Death by Drugs
Colorado at Record High
APRIL 2018
Death by Drugs
Colorado at Record High
CHI staffers contributing to this report
• Jaclyn Zubrzycki, lead author
• Eli Boone
• Brian Clark
• Chrissy Esposito
• Cliff Foster
• Deborah Goeken
• Liana Major
• Teresa Manocchio
• Adrian Nava
3 Number of Drug Deaths Head Higher, Rate of Deaths Levels Off
4 Numbers of Overdose Deaths: El Paso County Recorded Most in State
4 Rates of Overdose Deaths: Huerfano, Other Small Counties Experience High Rates
5 Colorado Drug Overdose Death Rates
7 The Rise of Opioids
8 Small Population, Big Problem
9 Policy Options
9 Conclusion
9 Methodology
Colorado Health Institute 3
APRIL 2018
Death by Drugs: Colorado at Record High
Drugs are killing more
Coloradans than ever.
Opioids, methamphetamines, cocaine and other
substances claimed the lives of 912 Coloradans in 2016,
an all-time high, according to the Colorado Department
of Public Health and Environment (CDPHE).
That’s more than the 627 Coloradans who died in a
car crash in 2016 and more than the 532 who died of
flu that year.
While the suffering is pervasive, it is hitting some
areas of the state harder than others.
This paper examines the numbers behind the crisis of
a generation.
Number of Drug Deaths Head Higher,
Rate of Deaths Levels Off
The numbers keep climbing.
Drug overdose deaths increased by 4 percent, from
880 in 2015 to 912 in 2016. Deaths have more than
doubled in the past 15 years: Just 406 Coloradans died
of a drug overdose in 2001.
Colorado has set records for drug overdose fatalities
in 13 of the past 15 years. And the newest data, while
not finalized, shows that trend continuing, with drug
overdose deaths climbing to a record high of 959 in
2017.
Colorado’s rate of drug overdose deaths — the number
per 100,000 residents — also increased steadily
Key Takeaways
• Colorado recorded 912 drug overdose deaths
in 2016, more than in any previous year. And
new data, while not final, suggest the deaths
increased to 959 in 2017.
• That translates to a rate of 16.1 drug overdose
deaths for each 100,000 residents, up 83
percent from a rate of 8.8 in 2001.
• There are wide variations across Colorado’s
counties. El Paso County led the state with 141
fatal drug overdoses in 2016, followed by Denver
County at 138. Colorado’s populous counties,
most located along the Front Range, generally
have the highest numbers of overdose deaths,
reflecting their larger populations.
• Huerfano County, with about 6,600 residents,
had six overdose deaths in 2016. That’s a rate
of 152.6 per 100,000, the highest in the state.
In fact, nine of the 10 counties with the highest
overdose death rates have populations of less
than 50,000.
between 2001 and 2015, rising to 16.1 deaths per
100,000 in 2016 from 8.8 deaths per 100,000 in 2001.
Still, it appears that the rate may be leveling off: The
death rate in 2016, 16.1, was little changed from 15.6 in
2015 and 15.7 in 2014.
From a national perspective, the U.S. recorded 63,500
drug overdose deaths in 2016 for a rate of 19.8 deaths
per 100,000, nearly four points higher than Colorado’s
rate.
Figure 1. Drug Poisoning Deaths in Colorado, 1999-2016 n Opioid n Non-Opioid
0
1999 2003 2007 2011 2012 2013 2014 2015 2016
200
400
600
800
1,000
237
360
423
459
430
437
402 408
408
108
137
305
379
377
402
468
472
504
912
880
870
839
807
838
728
497
345
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
4 Colorado Health Institute
Numbers of Overdose Deaths: El Paso
County Recorded Most in State
While the drug overdose crisis is impacting all of
Colorado, some counties and regions have been hit
harder than others.
CHI examined trends in the greatest number of
overdose deaths, generally in urban and suburban
counties, and the highest rates of overdose deaths,
generally small rural counties, especially in southern
Colorado.
Colorado’s more populous counties generally report
the highest number of deaths due to overdoses. (See
Table 1.) El Paso County led the state with 141 fatal
drug overdoses in 2016, followed by Denver County at
138.
Denver County had the state’s highest number of
overdose deaths each year from 2001 to 2014. Its
overdose deaths peaked at 169 in 2009. El Paso
County’s overdose deaths, meanwhile, have
increased each year, and it surpassed Denver for the
most overdose deaths in 2015.
In some large counties, however, overdose deaths are
dropping:
• Adams County had 92 overdose fatalities in 2016,
down from a peak of 100 in 2012.
