U.S. Drug Overdose Crisis: Past, Present, and Future

October 2025

Authors

Kaitlyn Fleigle, FSA, CERA
Actuary
Reinsurance Group of America

Hilary Henly, FCII
Global Medical Researcher
Reinsurance Group of America

Daniel Brandt, FSA, FLMI
VP & Actuary
Reinsurance Group of America

Sara Goldberg, FSA, MAAA
VP & Actuary
Reinsurance Group of America

Julianne Callaway, FSA, ACAS
VP & Senior Actuary
Reinsurance Group of America

Executive Summary

Reinsurance Group of America, Incorporated (RGA) and the Society of Actuaries Research Institute (SOA) collaborated to investigate the trends and drivers behind drug overdose mortality and substance-related deaths as a whole. These investigations included a comprehensive medical literature review, discussions with experts, and analyses of both general and insured population datasets. Findings provided a range of insights surrounding substance use disorder, drug overdose and alcohol-induced mortality, and considerations for insurers.

For decades, drug overdose deaths have been increasing within the U.S., with opioid-related mortality driving this increase. The recent opioid overdose epidemic in the U.S. consisted of five primary stages driven by:

• the complex array of issues that led to widespread use of legal prescription opioids;
• the rise in heroin overdose deaths;
• the emergence of synthetic opioids, such as highly potent illicit fentanyl;
• the COVID-19 pandemic and the impacts of isolation and stress; and
• And the current post-pandemic environment.

Fentanyl remains the leading contributor of overdose deaths, but the presence of other – sometimes deadlier – substances mixed into drugs further contributes to the problem. Substances such as xylazine, carfentanil, and nitazenes are increasingly detected in overdose cases. These substances can make treating an overdose difficult, as they either do not respond to naloxone treatments or require significantly higher doses of the medication to respond. Despite this, available treatments and harm-reduction measures – many of which only recently became widely available in the U.S. – may be impacting mortality experience. After decades of increases, drug overdose deaths began to decline in 2023, and provisional data suggest further declines in 2024.

Certain demographic groups in the U.S. general population exhibit higher drug overdose mortality, including males, unmarried individuals, those with a lower level of educational attainment, and people working in construction-related occupations. The average age of death is also about 30 years younger for drug overdose deaths compared to that of all-cause mortality, with about 25%-30% of deaths for ages 25-39 being attributed to drug overdoses.

Substance-related mortality spans beyond drug overdose deaths. It is worth noting that alcohol use in the U.S. is more prevalent than illicit drug use (excluding marijuana); however, alcohol-induced mortality is lower than drug overdose deaths for the U.S. general population. Like drug overdose deaths, alcohol-induced mortality increased sharply during the acute phase of the COVID-19 pandemic, but it has decreased starting in 2022 and remains above 2019 levels. Interestingly, the university-educated population has recently experienced higher alcohol-induced deaths than drug overdose deaths. Additionally, in comparing drug overdose mortality to alcohol-induced mortality, the age of death is generally higher for alcohol-induced mortality, potentially due to its long-term impacts. Like drug overdose deaths, males also exhibited higher alcohol-induced mortality than females. However, due to differences in cause of death definitions, it is expected that total alcohol-related deaths are greater than the studied alcohol-induced deaths.

An analysis of RGA’s proprietary data on drug- and alcohol-related claims in the insured population revealed additional insights. Insured experience had several similarities to that of the general population: Claims peaked in 2021 and have declined in recent years, and insured males exhibited higher drug- and alcohol-related mortality than insured females. Additionally, there was higher drug- and alcohol-related mortality in smokers, policies with face amounts below $100,000, and policies in their later durations. These analyses highlight the importance of considering differences in cause of death trends between the insured and general populations when setting mortality improvement assumptions. With recent underwriting practices and the degree of non-disclosure, it is also important for underwriters to “read between the lines” to identify potential substance use disorder based on a variety of clues within an application.

The U.S. has higher reported drug-related mortality than other countries, due in part to differences in the drug supply chain, regulations, and treatment availability, as well as a limited presence of supervised consumption sites relative to other countries. In particular, the U.S. prescription drug marketing and regulatory environment that fueled the epidemic was not seen in many other countries. An analysis of Canadian drug overdose mortality relative to the U.S. reveals a similar experience trend and age profile for deaths but with lower mortality rates.

While the future of the U.S. drug overdose crisis and overall substance-related mortality remains uncertain, recent decreases in mortality trends – potentially impacted by improvements in harm-reduction strategies – provide hope. However, the contamination of the drug supply chain and the emergence of other highly potent, illicit substances is an evolving situation and poses a major threat.

Material

U.S. Drug Overdose Crisis: Past, Present, and Future - Report

Perceptions of Opioid Misuse – Consumer Market Survey

Acknowledgements

The researchers’ deepest gratitude goes to those without whose efforts this project could not have come to fruition: the Project Oversight Group for their diligent work overseeing, reviewing and editing this report for accuracy and relevance.

Project Oversight Group members:

Jean-Marc Fix, FSA, MAAA (Chair)

Carolyn Covington, FSA, MAAA, CERA

Matthew Farmer, FSA

Sam Gutterman, FSA, MAAA, FCAS, FCA, HonFIA, CERA

Eric McKeeman, FSA, MAAA, FCA

Loraine Oman-Ganes, MD, FRCPC, CCMG, FACMG

Rebecca Reppert, FSA, MAAA, CERA

Danielle Rubin, FSA, MAAA

Larry Stern, FSA, MAAA

Justin Williford, FSA, CERA

At the Society of Actuaries Research Institute:

Kara Clark, FSA, MAAA, Senior Practice Research Actuary

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