Finally! Some Good News About U.S. Drug Overdose Deaths

“When I realized it wasn’t a quirk, it made me cry, because every one of these deaths is a story with children and loved ones. They’re all stories to me. They're not just numbers.” The speaker is Dennis Cauchon, founder and president of Harm Reduction Ohio. He’s been tracking provisional drug overdose data for nearly seven years and viewing tiny decreases. “It would have been just like small numbers—just, instead of 40 deaths in September, it was like 20, and so it wasn't enough to go on,” Cauchon told me. But by early 2024, when that line continued to arch downward, Cauchon said the data was showing him more than tiny incremental changes. These were real changes.

National surveys compiled by the Centers for Disease Control and Prevention (CDC) show an unprecedented 10.6 percent decline in drug deaths. That's a massive reversal from recent years, when fatal overdoses regularly increased by double-digit percentages.

"The trends are definitely positive," says Keith Humphreys, a leading drug policy researcher at Stanford University. "This is going to be the best year we've had since all of this started."

While many are offering theories about why the drop in deaths is happening at unprecedented speed, most experts agree the data doesn't yet provide clear answers. Fentanyl may be harder to find and less pure in some areas because of law enforcement efforts targeting Mexican drug cartels.

Naloxone, Buprenorphine, and Methadone Helped

Many people abusing fentanyl now carry naloxone (Narcan), a medication that reverses most opioid overdoses. Also, most friends of drug abusers carry the lifesaving drug and are ready to use it if a friend overdoses. Many people who use drugs have been rescued with naloxone and entered treatment programs with medication-assisted treatments like buprenorphine or methadone. While they are in treatment, the risks of overdose and death are markedly reduced.

Maybe Xylazine, Too

Another possible reason for the drop in overdose deaths is that the chemical xylazine is being mixed with fentanyl by drug gangs. While toxic to humans, causing zombie-like behavior in addicts and serious long-term health problems, xylazine could affect the number of deaths by diluting the amount of fentanyl users get. Experts point also to the end of the COVID pandemic, combined with the incredibly high number of people who have already died from drug overdoses (and were at high risk), as possible causes of the abrupt change.

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Jessica Hulsey, CEO, Founder, Advocate

Source: Addiction Policy Forum

A Few States Had Much Higher Death Rates

Surprisingly, Washington and Oregon experienced notable increases in overdose deaths. Washington and Oregon experienced the highest percentage increases in overdose deaths in the U.S. from September 2022 to September 2023, with Washington seeing a 41.4% rise and Oregon 41.5%. Efforts in both states to decriminalize drug possession have not reduced overdose deaths.

Methamphetamine and Cocaine Deaths Increased

According to the CDC provisional data, opioid overdose deaths dropped from 84,181 in 2022 to 81,083 in 2023. However, deaths related to psychostimulants (like methamphetamine) and cocaine rose during that time. This divergence highlights the complexity of the drug crisis, which some experts have called the American Disease; as we go from one substance to the next, never learning that it is unlikely we will find the new perfect drug.

Cautious Enthusiasm: It’s Not Over

It’s not all over, of course. Roughly 100,000 drug overdose deaths still occur in the U.S. annually. Canada has the second most overdose deaths in the world, at 7,000; the United Kingdom has 4,500, Australia and Germany around 2,000. In the U.S., street drug cocktails, including fentanyl, methamphetamines, xylazine, and other synthetic chemicals are more poisonous than ever. Youths are dying taking fentanyl-adulterated pills, and intravenously injected or smoked speedballing is ubiquitous in the U.S.

Summary

Based on CDC provisional data, opioid overdose deaths dropped from 84,181 in 2022 to 81,083 in 2023. Many people abusing fentanyl, and their friends, have started carrying and using Narcan (naloxone), the lifesaving drug, and are ready to use it if a friend overdoses. Many drug users have been rescued with Naloxone and entered treatment with medication-assisted treatments like buprenorphine and methadone. While users are in treatment, their risks of overdose and death are markedly reduced.

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The data is encouraging, a step in the right direction. However, 100,000 overdose deaths per year are still alarming and unacceptable. While the average state had marked decreases in deaths, increases were reported in Oregon and Washington. In addition, as opioid overdoses decreased, the switch to psychostimulants (such as methamphetamine) continued, and meth and cocaine deaths rose at the same time.