• Larimer County dropped to 39 in 2016 from 61 in
2013.
• And Boulder County fell to 37 in 2016 from a peak of
54 in 2013.
More findings about the number of Colorado drug
overdoses between 2001 and 2016 include:
• Overdose deaths tripled in Weld and Douglas
counties.
• Mesa County, Colorado’s 11th-largest county and
home of Grand Junction, saw a bigger percentage
increase in the number of deaths in the past 15 years
than other large counties, climbing 440 percent,
from 5 deaths in 2001 to 27 deaths in 2016.
• Aggregating data for small rural counties helps
paint a picture of what is happening in regions
where the state does not provide county-level data
due to the small number of deaths.
• Sixteen rural Eastern Plains counties — Sedgwick,
Phillips, Yuma, Logan, Washington, Morgan,
Kit Carson, Cheyenne, Lincoln, Kiowa, Powers,
Bent, Otero, Crowley, Baca and Las Animas —
recorded 93 total deaths between 2014 and 2016,
up 158 percent from 36 in the three-year period
between 2002 and 2004.
• Eight counties in the San Luis Valley — Custer,
Huerfano, Saguache, Alamosa, Rio Grande,
Conejos, Costilla and Mineral — recorded 29
overdose deaths between 2014 and 2016, more
than double the 14 fatalities between 2002 and
2004.
Rates of Overdose Deaths:
Huerfano, Other Small Counties
Experience High Rates
Rates of overdose fatalities— the number of deaths
per 100,000 residents — increased in every region of
the state between 2001 and 2016. (See Table 2.)
The most striking increases took place in rural
Colorado. Even though many of these sparsely
populated counties had a relatively small number
of deaths, the high rates signal significant cause for
concern. (See Map 1 and Map 2.)
Findings about the rate of Colorado drug overdoses
between 2001 and 2016 include:
• Huerfano County, with about 6,600 residents, had
six overdose deaths in 2016. That translates into a
rate of 152.6 per 100,000, the highest in the state.
Table 1: Counties with Highest Numbers of
Fatal Overdoses, 2016
Rank County Deaths Population Rate
1 El Paso 141 690,207 20.4
2 Denver 138 693,292 19.2
3 Adams 92 497,673 18.6
4 Jefferson 91 571,711 16.4
5 Arapahoe 90 637,254 13.8
6 Pueblo 40 165,109 2 7.7
7 Larimer 39 338,663 11.2
8 Weld 38 294,397 13.3
9 Boulder 37 321,989 11
10 Douglas 33 328,330 10
Source: Vital Statistics Program,
Colorado Department of Public Health and Environment
Colorado Health Institute 5
APRIL 2018
Death by Drugs: Colorado at Record High
Go to coloradohealth
institute.org/research
/death-drugs to view an
interactive GIF that shows
the year-by-year change
in Colorado drug overdose
deaths by county from
2001 through 2016.
Source: Vital Statistics
Program, Colorado
Department of Public
Health and Environment
Colorado Drug Overdose Death Rates
2001
Colorado Rate: 8.8 per 100,000
2016
Colorado Rate: 16.1 per 100,000
Rate per 100,000
6 Colorado Health Institute
• Rio Blanco County, with about 6,500 residents, had
three deaths, posting the second highest overdose
death rate of 52.2 per 100,000. Meeker and Rangely
are its largest towns.
• Las Animas County in southeast Colorado,
Montezuma County in the southwest Four Corners
area, and Rio Grande County in the San Luis Valley
rounded out the top five counties for highest drug
overdose death rates.
• Pueblo County’s rate increased nearly threefold in
the past 15 years to 27.7 deaths per 100,000 people
in 2016. Mesa County saw an even more striking
increase, rising to 19.8 deaths per 100,000 in 2016
from 4.5 deaths per 100,000 in 2001.
• Again, aggregating data for small rural counties
helps paint a picture of what is happening in
regions where the state does not provide local data
due to the small number of deaths.
• Sixteen Eastern Plains counties — Sedgwick,
Phillips, Yuma, Logan, Washington, Morgan, Kit
Carson, Cheyenne, Lincoln, Kiowa, Powers, Bent,
Otero, Crowley, Baca and Las Animas — had an
overdose death rate of 20.6 per 100,000 residents
Table 2: Top 10 Overdose Death Rates By County, 2016
Rank County Deaths Population Rate
1 Huerfano 6 6,642 152.6
2 Rio Blanco 3 6,497 52.2
3 Las Animas 8 14,082 50.9
4 Montezuma 10 26,906 42.8
5 Rio Grande 4 11,424 38.5
6 Conejos 3 8,039 34.9
7 Fremont 15 47,487 30.2
8 Pueblo 40 165,109 2 7. 7
9 Logan 6 22,047 24.5
10 Routt 6 24,679 23.2
between 2014 and 2016, higher than the 15.8
statewide death rate for that three-year period.
