CLOSE The overprescription of opioids is leveling off, but deaths continue rising, says Dr. Marc Fishman of the Maryland Treatment Centers. He talks about addiction, treatment and bootleg fentanyl with USA TODAY Editorial Page Editor Bill Sternberg. USA TODAY 
 
 Bags of heroin, some laced with fentanyl, are displayed before a press conference regarding a major drug bust, at the office of the New York Attorney General, September 23, 2016 in New York City. (Photo: Drew Angerer, Getty Images) 
 
 Fentanyl is now the deadliest drug in America, federal health officials announced Wednesday, with more than 18,000 overdose deaths in 2016, the most recent year for which statistics are available. 
 
 It's the first time the synthetic opioid has been the nation's deadliest drug. From 2012 to 2015, heroin topped the list. 
 
 On average, in each year from 2013 to 2016, the rate of overdose deaths from Fentanyl increased by about 113 percent a year. The report said fentanyl was responsible for 29 percent of all overdose deaths in 2016, up from just 4 percent in 2011. 
 
 Overall, more than 63,000 Americans died of drug overdoses in 2016, according to the report, which was prepared by the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention. That's an average of 174 deaths a day. 
 
 The study also said many people who die from overdoses have multiple drugs in their system. “We’ve had a tendency to think of these drugs in isolation," Dr. Holly Hedegaard, lead author of the report, told HuffPost. "It’s not really what’s happening." 
 
 As an example, roughly 40 percent of people listed as dying of a cocaine overdose also had fentanyl in their system. 
 
 After fentanyl, heroin, cocaine and methamphetamine were the deadliest drugs in 2016. After declines earlier in the decade, the report said, overdose deaths from both cocaine and methamphetamine were starting to rise again. 
 
 The study said illegal drugs such as fentanyl and heroin were the primary causes of unintentional overdoses, while prescription drugs such as oxycodone tended to be used in suicide overdoses. 
 
 More: Opioid crisis: DEA data show spike in deaths led by prescription drugs, heroin and synthetics such as fentanyl 
 
 More: She reported on the opioid epidemic for years. Then, her daughter died of an overdose 
 
 Read or Share this story: https://www.usatoday.com/story/news/nation/2018/12/12/fentanyl-now-america-deadliest-drug-overtakes-heroin/2287343002/ ||||| A new report analyzing the drugs involved in fatal overdoses once again emphasized fentanyl’s role in the United States’ opioid crisis and highlighted a point frequently made by public health experts: Most people who fatally overdose have more than one drug in their system. 
 
 In 2016, about 70 percent of fatal overdoses involving fentanyl or heroin involved another drug as well, and roughly 74 percent of fatal overdoses involving cocaine also involved one or more other drugs. 
 
 “We’ve had a tendency to think of these drugs in isolation. It’s not really what’s happening,” said Dr. Holly Hedegaard, lead author of the report and injury epidemiologist at the National Center for Health Statistics. 
 
 More than 72,000 Americans died of drug overdoses in 2017, according to the U.S. Centers for Disease Control and Prevention. 
 
 Most reports on drug overdose deaths only determine what class of drugs were involved. The new report, published Wednesday by the National Center for Health Statistics, analyzed the text of death certificates and compared it with National Vital Statistics System data, drilling down to determine the specific drug ― not just the class of drugs ― involved in overdose deaths from 2011 to 2016. 
 
 What researchers found mirrored news reports in recent years. Oxycodone, which was the most common drug cited in fatal overdoses in 2011, was eclipsed by heroin from 2012 to 2015, and then fentanyl in 2016. On average, the U.S. death rate involving fentanyl increased about 113 percent per year from 2013 to 2016. 
 
 In most of these cases, the researchers found that more than one drug was used, and from those data they were able to identify the most common combinations of drugs that led to fatal overdoses. 
 
