During 1990-2001, the death rate from poisoning in the United States increased 56%, from 5.0 per 100,000 population in 1990 to 7.8 in 2001. In 2001, of 22,242 poisoning deaths, 14,078 (63%) were unintentional. To describe trends in poisoning deaths, state health professionals in 11 states analyzed vital statistics data for 1990-2001. This report summarizes the results of that analysis, which indicated that increases in state death rates from unintentional and undetermined poisonings varied, but increased by an average of 145%; a total of 89% of poisonings involved drugs and other biologic substances. State public health professionals can use local, state, and national surveillance data to monitor trends in drug misuse and to develop effective interventions that can reduce deaths from drug overdoses.