2018 to 2021 saw 41.6 percent increase in firearm death rate; 82.6 percent of deaths were in children aged 15 to 19 years

Cannabis most common illicit drug, but polysubstance use also common

Rates of increase were higher among women than men, with 2018 to 2020 age-adjusted mortality rates up by 14.7 versus 12.5 percent

Age-adjusted rate of overdose deaths involving cocaine and opioids increased more quickly than cocaine alone from 2011 to 2021

83 percent of deaths due to external causes were excess, while 51 percent of deaths due to somatic causes were excess

Association partially mediated by neighborhood-level socioeconomic factors

Increased risk found for mortality from infections and suicide, while risk for mortality from cancer is reduced

Years of life lost due to opioid toxicity plateaued between 2017 and 2019, then increased through 2021

Suicide rate tripled for those aged 10 to 14 years from 2007 to 2018, while homicide rates doubled from 2016 to 2021

Findings seen across drug types and most ages, even when accounting for rates of drug misuse