Trends of all opioid-, heroin-, and fentanyl-involved nonfatal overdoses in the United States, October 2020 - April 2025.

Abstract

This study examined monthly trends of suspected, nonfatal opioid-involved overdoses from October 2020-April 2025 and assessed whether demographics and geographic region vary between opioid type, including heroin and fentanyl. CDC's National Syndromic Surveillance Program data using the Drug Overdose Surveillance and Epidemiology definitions for all opioid-, heroin-, and fentanyl-involved overdoses in EDs were used. The average monthly percentage change (AMPC) was estimated using Joinpoint regression for counts of all opioid, heroin, and fentanyl-involved overdoses. Demographic characteristics between heroin- vs. fentanyl-involved overdoses and regional differences by region were compared between all opioid-, heroin-, and fentanyl-involved overdose ED rates. From October 2020 to April 2025, nonfatal opioid-involved overdoses declined (AMPC=-0.5 %) and showed more counts in summer months. Heroin-involved overdoses decreased (AMPC=-3.1 %); conversely, fentanyl-involved overdoses increased (AMPC=2.0 %). Counts of heroin (n = 5571) were higher than fentanyl (n = 913) in October 2020; however, in February 2023, fentanyl (n = 2464) surpassed heroin (n = 2341) and remained higher through April 2025. Demographic characteristics were similar among persons with fentanyl-involved overdose compared with heroin except a higher proportion of fentanyl occurred among individuals aged 15-24 years (12.8 % vs. 5.7 %) compared to heroin. Heroin- and fentanyl-involved overdose rates were highest in Region 5-Chicago and Region 10-Seattle, respectively. A better understanding of trends, demographics, and geography in nonfatal opioid-involved overdoses by drug type has implications for tailored prevention messages, but regardless of opioid type, results suggest the continued opioid overdose reversal medication distribution and linkage to evidence-based treatment for opioid use disorder in EDs.