 Though it’s impossible to tease out what specific effect one drug had versus another used at the same time (or what other medical factors may have contributed to the deaths), better understanding these drug combinations “helps us identify potential areas of risk,” Hedegaard said. For instance, about 40 percent of cocaine deaths also involved fentanyl. 
 
 Bebeto Matthews/ASSOCIATED PRESS Heroin is prepared using a fentanyl test strip to check for contamination. A new report drilled down to determine the specific drug ― not just the class of drugs ― involved in overdose deaths from 2011 to 2016. 
 
 Hedegaard and her co-authors used the same death certificates that the CDC typically uses for overdose reports but went deeper in their analysis, scouring the records for drug misspellings, chemical names, brand names and street names recorded by coroners and medical examiners. 
 
 The amount and quality of information on the reports varied widely. Death investigations, resources and reporting requirements differ from county to county and state to state, and medical examiners and coroners are a patchwork of officials and an unregulated group. In some municipalities, coroner is an elected or appointed position, not necessarily a medical doctor. 
 
 Though reporting by medical examiners and coroners improved over the course of the report, Hedegaard noted, in 2016, 15 percent of drug overdose death certificates still didn’t include any specific drug. 
 
 After an in-depth analysis of the information, the researchers also found that certain drugs were more likely to be the cause of death in unintentional overdoses, while others were more likely to be implicated in death by suicide. In 2016, the street drugs fentanyl, heroin and cocaine were most frequently recorded in unintentional fatal overdoses, while prescription and over-the-counter medicines, including oxycodone, diphenhydramine, hydrocodone and alprazolam, were most frequently recorded in deaths by suicide. 
 
 Better understanding those patterns could help experts and policymakers who are working to end the nation’s suicide and overdose crises. ||||| (CNN) More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic, according to a new report from the National Center for Health Statistics, part of the US Centers for Disease Control and Prevention. 
 
 Most of those deaths involved opioids, a family of painkillers including illicit heroin and fentanyl as well as legally prescribed medications such as oxycodone and hydrocodone. In 2016 alone, 42,249 US drug fatalities -- 66% of the total -- involved opioids, the report says. That's over a thousand more than the 41,070 Americans who die from breast cancer every year. 
 
 Much of the increase was driven by the rise in illicit synthetic opioids like fentanyl and tramadol. The rate of deadly overdoses from synthetic opioids other than methadone has skyrocketed an average of 88% each year since 2013; it more than doubled in 2016 to 19,413, from 9,580 in 2015. 
 
 Heroin also continues to be a problem, the report says. Since 2014, the rate of heroin overdose deaths has jumped an average of 19% each year. 
 
 The opioid crisis has raised significant awareness of prescription painkillers. Between 1999 and 2009, the rate of overdoses from such drugs rose 13% annually, but the increase has since slowed to 3% per year. 
 
 In 2009, prescription narcotics were involved in 26% of all fatal drug overdoses, while heroin was involved in 9% and synthetics were involved in just 8%. By comparison, in 2016, prescription drugs were involved in 23% of all deadly overdoses. But heroin is now implicated in about a quarter of all drug fatalities, and synthetic opioids play a role in nearly a third. 
 
 These increases have contributed to a shortening of the US life expectancy for a second year in a row. 
 
 A state-by-state look 
 
 The states with the highest rates of overdose in 2016 were West Virginia, Ohio and New Hampshire, the report said. The rate of overdose in West Virginia was over 2.5 times the national average of 19.8 overdose deaths for every 100,000 people. 
 
 While the outlook nationwide is fairly bleak, it's particularly bad in some states. Twenty-two states and the District of Columbia had overdose rates significantly higher than the national average. 
 
 While overdose rates increased in all age groups, rises were most significant in those between the ages of 25 and 54. 
 
 Provisional data for 2017 from the CDC show no signs of the epidemic abating, with an estimate of more than 66,000 overdose deaths for the year. "Based on what we're seeing, it doesn't look like it's getting any better," said Bob Anderson , chief of the mortality statistics branch at the National Center for Health Statistics. 
 
