A CDC analysis of more than 309,000 overdose deaths found that stimulants, mainly methamphetamine and cocaine, were involved in 59% of them, and that nearly three in four of those deaths also involved opioids. Prescription stimulants were rarely involved. Final 2024 data released since then show both cocaine and psychostimulant death rates falling.

By PDMPNews Staff

Source: Tanz et al., “Drug Overdose Deaths Involving Stimulants, United States, January 2018 to June 2024,” MMWR 74(32), Aug. 28, 2025 (DOI)

What happened

CDC’s Division of Overdose Prevention used two data systems. The State Unintentional Drug Overdose Reporting System (SUDORS), which draws on death certificates, postmortem toxicology, and medical examiner and coroner reports, described the circumstances of overdose deaths from January 2021 to June 2024 in 49 states and the District of Columbia. The National Vital Statistics System (NVSS) tracked national death rates by drug and by race and ethnicity from 2018 to 2023.

The number of overdose deaths involving cocaine rose from 4,681 in 2011 to 29,449 in 2023. Deaths involving psychostimulants with abuse potential, mostly methamphetamine, rose from 2,266 to 34,855 over the same years.

Key numbers

  • Of 309,274 overdose deaths from January 2021 to June 2024, 182,502 (59.0%) involved a stimulant.
  • 43.1% of all overdose deaths involved both stimulants and opioids; 15.9% involved stimulants and no opioids.
  • Methamphetamine was involved in 31.2% of deaths and cocaine in 30.0%. Prescription stimulants were involved in 1.6%, synthetic cathinones in 0.7%, and MDMA or MDA in 0.4%.
  • 73.0% of stimulant-involved deaths also involved opioids, including 79.1% of cocaine deaths and 68.8% of methamphetamine deaths.
  • Rates from 2018 to 2023: cocaine 4.5 to 8.6 per 100,000; psychostimulants 3.9 to 10.4. The steepest increases were psychostimulant deaths among American Indian or Alaska Native people (11.0 to 32.9) and cocaine deaths among Black people (9.1 to 24.3).
  • Compared with deaths involving stimulants and opioids, deaths involving stimulants without opioids were more often among people 45 or older (66.5% vs. 44.2%), more often had a history of cardiovascular disease (38.7% vs. 21.2%), and were more often seen in an emergency department for the fatal overdose (33.1% vs. 18.4%).

What has happened since

Final 2024 mortality data from the National Center for Health Statistics, published in NCHS Data Brief No. 549 in January 2026, show the declines that the MMWR report saw only in provisional numbers. Total overdose deaths fell to 79,384 in 2024, and the age-adjusted rate dropped 26.2%, from 31.3 to 23.1 per 100,000. Deaths involving psychostimulants fell from 34,855 to 28,722 (rate 10.6 to 8.5, down 19.8%). Deaths involving cocaine fell from 29,449 to 21,945 (rate 8.6 to 6.3, down 26.7%).

The two reports count slightly differently. The MMWR rates cover unintentional and undetermined-intent deaths, while the data brief also includes suicides and homicides. That is why the 2023 psychostimulant rate appears as 10.4 in one and 10.6 in the other.

Why it matters for PDMPs

Most of the stimulant death toll is outside what a PDMP can see. Prescription stimulants were involved in 1.6% of overdose deaths in the SUDORS data, while methamphetamine and cocaine dominate. That makes the PDMP’s role here narrower, but not zero.

First, the national rate category “psychostimulants with abuse potential” includes methamphetamine, amphetamine, and methylphenidate, according to NCHS definitions. The category itself does not show whether a drug was prescribed or illicit. Prescription amphetamine and methylphenidate are Schedule II controlled substances, which state PDMPs generally collect, so PDMP fill records can help a state check whether a stimulant death had any link to the legal supply.

Second, the overlap with opioids matters. In the SUDORS data, 43.1% of all overdose deaths involved both. The CDC authors note that stimulant use complicates opioid use disorder treatment and that guidance for treating both together is limited. PDMP data showing buprenorphine fill history, linked with overdose surveillance, can help states see whether people dying of combined overdoses were ever in treatment.

Analysis

The authors list limits that likely make these numbers low rather than high. Some stimulant deaths may be recorded as cardiovascular events and missed as overdoses. Postmortem toxicology varies by jurisdiction, and testing for emerging stimulants is not routine. Coverage also varies: Texas and Wyoming only entered SUDORS for deaths in January to June 2024, and North Dakota is not funded.

The emergency department figure stands out. In jurisdictions with circumstance data, about one in three people who died of a stimulant overdose without opioids was seen in an emergency department for that fatal event, compared with fewer than one in five when opioids were also involved. The CDC authors note that opioid reversal agents do not reverse stimulant effects, and that people who use stimulants might be missed by opioid-focused prevention efforts. For state overdose teams, including PDMP staff who already share data with public health partners, that is a reason to make sure stimulant deaths without opioids get the same review as opioid deaths. PDMPNews has covered related drug supply findings in NIST drug-checking data on fentanyl adulterants.

Read the report: PubMed Central PMC12393691 | NCHS Data Brief 549