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/ ||||| This crawl of online resources of the 115th US Congress was performed on behalf of The United States National Archives & Records ||||| 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.
– 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: