Late last year, however, the country received an unexpected positive signal: the number of overdose deaths fell by 10%. This marked the first decline since 2018, when the numbers stabilized for only a few months before starting to rise again. Things are looking better now, with the latest data from the Centers for Disease Control and Prevention (CDC) showing an impressive 26% decrease in deaths in 2024, with fewer than 81,000 deaths recorded in the past 12 months. Individual regions such as West Virginia, New Hampshire, and Ohio have seen a 40-50% year-over-year decline in deaths.
While the death toll remains very high and many people still die from preventable causes, this progress represents a significant improvement on the situation that has plagued health services since the early 2000s, when the massive opioid epidemic began.
How has this progress been achieved? The exact reasons are not yet clear, and some experts have raised concerns that the decline may be temporary. However, there are several explanations that look compelling. First, the pandemic has ended. Overdose deaths spiked between 2020 and 2021, likely due to increased isolation, overburdened medical services, and other factors. These negative trends are now on the decline.
Second, people who use opioids and other dangerous drugs have become more informed about the risks associated with fentanyl and synthetic opioids and are more cautious. It is hypothesized that the number of potential victims has decreased because more than 1.5 million people have died from overdose over the decades — and those who were most vulnerable have already died. It is also possible that some are choosing to switch to less lethal substances or using non-lethal forms of use such as cannabis, psychedelics, and cocaine and other stimulants, which, despite the risks, cause fewer deaths on average. It is important to note that fentanyl-laced cocaine remains a problem, but its lethality is lower compared to more dangerous drugs.
In addition, the U.S. has invested billions of dollars in public health programs aimed at reducing mortality. These initiatives raise awareness about the risks of fentanyl and provide free test strips to check the drug's contents so users can identify the dangerous quality. Access to treatment for opioid dependence is increased: the network of methadone and buprenorphine treatment centers is expanded.
Of particular note is the distribution of naloxone (e.g., Narcan), which quickly reverses an overdose. In 2021, rescuers dispensed nearly 70,000 doses of the drug, saving many lives. As Jessica Hulsey, founder of the Addiction Forum, notes, the widespread use of naloxone has significantly reduced deaths by allowing real-time response to overdoses.
This was a major public health achievement: despite resistance from some who did not want to bring overdose treatment into medical settings, the concept of harm reduction won out — and such interventions are now available to more people.
As for the current situation — despite the positive news — there are some troubling aspects. President Trump's administration is developing plans to cut millions of dollars in federal spending on opioid addiction programs. The recently released draft budget proposes to cut funding for programs to bring Narcan to medical centers, train emergency services, and support treatment programs. While the draft budget is not yet final and Congress has the authority to make amendments, there is a risk that the U.S. could lose the progress that has been made. If funding is cut, EMTs and first responders may not have the necessary funds to help people suffering from overdose in emergency situations.
Even leaders like HHS Secretary Robert F. Kennedy Jr. have previously publicly emphasized the need for naloxone despite plans to cut it. In the first term of President Trump's presidency, important legislation was passed to provide funding to fight the epidemic, but the pandemic has led to an increase in deaths. Trump is currently focused on combating the smuggling of fentanyl and its derivatives.
Experts like Andrew Kessler of Slingshot Solutions emphasize that while the decline in mortality is a good sign, there is still much work to be done. As with HIV or COVID-19, evidence-based investments in research, prevention and treatment remain key — a proven strategy that must not relent.
According to the latest CDC data, more than 48,400 deaths in 2024 were related to overdoses, accounting for about 60% of all overdose deaths this year. Of those, approximately 29,500 of those deaths are from synthetic opioid overdoses, indicating that their impact is significant. The number of deaths related to psychostimulants such as methamphetamine decreased by about 21% from 2023 to about 21,500. There was also a decrease in cocaine-related deaths, down 28% to about 22,200 cases.
«Overdose rates remain very high. Constant pressure is needed. As soon as we stop paying attention or reduce the intensity of efforts, the situation can get worse» — said Dr. Daniel Ciccarone, a professor at the University of California, San Francisco, and an expert on illegal drug trends in the United States.
He said the scale of the population at risk of overdose is probably much higher than official estimates. But the number of people leaving the at-risk group — due to fatal overdoses or through successful treatment — may be greater than the number of new users joining the at-risk group.
He added that a sharp drop in deaths would require a sudden «shock» to the system, such as disruptions in the supply of fentanyl. However, evidence of such disruptions is still scarce. Researchers at the University of North Carolina, Nabarun Dasgupta and Adams Sibley, disagree with this hypothesis. They note that the decline in mortality has been gradual and began about a year and a half ago, with different regions showing the onset at different times.
In addition to changes in user patterns, key factors in the decline in overdoses include the characteristics of the drugs themselves (e.g., their cost and consequences of use) and the behavior of users and their communities. «The general discontent with the illicit opioid trade is very high right now. Especially with the advent of xylazine, known as 'trance', which often causes severe skin wounds. People didn't sign up for such dangerous and unpredictable substances» — stated Dasgupta.
Despite localized initiatives, federal support is critical to fighting the epidemic. In March, the U.S. Department of Health and Human Services re-declared a state of emergency for the opioid crisis, expanding funding and regulatory options to combat overdoses. The 2025 strategy plans to increase access to preventive measures such as naloxone and improve response infrastructure.
However, recent budget cuts and staff reductions at federal agencies such as CDC and SAMHSA have raised concerns about continued progress. For example, CDC recently underwent massive cuts, which could negatively impact data collection and prevention programs. Dr. Reynard Washington noted that decreased funding is forcing alternative sources of support or staff reductions, which will negatively impact teams dealing with the crisis.
The CDC report emphasizes that sustained funding is needed to support prevention efforts and situational monitoring, such as the Overdose Data to Action program. Despite improvements, overdoses remain the leading cause of death among Americans ages 18-44, underscoring the need for continued efforts.
The budget proposals also include funding cuts to the Substance Abuse Services Administration (SAMHSA), raising concerns among professionals. In an open letter, hundreds of scientists and health care providers warned Congress of the potential negative consequences of such decisions, especially in the context of prevention and treatment programs.
Ensuring access to naloxone and addiction treatment through Medicaid remains a priority. Dr. Ciccarone emphasized that mortality reduction has a lot to do with engagement and initiatives supported by harm reduction programs. He noted that without continued support for these activities, the risk of a return to high mortality rates increases and it is important to maintain efforts to sustain gains.
