In 1989, Ernesto Cruz, a deep-cover DEA agent, leads a troop of DEA agents against a militia in a jungle to take some information on Papa Muerte. After the attack, Ernesto is thrown from a plane and killed: his C.O. Colonel Trust believes it's a drug overdose. Ernesto's son Tommy, a high-ranking DEA agent, goes to Mexico and finds Marco, who is his primary contact with Morales Cartel. Tommy destroys a Virgillo gang convoy and their gas station but is seriously wounded by a grenade explosion. With no alternative, Tommy calls his younger brother Ramiro, an imprisoned criminal, to take the job.
Ramiro then goes to the jungle to Montanez's military base, extracting information about Papa Muerte and the DEA spy. Ram engages and kills Montanez, escaping the jungle. Trust finds out that Papa Muerte had planned to sneak into the DEA and steal the contraband cocaine which the DEA had seized, leaving a bomb to cover their tracks. Ramiro waits at Angel's apartment for extraction, only to find Papa Muerte's henchmen trying to kill him: meanwhile, Agent Johnson reveals himself as the Eagle and induces Tommy and Trust with a lethal drug overdose, although Tommy is able to patch Ramiro in to hear that Johnson had kidnapped Angel and killed their father. Ramiro returns to the DEA, fighting through Muerte's henchmen to save Tommy and Trust with an antidote while Johnson escapes on an armored train with Angel. Using a locomotive to carry the bomb away, Ramiro pursues and boards Johnson's train. Johnson, separating the coaches from the engine, battles Ramiro until Trust sends air support to destroy a canyon bridge ahead: Ramiro rescues Angel, and they jump over the broken rail on a dirtbike as the train falls into the canyon, dragging a trapped Johnson to his doom.
It's a total mishmash of ideas, and they flood out of its pea-sized brain like it probably thinks the dirty foreigners flood over its precious borders. In the first 15 minutes I zip-lined, shot and then flew my dead father to his death, took over my twin brother and broke his leg, turned out to be the black sheep of the family and learned around 20 specific game mechanics one by one, and got to free-roam around US/Mexican border towns while being told about a billion different icons and points I could build up.
This data visualization presents provisional counts for drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. Counts for the most recent final annual data are provided for comparison. National provisional counts include deaths occurring within the 50 states and the District of Columbia as of the date specified and may not include all deaths that occurred during a given time period. Provisional counts are often incomplete and causes of death may be pending investigation (see Technical notes) resulting in an underestimate relative to final counts. To address this, methods were developed to adjust provisional counts for reporting delays by generating a set of predicted provisional counts (see Technical notes).
The provisional data presented in this visualization include: (a) the reported and predicted provisional counts of deaths due to drug overdose occurring nationally and in each jurisdiction; (b) a U.S. map of the percentage changes in provisional drug overdose deaths for the current 12 month-ending period compared with the 12-month period ending in the same month of the previous year, by jurisdiction; and (c) the reported and predicted provisional counts of drug overdose deaths involving specific drugs or drug classes occurring nationally and in selected jurisdictions. The reported and predicted provisional counts represent the numbers of deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.
Several data quality metrics, including the percent completeness in overall death reporting, percentage of deaths with cause of death pending further investigation, and the percentage of drug overdose deaths with specific drugs or drug classes reported are included to aid in interpretation of provisional data as these measures are related to the accuracy of provisional counts (see Technical notes). Reporting of the specific drugs and drug classes involved in drug overdose deaths varies by jurisdiction, and comparisons of death rates involving specific drugs across selected jurisdictions should not be made (see Technical notes). Provisional data presented in this visualization will be updated on a monthly basis as additional records are received.
Provisional drug overdose death counts are based on death records received and processed by the National Center for Health Statistics (NCHS) as of a specified cutoff date. The cutoff date is generally the first Sunday of each month. National provisional estimates include deaths occurring within the 50 states and the District of Columbia. NCHS receives the death records from state vital registration offices through the Vital Statistics Cooperative Program.
The timeliness of provisional mortality surveillance data in the National Vital Statistics System (NVSS) database varies by cause of death. The lag time (i.e., the time between when the death occurred and when the data are available for analysis) is longer for drug overdose deaths compared with other causes of death (1). Thus, provisional estimates of drug overdose deaths have traditionally been reported 6 months after the date of death. Given recent improvements in data timeliness, starting in February 2022, the 6-month lag was shortened to 4 months.
The reporting lag was shorted from 6 months to 4 months after years of monitoring the improving timeliness of death reporting and a recent comparison of predicted estimates calculated using the 4-month and 6-month lags. Estimates produced with the 6-month and 4-month lags had a difference of less than 0.2% for national predicted drug overdose death counts. State predicted drug overdose death counts differed by an average of 0.1% (ranging from 0.0 to 0.5%). National predicted counts for deaths involving opioids had a difference of 0.1%, while state predicted counts had an average difference of 0.3% (ranging from 0.3 to 2.9%).
Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs. For example, a death that involved both heroin and fentanyl would be included in both the number of drug overdose deaths involving heroin and the number of drug overdose deaths involving synthetic opioids other than methadone.
The percentage of death records in which a specific drug or drug class is identified as involved in a drug overdose death varies by jurisdiction (7). Selected jurisdictions consistently had 90% or more of drug overdose death certificates mentioning at least one specific drug for all of the 12-month ending periods included in the dashboard. Provisional counts of drug overdose deaths where a specific drug or drug class is reported on the death certificate are presented for the United States and for jurisdictions meeting this threshold. Additionally, as a data quality metric, the percentage of drug overdose death records where at least one drug or drug class is recorded is presented.
As the timeliness and data quality of the drug overdose mortality data improve, the list of included jurisdictions will be re-examined to determine whether additional jurisdictions should be included or excluded based on the criteria described above. Due to reporting variations by jurisdiction, comparisons across selected jurisdictions should not be made. Data quality measures are shown for all jurisdictions in the below table. Values are updated with each monthly release and reflect the most current data available.
Timeliness of drug overdose death reporting has improved in recent years. Adjustments for delayed reporting are based on final data from 2019. Relative to final data, 12-month ending provisional counts of drug overdose deaths for 2019 were 98.3% to 99.2% complete after a 6-month lag. The degree of underestimation was largest for 12-month periods ending in October and November. Completeness was slightly higher in 2019 than in 2018. With improvements in reporting and completeness, predicted values will be closer to reported values and the completeness of reported drug overdose death counts may be higher than in prior years. Adjustments are typically updated once the prior year of data are finalized. Given atypically high death counts and temporary changes to reporting through 2020 and 2021, adjustments will continue to be based on 2019 final data.
Coefficients from these updated models were used to update the multiplication factors applied to the reported provisional counts of drug overdose deaths. Model results for each of the ten drug outcomes of interest are presented below.
There may be slight differences between provisional and final data for a given data year (e.g., 2021). Final drug overdose death data published annually through NCHS statistical reports (8) and CDC WONDER are typically tabulated by state of residence and limited to residents of the United States. Provisional data, such as the Drug Overdose Death Counts released through the Vital Statistics Rapid Release (VSRR) program, include all deaths that occurred within the 50 states and the District of Columbia, including foreign residents. As such, provisional counts include approximately 400-500 additional drug overdose death records where the decedents were not US residents. Provisional data are tabulated by state of occurrence to capture the burden on the place where the deaths occur, and to correspond to the various data quality metrics that are provided.
The new data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths from synthetic opioids (primarily fentanyl), psychostimulants such as methamphetamine, and cocaine also continued to increase in 2021 compared to 2020.
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