• Eight rural south-central counties – Custer,
Huerfano, Saguache, Alamosa, Rio Grande,
Conejos, Costilla and Mineral – had an overdose
rate of 21.6 per 100,000 between 2014 and 2016,
also higher than the statewide rate.
0
20
40
60
44
92
90
37
138
33
141
91
39
40
38
27
53
25
78
11
60
44
15
15
10
5
80
100
120
140
160
Adams Arapahoe Boulder Denver Douglas El Paso Jefferson Larimer Pueblo Weld Mesa
Figure 2. Change in Drug Overdose Deaths in Colorado’s Biggest Counties, 2001-16
n 2001 n 2016
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
Source: Vital Statistics Program,
Colorado Department of Public Health and Environment
Colorado Health Institute 7
APRIL 2018
Death by Drugs: Colorado at Record High
Heroin Prescription Opioids Methamphetamines Cocaine
The Rise of Opioids
Opioids — including prescription
painkillers and heroin — are
a major driver of Colorado’s
increase in drug overdose deaths.
The 504 overdose deaths from
opioids in 2016 accounted for
more than half (55 percent) of
the drug-related deaths, up from
about a third (32.5 percent) in
2001. (See Map 3.)
Some Colorado counties are
disproportionately impacted by
the opioid crisis.
It’s particularly acute in Pueblo
and other southern Colorado
counties. While the state as a
whole saw a rate of 8.8 deaths
due to opioids (including
prescription drugs and heroin)
per 100,000 residents between
2014-16, Huerfano and Las
Animas counties had more than 20 deaths per
100,000 residents, and Pueblo experienced 15 deaths
per 100,000 residents in that time period.
Denver and surrounding metro area counties, El
Paso County, and several mountain counties also
had higher-than-average rates of deaths due to
opioids, and, reflecting their larger populations,
recorded the largest number of deaths in that time
period. Denver lost 249 people due to an opioid
or heroin overdose between 2014 and 2016, and El
Paso County lost 209.
Figure 3. Number of Drug Poisoning Deaths in Colorado by Drug Type, 2001-2016*
Map 3: Opioid Death Rates Per 100,000 Residents By County, 2014-16
0
50
100
150
200
250
300
400
350
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: Colorado Department of Public Health and Environment
* Categories are not mutually exclusive (may total to more than 100% of total drug overdoses) or comprehensive (other drugs not listed).
118
92
23
22
300
228
196
101
Source: Vital Statistics Program, Colorado Department of Public Health and Environment
8 Colorado Health Institute
Huerfano County Has State’s
Highest Overdose Rate – and That’s
No Surprise to Huerfano County
W
alsenburg, the largest town in Huerfano County,
prides itself on its history as a coal town, though
its last mine shut down in the 1950s.
Today, there are few job opportunities in Walsenburg
and the surrounding county, which sits between Pueblo
and Trinidad in the shadow of the Spanish Peaks.
Huerfano is one of the poorest counties in the state.
It also has Colorado’s highest rate of drug overdose
deaths: Six people died of an overdose in 2016. That
may not sound like many deaths, but in a county with
just 6,640 people, that translates to a rate of 152.6
deaths per 100,000 residents.
For better and for worse, that rate doesn’t come as a
shock to residents of this rural Colorado county just
south of Pueblo.
“Data goes back for over a decade showing Huerfano
as having some of the
worst overdose rates in
the country,” said Vic
Meyers, who works for
the Las Animas-Huerfano
County District Health
Department.
“It’s not a surprise.”
In fact, Huerfano County
— in a first for a local
government in Colorado
— is suing the nation’s top
pharmaceutical companies and distributors, claiming
that its residents were induced to take opioids for pain
management.
Meyers, Huerfano County’s coordinator for
Communities That Care, a substance use and violence
prevention program focused on youth and funded by
the state, said that the opioid crisis is confounding for
local leaders.
“The good news is when you talk to a county
commissioner or city councilmen or Joe on the street,
and you say, ‘We have a serious drug problem,’
everyone’s in agreement,” he said.
“The bad news is . . . nobody believes it can get better.”
