A Parallel Epidemic: More Overdose Deaths in 2020, Fentanyl Fatalities Spike

CHI’s most up-to-date analysis highlights changes in overdose rates in Colorado

Key Takeaways

  • Opioid overdoses rose by 54% in 2020, accounting for nearly two in three overdose deaths in Colorado.
  • Fentanyl overdoses became more common, more than doubling between 2019 and 2020 and increasing by 10 times since 2016.
  • Existing inequities and the COVID-19 pandemic exacerbated the increase in overdose deaths in communities of color.
May 8, 2023

NOTE: An earlier version of this analysis used the term “prescription opioids,” in line with previous drug categorizations used by the Centers for Disease Control and others. This version uses the term “opioid analgesics” to reflect the increasing use of fentanyl outside of prescriptions.

Drug Overdoses Increased Drastically in 2020

In 2020, 1,477 Coloradans died of drug overdoses – the most overdose deaths ever recorded in the state, and a 38% increase from 2019 according to data from the Colorado Department of Public Health and Environment (CDPHE). This represents an age-adjusted death rate of 24.8 residents per 100,000, up from 18.0 per 100,000 in 2019 (Figure 1). For comparison, 15.2 residents per 100,000 died of a heart attack in 2020.

Drug overdose deaths were already on the rise in Colorado, but the COVID-19 pandemic had an unprecedented impact on substance use and on access to treatment and support options. Social isolation, the pandemic-induced recession, and changes to care delivery brought about by shut-downs contributed to the most significant one-year increase in drug overdose deaths in recent memory.

Each data point presented in this report represents a life lost. CHI acknowledges the many people have been affected by addiction and overdose deaths. We provide this information to inform them and all of those working to expand and improve prevention, treatment, and recovery options in our state.

The Colorado Health Institute created the graphics in this report. They are free for public use and available to download. The Colorado Department of Public Health and Environment is the source of all Colorado drug overdose data in this report.


In 2020, there were 798 deaths recorded involving opioid analgesics, 525 involving methamphetamine, 220 involving heroin, and 219 involving cocaine (Figure 2). There was a notable uptick in the number of deaths related to opioid analgesics, increasing by 82% between 2019 and 2020. The number of methamphetamine overdose deaths increased by just over 50%, while deaths involving cocaine increased by 62%. The number of deaths due to heroin stayed constant during this time period.


Opioid Overdose Deaths Continued to Rise, But Fentanyl Was the Main Driver

Colorado recorded a large increase (54%) in the number of overdose deaths due to opioids, a category which includes opioid analgesics and heroin (Figure 3). These deaths made up nearly two thirds of all drug poisoning deaths in Colorado in 2020.


One issue that could have impacted opioid overdose numbers was access to Naloxone, the medicine used to help reverse an opioid overdose. Data released in May 2021 showed that the number of prescriptions filled for this life-saving drug decreased significantly after March 2020 and has remained low. Access to follow-up care for addiction recovery was also curtailed during the pandemic, leaving many who had completed treatment without adequate peer support or a care team to support their ongoing recovery.

In more recent years, there has been an alarming increase in the number of deaths involving a specific type of opioid: fentanyl. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, so it is deadly in small amounts due to its potency and can cause overdoses to happen more quickly than other types of opioids. Fentanyl can be prescribed by a doctor, but it is also produced illicitly in labs – these forms of fentanyl are the more common type associated with overdoses. In current data reporting, fentanyl-related overdoses are classified under opioid analgesic deaths no matter the source. This is a change from previous categorizations under which all fentanyl-related overdoses were classified under prescription opioids no matter the source.

In 2020, overdoses involving fentanyl made up about 68% of all opioid analgesic deaths. Between 2019 and 2020, the number of overdose deaths involving fentanyl more than doubled, from 222 to 540. There were 10 times as many overdoses involving fentanyl in 2020 as in 2016 (Figure 4). During this same time frame, deaths associated with other prescription opioids appear to have stabilized, with similar overdose death rates reported since 2011 (Figure 5). And while other opioid analgesic overdoses decreased between 2017 and 2019, the opposite effect occurred for fentanyl-related overdoses. Now, the fentanyl overdose death rate is over twice that of other opioid analgesics.

This sizable increase in fentanyl-related deaths was a nationwide trend. A report from the Commonwealth Fund showed that synthetic opioids, including fentanyl, were the primary driver of the surge in overdose deaths in 2020. In December 2020, the CDC reported large increases in the availability of illicitly manufactured fentanyl in western states, including Colorado.

While screening in early years of the opioid epidemic may have underreported counts of fentanyl-related deaths, recent years show us that this upward spike in fentanyl-related overdoses does not appear to be abating.

COVID-19 Pandemic Exacerbates Impact of Overdose Deaths in Communities of Color

In 2020, Black or African American Coloradans had the highest rate of death from drug overdose across all racial or ethnic groups: 36.3 per 100,000 people, which is double the rate for this population in 2018 (Figure 6). The rate of overdose deaths among American Indian or Alaska Native Coloradans was the second highest in 2020, at 30.3 per 100,000 people. Asian or Pacific Islander Coloradans had the lowest death rates due to drug overdose across all years of data. (Sample size limitations for those who are Asian or Pacific Islander or American Indian or Alaska Native impact the reliability of estimates from year to year. We report data for these specific groups to help illustrate the impact of substance use among communities that would otherwise be unrepresented in the data.) 

Racial disparities in drug overdose rates have complex root causes, ranging from longstanding lack of access to health care for Black or African American Coloradans and American Indian or Alaska Natives to inadequate treatment of Black and African American patients’ pain due to provider bias. Issues like lack of access to culturally competent care and neighborhood environment can reduce the chances of people of color getting treatment and follow-up care when needed. This effect is compounded by the stigmatization of people seeking treatment, especially for Black or African Americans. The compounded effects of racial discrimination, stigma, and low quality of care can result in individuals not seeking or continuing treatment.

Paired with higher rates of drug criminalization among communities of color, these race-specific barriers make it harder for some Coloradans to get the treatment and care that they need for substance use disorders.

Those who are struggling with opioid-use disorders have an increased risk of serious illness and death from COVID-19, as these substances are shown to negatively impact lung and heart health. Existing social, economic, and access inequities were compounded by the COVID-19 pandemic for communities of color, as a disproportionate number of deaths and economic impacts from the pandemic have been recorded in Black, Hispanic, and Native American communities. While gaps in access to prevention and treatment services already existed before the pandemic, disruption of these services due to COVID-19 only made access more difficult for these communities. The intersection of racial disparities, the COVID-19 pandemic, and the overdose crisis culminated into an especially deadly year for Colorado’s communities.

Click on the race/ethnicity tabs below to explore the data for each category.