The United States has the highest rate of drug overdose deaths out of 30 countries, according to a new report from the health nonprofit the Commonwealth Fund.  

Overdose deaths in the U.S. dipped slightly around 2018 after a years-long rise. But those deaths began to rise again in 2019 and shot up during the onset of the COVID-19 pandemic, according to data from the Centers for Disease Control and Prevention.  

Overdose deaths decreased slightly again in 2023 by 3 percent but still more than 100,000 people across the country died from an overdose, according to provisional CDC data.  

The report ranks 30 countries and one U.S. territory from lowest to highest overdose death rate based on 2022 mortality data.  

In the report, the U.S. earned the bottom spot with 324 overdose deaths per 1 million residents in 2022, followed by Puerto Rico, which was categorized separately, with 246 overdose deaths per 1 million people that year. 

Scotland had the third-highest overdose death rate in 2022 with 219 overdose deaths per million people followed by Canada with 193.  

There are multiple reasons why the U.S. has far more overdose deaths than any of the other nations examined in the report.  

One possible reason is that other countries have more harm reduction essentials like Naloxone access and drug consumption rooms than the U.S., according to Evan D. Gumas, the research associate at The Commonwealth Fund responsible for the report.  

Another is that the U.S. has a larger supply of fentanyl than the other countries listed in the report.  

“They have other synthetics but not nearly to the level that the U.S. does,” Gumas said.  

Fentanyl, a synthetic opioid, is 50 times stronger than heroin and has caused a large portion of overdose deaths in the country for the last decade, according to the National Institute on Drug Abuse.  

CDC data show 84,181 overdose deaths in the U.S. involved a synthetic opioid, like fentanyl.  

In some European countries, especially in the Baltic region and the United Kingdom, a new class of synthetic opioids called nitazenes is becoming more common.  

Nitazenes now make up the bulk of synthetic opioids detected in the drug supply in Brazil, according to the report.  

“The big issue, too, is that the U.S. is such a huge country with a lot of variation in state policy towards treating drug users,” Gumas said. “I think that, at least on the research side, that tends to not work on a national scale.”