Preliminary drug death trends in Washington state

What you will find on this page

We analyze both preliminary death certificate data and preliminary quarterly counts of deaths involving major drug categories. The counts in the most recent quarter are almost always an undercount due to the lag in reporting.
Drug poisonings continue to increase in Washington, largely driven by psychostimulants with abuse potential (mostly methamphetamine) and synthetic opioids, almost entirely fentanyl and fentanyl analogues.
Opioids are now present in over 80% of drug poisonings. The share involving synthetic opioids is approaching 80%.
Notable increases in deaths in the past two quarters were observed in Ferry, Jefferson, Walla Walla, and Whitman Counties. These data are preliminary and counts will increase.

Here we present preliminary drug overdose deaths based upon Washington State Department of Health quarterly data. These have yet to be finalized, so they will change somewhat, most likely increasing counts. We provide detailed discussion of data issues at the bottom of this page.

Drug categories are based on ICD-10 codes:

Any Opioid:

Heroin (T40.1)
Prescription Opioid: Commonly prescribed opioids include:

Methadone (T40.3)
Other commonly-prescribed natural and semisynthetic opioids (T40.2)

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Includes oxycodone, codeine, morphine, etc.

Synthetic Opioids (T40.4)
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Most prominent among this class are fentanyl and fentanyl analogues. The most common way to identify fentanyl death trends uses this ICD code, which may catch deaths involving other synthetics such as pethidine and tramadol. The increase in recent years of the number of deaths involving this code, however, indicates that most of them involve one of the fentanyls.

Cocaine (T40.5)
Psychostimulants with abuse potential (T43.6)

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Many reports on methamphetamine death trends actually use this code, which also includes drugs such as amphetamine, methylphenidate, and methylenedioxymethamphetamine or MDMA. Our research indicates that, in a given year, 3.5% to 13.6% of death certificates so coded in Washington do not mention methamphetamine. In our county-based flagging of notable increases in deaths by drug category, we use our own text-based search for methamphetamine to be more specific.

Statewide deaths involving drug types of interest

In the time trends graph below, click on "All drug poisonings" and other collective series in the legend in order to better see less aggregated or common drug categories.

Data sources: Washington State Department of Health. Q = quarter. Data for recent quarters are preliminary, and counts will increase.

Data sources: Washington State Department of Health. Q = quarter. Data for recent quarters are preliminary.

County-specific increases in deaths involving drug types of interest

Our analysis of notable quarterly increases in deaths at the county level now relies on preliminary individual death certificate data, while adhering to the DOH data suppression requirements (see details below). By "notable" we mean the count in the most recent quarter is more than double the average over the prior 3 years (12 quarters).

Preliminary first quarter 2024 death data showed an increase in poisonings in Ferry County, representing a (censored) small number of cases. Preliminary second quarter 2024 data indicate an increase in drug poisonings in Whitman and Douglas Counties.

Data details

Certification of deaths in the United States relies on a devolved, usually county-based process. As we discuss elsewhere in these pages (see our opioid deaths page and major drug deaths page for more information) deaths involving drugs are a particular challenge. This New York Times Magazine article addresses some of the myriad issues inherent in the US death certification system through the lens of the opioid crisis.

Whereas the "official" death certificate data we use elsewhere go through a centralized process designed to create a more uniform national dataset, the time trends on this page use a different data source. The Washington state Department of Health publishes preliminary drug death counts for recent quarters. Drug deaths take longer to certify than most other deaths, and so pending death certificates at any point in time will be disproportionately drug deaths. As such, some counts presented for more recent quarters will almost certainly increase. DOH appears to be attempting to update these data more often, which means that the most recent quarter may have more incomplete counts than previously.

Drug-caused deaths are compiled by the state Department of Health based on individual-level death certificate data. They represent reported drug poisonings (based on ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14 as the underlying cause of death) involving Washington residents who died in Washington. This common definition excludes cases where alcohol poisoning or alcoholism, carbon monoxide poisoning, etc., was coded as the underlying cause of death. Many drug deaths involve multiple drugs, and identifying the single drug out of many that resulted in death is impossible. Thus, these deaths are best described as drug poisonings involving the drug or category of drugs specified.

Although identification of drugs in deaths has improved over time, for heroin as well as fentanyls in particular, the time period presented here entails fairly constant accuracy of drug classification within jurisdiction. There may remain important differences across jurisdictions, particularly to the extent that death determination does not involve enlisting the aid of the state toxicology lab. Furthermore, some counties have recently put special emphasis on fentanyl deaths and are identifying those deaths more quickly than other deaths. Again, the data presented here are preliminary and will change.

The Department of Health, beginning with Q1 and Q2 2021, now suppresses counts between 1 and 9. Unlike with the prior version of this page, we switched to using individual death certificate data, also preliminary, to examine quarter-to-quarter increases rather than the DOH-compiled counts. Mapping is still limited by the suppression standard. See our opioid deaths page and major drug deaths page for more information and analysis using this individual-level data.