How do fentanyl overdose death totals compare to other opioid-related deaths annually since 2016?
Executive summary
From 2016 onward, deaths involving synthetic opioids—primarily illicitly manufactured fentanyl—rose dramatically and overtook other opioid categories as the dominant cause of opioid-related mortality, with annual fentanyl-involved deaths growing from a small fraction of opioid deaths in 2016 to roughly 70–73 thousand deaths by 2023 according to federal and public-data trackers [1] [2] [3]. That surge made fentanyl the single largest contributor to the U.S. overdose toll, even as overall overdose counts edged down slightly from 2022 to 2023 [2] [4].
1. The raw trend: fentanyl’s explosive rise since 2016
Synthetic-opioid (mostly fentanyl) deaths climbed sharply after 2016: age-adjusted rates for synthetic opioids rose from single digits per 100,000 earlier in the decade to large double-digit rates by 2021, and out-of-hospital fentanyl deaths increased by 282% from 2016 to 2021 (from 46.6 to 178.0 per million) according to a JAMA analysis using NCHS cause-of-death data [5] [6]. Public-source counts put synthetic-opioid deaths at roughly 73,838 in 2022 and 72,776 in 2023 (NIDA citing CDC data) and similar totals appear in other compilations [2] [1] [3].
2. How fentanyl compares to heroin and prescription opioids year-by-year
Since about 2016, fentanyl-involved deaths surpassed deaths tied to heroin and to commonly prescribed natural/semisynthetic opioids (oxycodone, hydrocodone, morphine), with synthetic opioids becoming the dominant opioid category by share and count [1] [6]. For context, heroin deaths peaked earlier and have trended down in later years (the number of heroin deaths decreased from highs in mid-2010s to under 4,000 in 2023), while deaths involving prescription opioids declined as synthetic opioids rose, so fentanyl became the primary driver of the net increase in opioid mortality [2] [7].
3. Share of total overdose deaths and recent shifts
Fentanyl and other synthetic opioids accounted for well over half, and in many reports roughly two-thirds to three-quarters, of opioid-related and total drug-overdose deaths in recent years: GAO and federal sources report synthetic opioids constituted around 60–70% of overdose deaths in recent reporting years, and some trackers put fentanyl involvement in roughly 69% of all drug overdose deaths in 2023 [4] [1] [2]. After several years of year-over-year increases, provisional data show a small decrease in synthetic-opioid deaths from 2022 to 2023 (about a 1–2% decline in counts or rates depending on the dataset), even as synthetic opioids remain by far the largest single contributor to overdose mortality [2] [8].
4. Why direct comparisons are tricky — data definitions, multiple drugs, and provisional counts
Comparisons across opioid categories are complicated because death certificates can list multiple drugs and a single death may be counted in several categories (for example both fentanyl and heroin) so category counts are not mutually exclusive [9] [7]; reporting lags and provisional methods produce small but real differences across sources and states (the CDC’s predicted counts vary slightly by jurisdiction) [9]. Researchers also warn of underidentification or nonspecific listings on certificates that can mask the true mix of drugs involved, and some analyses note challenges attributing the primary cause when multiple substances are present [10] [9].
5. What the comparison actually shows and the policy implication
The quantitative picture since 2016 is clear: fentanyl transformed the opioid landscape by becoming the largest single cause of opioid-involved deaths, dramatically outpacing heroin and prescription-opioid fatalities and accounting for the majority share of overdose deaths through the early 2020s; record totals peaked around 2022 and held near that level in 2023 with modest declines in some datasets [1] [2] [3]. However, the overlapping nature of drug involvement and differences in reporting mean exact year-to-year comparisons depend on which dataset and coding rules are used, so policy and public-health responses must be informed by the dominance of synthetic opioids while recognizing measurement limits and the growing role of polysubstance—stimulant-plus-fentanyl—overdoses [9] [5] [2].