More people died from drug overdoses in 2021 than in any year since city officials began tracking more than two decades ago, according to a report released by New York City’s health department on Thursday.

In 2021, 2,668 people died from overdoses across the city, an increase of more than 500 deaths from the prior year, the report found. For the fifth consecutive year, fentanyl was the most common substance involved, detected in 80% of fatalities. Cocaine was detected in 47% of the city’s overdose deaths, followed by alcohol (39%) and heroin (37%).

“These deaths are heartbreaking and many, if not most, are absolutely preventable,” Health Commissioner Dr. Ashwin Vasan said in a statement. “As a city we must use every evidence-based tool at our disposal to reach people with services and – most of all – support and compassion.”

Black New Yorkers had the highest rate increase in overdose deaths and four Bronx neighborhoods topped the city for the highest rates of drug overdoses. In Hunts Point and Mott Haven, the rate of overdose death was three times the city average: 119 deaths per 100,000 residents.

Rates of overdose deaths in New York City since the year 2000.

NYC Health Epi Data Brief, January 2023

In November 2021, amid the skyrocketing rise in overdose deaths, New York City opened two overdose prevention centers — also known as supervised injection sites — in East Harlem and Washington Heights, the first in the nation. OnPoint NYC, the nonprofit running the two locations, has since prevented more than 670 potentially lethal overdoses, according to the city's health department. The centers have been used over 52,000 times by more than 2,200 unique individuals, the department added.

But overdose prevention centers remain politically fraught despite studies showing that they help avert deaths, lower health care costs, reduce public drug consumption and increase access to drug treatment.

The U.S. Justice Department under President Joe Biden has repeatedly delayed a decision over the legality of a potential overdose prevention center in Philadelphia. The case is viewed as a potential key to making the sites legal on the federal level.

In December, New York Gov. Kathy Hochul rejected a plan from the state’s Opioid Settlement Advisory Board to fund supervised injection sites with some of the $2 billion New York obtained through settlements with major opioid companies. Her administration’s rejection letter cited the lack of federal and state legality. Likewise, Mayor Eric Adams has said he supports overdose prevention centers but won’t allot city funding to support them.

The surge in drug-related deaths in New York City mirrors nationwide trends, with more than 106,000 overdose fatalities recorded across the country in 2021, according to the Centers for Disease Control and Prevention.