Huerfano County faces challenges common to many
rural areas: A downturn in business activity has eaten
into the property tax base, leaving less money for
substance use prevention and treatment even as
more people are using drugs. There are no addiction
recovery centers in the county and few programs to
deter drinking and drug use by young people.
There are some unique factors at play as well.
For instance, Walsenburg disbanded its police
department in 2016, leaving all enforcement up to
an already-overtaxed county sheriff. And the illegal
drug trade of substances, including heroin and
methamphetamines, is a significant concern in this
region of the state.
Meyers is concerned about the lack of funding and
resources targeting his region.
“Our challenge is, we’re kind of forgotten,” he said.
“We’re definitely forgotten. We need state leaders
to do a better job recognizing the value of our
community.”
While programs like the state-funded Communities
That Care are a good first step, he said, “we need
people to come down here and say, ‘Things can be
better,’ to put some effort into improving conditions in
rural Colorado.”
Small Population, Big Problem
“Our challenge
is, we’re kind
of forgotten.
We’re definitely
forgotten.”
Vic Meyer, Communities
That Care Coordinator
Colorado Health Institute 9
APRIL 2018
Death by Drugs: Colorado at Record High
There is some good news: Since 2007, overdose
deaths due to prescription opioids have been leveling
off. In 2016, 300 people died of an overdose due to
a prescription, down from a high of 338 in 2014. This
trend is most likely occurring as physicians become
more mindful about prescribing opioids.
But there could be a downside to this trend.
Coloradans with a dependence on opioids may be
turning to heroin, which is becoming cheaper and
more readily available. In 2016, 228 Coloradans died
of a heroin overdose, up from 160 in 2015 and just 21 in
2003. Early numbers suggest that trend continued in
2017.
While the opioid crisis has been at the center of the
state and national discussion, Colorado overdose
fatalities due to other substances also have increased
since 2001. (See Figure 3.)
Deaths due to methamphetamines, for example,
increased consistently in the past 15 years. Colorado
saw 196 deaths due to methamphetamines in 2016,
up from 139 in 2015 and just 22 in 2001. This trend is
likely connected to the increase in heroin overdoses,
as the drugs are often sold together.
Policy Options
The overdose crisis is the result of a complex set of
dynamics, including the development, promotion
and over-prescribing of potent legal painkillers, easy
access to substances through the illegal drug trade,
and diverse personal, social and economic pressures.
It can be difficult for policymakers to know where to
target limited resources.
Will statewide programs and policies be most
effective? Should the focus be on opioids or should
other substances receive targeted attention? Should
policymakers target regions with the highest numbers
of overdose deaths — primarily the urban Front Range
counties? Or should there be more attention paid to
the highest rates of overdose deaths — mostly rural
counties?
Colorado lawmakers are hard at work on some
potential policy changes.
An interim committee focused on opioids and
substance use developed six bills for the 2018 session.
Five are still active as of March 2018. They range from
requiring Medicaid to cover residential treatment
for substance use to allowing school-based health
centers to apply for funds to address substance
use.
But a problem this complex will require multisector
solutions extending beyond the legislature.
Medical professionals are changing prescribing
practices and searching for alternative approaches
to treating pain. Health policy experts are working
to ensure people have access to the best treatment
possible. Law enforcement agencies are addressing
the illegal drug trade while also developing
solutions for the growing number of people in their
custody who are addicted to drugs. Social workers,
schools and courts tend to the children and families
struggling with the consequences of overdose
deaths and substance use. And other community
organizations are working on prevention and
addressing the factors that lead people to seek
substances in the first place.
Conclusion
Colorado lost 912 people to drug overdoses in
2016. Each person had a story. But each is part of
a bigger picture as well. Deaths due to drugs are
increasingly, and distressingly, common across
Colorado. While each community is unique, no
region is immune.
As Colorado confronts the drug overdose crisis,
this analysis is a reminder of the thousands of
Coloradans who have lost their lives to drugs in the
past 15 years, and the families and communities
that have been affected by substance use and
addiction.
Methodology
The Colorado Department of Public Health and
Environment’s Vital Statistics Program provided the
data for this paper.
This analysis uses age-adjusted death rates (deaths
per 100,000 residents). Because different diseases
or causes of death may be more likely to occur in
certain age brackets, it is helpful to age-adjust to
prevent data from being biased simply because a
population skews older or younger.
1,000
800
600
400
200
0
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10 Colorado Health Institute
Notes
Colorado Health Institute 11
APRIL 2018
Death by Drugs: Colorado at Record High
12 Colorado Health Institute
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