Preliminary drug death trends in Washington state

What you will find on this page

While awaiting finalized yearly death data, we access 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.
Each quarter of 2020 each had more drug deaths than any quarter since 2017. The largest contributor to this increase is synthetic opioids, almost entirely fentanyl and fentanyl analogues.
Notable increases in fentanyl deaths in the fourth quarter were seen in 11 counties. This was the second successive such quarter for Pierce, Clark, and Spokane counties.
Notable increases in deaths involving psychostimulants were seen in Mason (n=4), Walla Walla (n=2), and Whatcom (n=4; second quarterly jump in a row) counties.

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. We provide detailed discussion of data issues at the bottom of this page.

Drug categories are based on ICD-10 codes with one exception:

All opioids:

Heroin (T40.1)
Commonly prescribed opioids:

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

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Includes oxycodone, codeine, morphine, etc.

Other 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.
- Fentanyls (text search)

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.

Statewide deaths involving drug types of interest

In the time trends graph below, click on "All drug poisoinings" 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.

County-specific increases in deaths involving drug types of interest

In the maps below, we present counties with notable increases (if any) in all drug poisonings and those involving fentanyls and psychostimulants with abuse potential. By "notable" we mean the count in the most recent quarter is more than double the average over the prior 3 years (12 quarters). We ignore counties with a single case in the quarter, which may or may not represent a real increase.

Data sources: Washington State Department of Health

Data notes

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, on this page we 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.

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.