Methamphetamine and Cocaine Overdose Deaths in the United States, 1999–2023

The ongoing “fourth wave” of the U.S. overdose epidemic has been marked by rising deaths co-involving fentanyl with stimulants such as methamphetamine and cocaine. Using data obtained from the CDC WONDER Multiple Cause of Death database, this serial cross-sectional study analyzed stimulant overdose mortality trends between 1999 and 2023. We stratified crude mortality rates by sex, race and ethnicity, and opioid co-involvement. We used Joinpoint regression to examine temporal trends and estimate annual percentage changes (APC) within time segments. From 1999 to 2023, methamphetamine-involved overdose deaths increased from 547 to 34,855, with mortality rates rising from 0.20 (95% CI, 0.18–0.21) to 10.41 (95% CI, 10.30–10.52) per 100,000 (AAPC: 18.49% [95% CI, 17.67–20.17]; p p Rising stimulant mortality, particularly in racial and ethnic minoritized populations, underscores the need for expanding access to harm reduction resources, greater funding for stimulant use disorder research, and targeted public health interventions.