US drug overdose deaths involving stimulants without opioids continued to rise in 2024

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Background: After two decades of persistent growth, US drug overdose deaths (DODs) declined sharply in 2024, largely driven by reductions in fentanyl-involved mortality. However, trends in DODs involving stimulants without opioids remain less characterized and may follow distinct patterns. Methods: We analyzed aggregated data on unintentional DODs from 2018 to 2024 using the CDC data. Age-adjusted DOD rates were calculated using the 2000 US standard population. Joinpoint regression was used to identify significant temporal changes in mortality trends across substance categories. We examined percent changes in rates from 2023 to 2024 for cocaine and methamphetamine DODs without opioids, stratified by race/ethnicity, age group, and US census region. Results: Nationally, DOD rates declined by 27.9% from their 2022 peak to 2024, paralleling reductions in fentanyl-involved deaths. In contrast, rates of DODs involving stimulants without opioids increased slightly (cocaine: +1.7%; methamphetamine: +2.4%) from 2023 to 2024. Increases were observed nationally among White populations for cocaine without opioids and among Black, American Indian/Alaska Native (AIAN), and 55+ populations for methamphetamine without opioids. The Northeast experienced the largest increases for stimulant-without-opioid deaths, while the Midwest showed pronounced racial/ethnic divergence, including increases among White populations but substantial declines among Hispanic populations. Methamphetamine-without-opioid DODs rose markedly among AIAN populations in some regions. Conclusion: These findings highlight an evolving overdose crisis and underscore the need for prevention strategies that extend beyond opioid-focused interventions to address stimulant-specific harms.

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