1 million people, or almost 108,000 deaths in 2022.

Puerto Rico, a U.S. territory, had the second highest overdose rate at 246 deaths per 1 million people, followed by Scotland (219 deaths per 1 million people), and Canada (193 deaths per 1 million people). Saudia Arabia, Argentina, and the Philippines had the lowest overdose rates at three or fewer deaths per 1 million people. 

According to the report, several trends have contributed to the high number of overdose deaths in the United States, including the use of polysubstance and new substances. For example, xylazine, a tranquilizer that is not approved for human use, is particularly lethal when combined with fentanyl, and has become more prevalent in overdose deaths across the country, particularly in southern states.

Counterfeit pills, which can contain more than one substance or drug, have also contributed to overdose deaths. Between 2019 and 2021, the percentage of overdose deaths involving counterfeit pills more than doubled.

Around the world, deaths from synthetic opioids are rising, with fentanyl being the primary driver in the United States. In some European countries, including the United Kingdom and areas of the Baltics, there has been a concerning rise in nitazenes, a type of synthetic opioid that has not yet been approved for medical use. 

Access to medication-assisted treatment also remains limited in the United States. According to research, only 11% of Americans with opioid use disorder (OUD) received opioid substitution therapy in 2020. In comparison, 87% of people with OUD in France and 86% of people with OUD in Norway received opioid substitution therapy.

Although there was a slight decrease in U.S. overdose deaths from 2022 to 2023, Gumas said it is still too early to take these findings as a positive development.

"[W]e must continue to prioritize reducing the harms associated with drug use," Gumas writes. "Catering messaging and interventions thoughtfully to account for differences in populations is crucial to ensuring communications and interventions to prevent drug deaths are as effective as possible."