In the US, the number of drug overdose deaths has been increasing dramatically over the last two decades. The number of drug overdose deaths in 2023 was nearly 10 times that in 1999. Since 2009, drug overdoses has been the leading cause of injury deaths, surpassing the number of deaths by both motor vehicle crashes and firearms. It’s widely recognized that opioids were driving the national drug overdose epidemic with consistent increases in opioid overdose deaths, and particularly sharp increases in the last couple of years. For the first time since 2018, opioid overdose deaths in the US decreased by 3% from 2022 to 2023, nevertheless, deaths involving opioids still remain high.
In Los Angeles County (LAC), increases in drug overdose deaths in LAC were observed starting in 2015, and were also particularly steep in the last couple of years. Compared to 2023, opioid overdose deaths decreased by 2% from 2022, but were still 22% more than in 2020 (Figure 1).
(Note: Based on death certificate data. For local opioid- and fentanyl-related death data from the Coroner’s Office, please see Figures 4-6).
In the US, the rise in opioid overdose deaths can be outlined in three distinct waves (Figures 2-3):
California followed a similar pattern as the overall US with a slight lag. In LAC, the number of synthetic opioid deaths sharply increased from 2015 through 2023, driving the increase in opioid deaths (Figures 2-3).
(Note: Routine testing for fentanyl among overdose deaths started in 2016).
According to LAC Medical Examiner’s data, accidental opioid overdose deaths increased every year in the past decade until 2023, then dropped by 34% in 2024.
Fentanyl has been a major driver of accidental overdose deaths, involved in 94% of all opioid overdose deaths during the peak of the opioid epidemic in 2023. From 2023 to 2024, fentanyl overdose deaths dropped by 37%.
The proportion of accidental drug overdose deaths involving prescription (Rx) opioids excluding fentanyl decreased from 38% in 2015 to 5% in 2024. Heroin-involved accidental drug overdose deaths decreased from 27% in 2017 to 4% in 2024 (Figure 4).
Note: Routine testing of fentanyl among overdose deaths began in May 2016.
In 2015-2024, opioids were often involved in accidental alcohol and drug (AOD) overdose deaths in LAC (ranging annually from 46% to 68%).
In 2015, 38% and 22% of AOD deaths involved Rx opioids (excluding fentanyl) and heroin, respectively. Over time, the involvement of heroin and Rx opioids in overdose deaths decreased, and they were each identified in less than 10% of AOD deaths in 2021 and thereafter.
In contrast, fentanyl-involved overdose deaths greatly increased, accounting for only 3% (rate=0.3 per 100,000 population) of AOD overdose deaths in 2015, to nearly two-thirds (64%; rate=20.0 per 100,000 population) in 2023 (Figure 5). Despite decreases, fentanyl continued to be involved in 52% (rate=12.8 per 100,000 population) of AOD overdose deaths in 2024.
In 2016-2024, opioid overdose deaths occurred most frequently among adults aged 40-64 years in LAC for all opioid types (Figure 6).
Since 2016, adults aged 40-64 years consistently had the highest number of deaths involving opioids for all opioid types, except fentanyl, which initially had more deaths among those aged 26-39 from 2016 to 2021 (Figure 7). However, when accounting for different population sizes, those aged 26-39 had the highest rates of opioid overdose deaths from 2017 to 2024 for all opioid types, except Rx opioids which had higher rates with increasing age (Figure 8).
In 2016-2024, males accounted for the majority (79%) of all opioid overdose deaths in LAC (Figure 9). The annual number and rate of opioid overdose deaths among males increased from 2016 to 2023, largely driven by fentanyl (Figure 10, 11). From 2023 to 2024, opioid overdose deaths fell by over 30% for both males and females.
From 2016-2024, Whites were the largest race/ethnicity group for all opioid overdose deaths, accounting for 44% of any opioid, 41% of fentanyl, 55% of heroin, and Rx 58% of Rx opioid overdose deaths (Figure 12).
Throughout 2016-2022, there were consistently more opioid overdose deaths among Whites compared to Hispanic/Latinos and Blacks, but in 2023, opioid overdose deaths decreased among Whites and were surpassed by Hispanic/Latinos (Figure 13).
The rate of all opioid overdose deaths was highest among Blacks starting from 2020, primarily due to fentanyl. Whites consistently had the highest rate of heroin overdose deaths from 2016 to 2024 (Figure 14).
According to LAC Medical Examiner’s report data, opioid overdose deaths were highest in the Metro region (SPA 4), and lowest in the Antelope Valley (SPA 1) region. Fentanyl overdose deaths were also highest in the Metro region and lowest in the Antelope Valley region, while heroin and Rx opioid (excluding fentanyl) overdose deaths were highest in the San Fernando region (SPA 2), and lowest in the West (SPA 5) and Antelope Valley regions (Figure 15).
Instructions: Hover over map to display drug name, and click on map to enlarge image.
Figure 15. Opioid, fentanyl, prescription opioid, and heroin overdose deaths, by SPA, LAC, 2020-2024
Source: LAC Medical Examiner
Notes:
1 Dot = 1 death
Blue dots = Prescription Opioid (excluding fentanyl) Overdoses
Green dots = Fentanyl Overdoses
Red dots = Heroin Overdoses
According to the Statewide Unintentional Drug Overdose Reporting System (SUDORS), in LAC, over half (54%) of accidental opioid overdose deaths during 2019-2023 took place in a private residence, such as a home or apartment. Outdoor settings (i.e., street, sidewalk, alley, highway, or freeway) were the next most frequently reported location (14%), followed by hotel/motels (7%) (Figure 16).
Figures 1-3. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 1999-2020 and 2018-2023 on CDC WONDER Online Database, released in 2024. Data are from the Multiple Cause of Death Files, 1999-2020 and 2018-2023, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-expanded.html on Feb 6, 2025.
Figures 4-15. Los Angeles County Department of Medical Examiner. Medical Examiner investigation reports. Data as of May 2025.
Figures 16. Statewide Unintentional Drug Overdose Reporting System. Data as of October 10, 2024.