 He said the data for this year were still incomplete because of the time it takes to conduct death and toxicology investigations. However, Anderson says, the 2017 estimates are alarming. "The fact that the data is incomplete and they represent an increase is concerning," he said. 
 
 But addiction specialist Dr. Andrew Kolodny said that despite the devastating overdose numbers, there appeared to be some indicators of good news. 
 
 "Even though deaths are going up among people who are addicted heroin users, who use black-market opioids ... it's possible that we are preventing less people from becoming addicted through better prescribing," said Kolodny, executive director of Physicians for Responsible Opioid Prescribing. 
 
 Studies have shown that while rates of opioid prescribing remain high in the US, they have decreased from a peak of 81 prescriptions for every 100 people in 2010 to about 70 per 100. Kolodny also pointed to recent surveys indicating that opioids were being less-frequently abused by teens. 
 
 A public health emergency 
 
 In October, President Trump declared the opioid crisis a public health emergency. "As Americans, we cannot allow this to continue. It is time to liberate our communities from this scourge of drug addiction," he said. "We can be the generation that ends the opioid epidemic." 
 
 The week following, the President's Commission on Combating Drug Addiction issued its final report with more than 50 recommendations to help solve the opioid crisis, including expanding medicated assisted treatment, increasing the number of drug courts, coordinating electronic health records and increasing prescriber education. 
 
 However, Kolodny and other public health experts were disappointed that the actions by the president and the commission were not accompanied by funds. 
 
 "You don't call it an emergency and sit around do nothing about it -- and that's where we are," Kolodny said. "The doing something should be a plan from the agencies ... and it should be seeking money from Congress." 
 
 Commission member and former Rep. Patrick Kennedy agreed. "It means nothing if it has no funding to push it forward. You can't just have a speech like the President gave." 
 
 But fellow commission member Bertha Madras said that funding requests can't be immediately answered and pointed out that the White House is working with agencies now to determine costs and processes to implement the group's recommendations. "The commitment has to be accompanied by wise decisions and wise planning and a very judicious use of funding," she said. 
 
 The White House's Council of Economic Advisers recently estimated that the cost of the opioid crisis in 2015 alone was $504 billion, nearly 3% of gross domestic product. 
 
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 Kennedy worries that the tax bill passed this week will only worsen the crisis. "It's going to be the vote that sets this country back further than anything else in our ability to tackle this crisis. Period. There's going to be no more significant vote on opioids." 
 
 The bill, which is now headed to the President's desk to be signed into law, eliminates provisions of the individual mandate or penalties for being uninsured that were required under Obamacare. Once it is enacted, the nonpartisan Congressional Budge Office estimates, 13 million individuals will be uninsured by 2027, and health insurance premiums will go up. According to the 2016 Surgeon General's Report on Alcohol, Drugs, and Health , 30% of Americans do not seek any sort of addiction treatment because they do not have insurance and cannot afford treatment. 
 
 "We've got a human addiction tsunami. We need all hands on deck," Kennedy said.
– Fentanyl killed 18,335 people in the US in 2016—the most of any drug, making the synthetic opioid the deadliest drug in America. Health officials announced the new ranking of overdose deaths from 2016, the most recent year for which data is available, on Wednesday. It's fentanyl's first time atop the list, which had heroin in the No. 1 spot from 2012 to 2015, USA Today reports. Oxycodone held the top spot in 2011. Fentanyl has experienced a disturbingly fast rise, causing just 4% of overdose deaths in 2011—but 29% in 2016. On average, the rate of fentanyl OD deaths increased by 113% per year from 2013 to 2016. Of note, as the Huffington Post reports, is the fact that most OD deaths involved multiple drugs; of the fatal ODs involving fentanyl or heroin, 70% involved at least one other drug as well, and about 40% of cocaine deaths also involved fentanyl. Read on for the top 10 deadliest drugs in the US: