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U.S. Drug Deaths Plunged in 2024. Trump Cuts May Reverse That, Experts Warn.

U.S. Drug Deaths Plunged in 2024. Trump Cuts May Reverse That, Experts Warn.

Yomiuri Shimbun15-05-2025

Mark Abramson/For The Washington Post
Nathalie Paradise holds the ashes of her father, Wade, who died in Seattle of a fentanyl overdose in 2024. Wade Paradise battled an opioid addiction for years after taking prescription pain killers.
U.S. drug deaths plunged in 2024, according to federal data published Wednesday, offering hope that public health measures are paying off even as the toll remains high.
Though there doesn't seem to be a single variable to attribute to the gains, the drop in overdose deaths comes amid concerns that cuts to federal public health agencies and proposals to cut Medicaid could undercut progress.
An estimated 80,391 people died from drugs in 2024, a decrease of nearly 27 percent from the previous year, according to provisional state data collected by the Centers for Disease Control and Prevention. Deaths from synthetic opioids – chiefly fentanyl, which has fueled the overdose crisis during the past decade – played a role in the majority of drug deaths but tumbled by nearly 28,000 fatalities, the estimates show.
The progress comes after drug deaths, which had been rising for more than a decade, soared to staggering levels during the coronavirus pandemic, surpassing 100,000 each year starting in 2021. This is the lowest death numbers since 2019, the year before the pandemic. The CDC said the 2024 death toll represents the lowest level since 2019, before the pandemic.
'I would characterize this as a historically significant decrease in overdose deaths,' said Brandon Marshall, a Brown University School of Public Health epidemiologist who studies overdose trends. 'We're really seeing decreases almost across the entire nation at this point.'
The data published Wednesday charts a dramatic decline in deaths during President Joe Biden's final year in office. The Trump administration has espoused hard-line rhetoric on fentanyl, declaring traffickers a top national security threat and citing them as a key reason for launching trade battles with China and allies Canada and Mexico.
The administration has also touted large fentanyl seizures and asked Mexico to allow the U.S. military to conduct counternarcotics operations on Mexican soil, a request denied by that country's president.
The CDC, in a statement, noted that Trump during his first administration declared the opioid crisis a public-health emergency in 2017. The declines since 2023 are a 'strong sign that public health interventions are making a difference and having a meaningful impact,' the agency said. 'Despite these overall improvements, overdose remains the leading cause of death for Americans aged 18-44, underscoring the need for ongoing efforts to maintain this progress.'
The White House Office of National Drug Control Policy, in an April statement of policy priorities, emphasized curbing the flow of illicit fentanyl, along with expanding access to treatment and research into cutting-edge technologies to identify and address emerging drug threats.
But public health advocates are raising alarm that the Trump administration is undercutting those goals with plans to gut federal funding that helps states pay for overdose antidotes, addiction treatment and other measures. A survey conducted by the nonprofit research firm Rand published in May suggests that more people may be using illicit opioids than previously estimated, underscoring the need for better monitoring.
In a letter to Congress on Monday, more than 300 academics warned that the Trump administration's proposed cuts to the Substance Abuse and Mental Health Services Administration and CDC could 'undermine the hard-fought progress we have made, especially in overdose prevention.'
Experts also worry Republican plans to slash Medicaid could leave former drug users without access to medication, forcing them to turn to street drugs, said Chad Sabora, a drug policy expert who helped organize the letter. 'It will equal more people dying,' he said.
What explains the drop?
The opioid crisis began decades ago with highly addictive prescription pain killers flooding states. Users later turned to cheaper street heroin, which was largely replaced by fentanyl manufactured by Mexican organized crime groups with precursor chemicals sourced from China. The synthetic drug can be up to 50 times more potent than heroin.
No single reason explains the sudden drop in deaths, researchers and health officials stress.
The Biden administration credited seizures of fentanyl at the southern border, arrests of high-level Mexican drug traffickers and cooperation from Beijing to crack down on unscrupulous Chinese companies exporting precursor chemicals. The administration also expanded access to addiction treatment medications such as buprenorphine, which wards off opioid withdrawals, and the overdose reversal drug naloxone. It also embraced harm reduction organizations that have saturated communities with free naloxone, fentanyl test strips and sterile needles to users.
Fewer deaths 'don't just happen overnight. And that's why we can credit them to the Biden administration's work,' said Sheila P. Vakharia, deputy director of research and academic engagement for the nonprofit Drug Policy Alliance.
Experts also believe that the illicit drug supply, at least in some regions, may be shifting to include less fentanyl. Other drugs added to fentanyl – such as the tranquilizer xylazine – may prolong the sedating effect and stave off opioid withdrawal so that users consume less fentanyl each day, researchers theorize.
Experts say fewer people are using alone as the social isolation of the coronavirus pandemic has receded.
Declines in deaths may also reflect the grim reality that fentanyl has killed so many regular users that there are fewer people at risk of overdose. The trajectory of deaths 'can't keep going up. It has essentially to kind of burn itself out,' said Caleb Banta-Green, an addiction expert and drug researcher at the University of Washington School of Medicine.
During Biden's first three years, the death toll topped 100,000 each year.
Deaths during a 12-month period peaked in June 2023 at a staggering 114,670, making the rapid drop nationally all the more remarkable, said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill. He stressed that deaths had been falling in certain regions where fentanyl had been entrenched for longer.
'Americans have responded to the overdose crisis with powerful community efforts, from every small town to large city. What we are seeing is the fruit of all that collective labor. These local efforts are the heart of overdose prevention,' Dasgupta said.
A state-by-state look
The CDC data released on Wednesday is not definitive; final death statistics lag because toxicology testing often takes months to complete.
Deaths involving stimulants such as methamphetamine and cocaine – which users increasingly take alongside fentanyl – also decreased, the statistics show.
Two states, Nevada and South Dakota notched slight increases from the previous year. But nearly all states showed declines in 2024. States such as New Hampshire, West Virginia and Ohio recorded declines of 35 percent or more.
In Washington state, where fentanyl became entrenched years later than on the East Coast, suspected drug deaths dropped by nearly 12 percent, after years of increases, for a total of 3,167.
In King County, home to Seattle, health officials distributed 124,700 naloxone kits in 2024 and opened three vending machines for people to obtain the medication, fentanyl test strips and other supplies. County officials and the University of Washington Department of Emergency Medicine also debuted a hotline for doctors to prescribe buprenorphine through free telehealth sessions at any time of day. The city's mayor in August announced an investment of nearly $3 million in opioid litigation settlement money to increase capacity for inpatient treatment.
But the state health department's top medical officer, Tao Kwan-Gett, urged cautioned. Washington overdose deaths fell through much of 2024 but spiked during the final four months of the year.
'It's too early to say that we're seeing a sustained decrease,' Kwan-Gett said. 'I certainly hope we are, but I think we have to continue being vigilant.'
The encouraging statistics in Washington and nationwide belie the heartbreak of addiction – and death.
Among the victims nationwide in 2024: a 17-month-old Los Angeles boy who ingested fentanyl during a child welfare-monitored visit with his mother; a 15-year-old girl who fatally overdosed on fentanyl at her Georgia high school, nine people who fatally overdosed in Austin, during one day.
In Seattle, former movie set designer Wade Paradise battled an opioid addiction for years after taking prescription pain killers. He was largely estranged from his family, living in squalor and suffering from myriad ailments, according to his daughter, Nathalie Paradise, 24.
She said Wade Paradise had struggled to get addiction treatment because of problems with health insurance. In December, he died at age 68 in his home from a pill made of fentanyl. His death received little attention but for Nathalie's GoFundMe page in which she recalled cherished childhood memories of summer swims in a lake and bargain hunting at thrift stores – and detailed his addiction.
'I didn't want it to be a secret anymore. I felt like the people in his life deserved to know the truth,' she said in an interview. 'I also have a lot of friends who use drugs, and I hoped that by sharing my story, it might encourage them to stop.'

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Chronic stress contributes to cognitive decline and dementia risk: What you can do about it
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Chronic stress contributes to cognitive decline and dementia risk: What you can do about it

By Jennifer E Graham-Engeland and Martin J Sliwinski The probability of any American having dementia in their lifetime may be far greater than previously thought. For instance, a 2025 study that tracked a large sample of American adults across more than three decades found that their average likelihood of developing dementia between ages 55 to 95 was 42%, and that figure was even higher among women, Black adults and those with genetic risk. Now, a great deal of attention is being paid to how to stave off cognitive decline in the aging population. But what is often missing from this conversation is the role that chronic stress can play in how well people age from a cognitive standpoint, as well as everybody's risk for dementia. We are professors at Penn State in the Center for Healthy Aging, with expertise in health psychology and neuropsychology. 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It is this relatively chronic stress that is most consistently linked with poorer health. In a recent review paper, our team summarized how chronic stress is a hidden but powerful factor underlying cognitive aging, or the speed at which your cognitive performance slows down with age. It is hard to overstate the impact of stress on your cognitive health as you age. This is in part because your psychological, behavioral and biological responses to everyday stressful events are closely intertwined, and each can amplify and interact with the other. For instance, living alone can be stressful – particularly for older adults – and being isolated makes it more difficult to live a healthy lifestyle, as well as to detect and get help for signs of cognitive decline. Moreover, stressful experiences – and your reactions to them – can make it harder to sleep well and to engage in other healthy behaviors, like getting enough exercise and maintaining a healthy diet. In turn, insufficient sleep and a lack of physical activity can make it harder to cope with stressful experiences. Stress is often missing from dementia prevention efforts A robust body of research highlights the importance of at least 14 different factors that relate to your risk of Alzheimer's disease, a common and devastating form of dementia and other forms of dementia. Although some of these factors may be outside of your control, such as diabetes or depression, many of these factors involve things that people do, such as physical activity, healthy eating and social engagement. What is less well-recognized is that chronic stress is intimately interwoven with all of these factors that relate to dementia risk. Our work and research by others that we reviewed in our recent paper demonstrate that chronic stress can affect brain function and physiology, influence mood and make it harder to maintain healthy habits. Yet, dementia prevention efforts rarely address stress. Avoiding stressful events and difficult life circumstances is typically not an option. Where and how you live and work plays a major role in how much stress you experience. For example, people with lower incomes, less education or those living in disadvantaged neighborhoods often face more frequent stress and have fewer forms of support – such as nearby clinics, access to healthy food, reliable transportation or safe places to exercise or socialize – to help them manage the challenges of aging As shown in recent work on brain health in rural and underserved communities, these conditions can shape whether people have the chance to stay healthy as they age. Over time, the effects of stress tend to build up, wearing down the body's systems and shaping long-term emotional and social habits. Lifestyle changes to manage stress and lessen dementia risk The good news is that there are multiple things that can be done to slow or prevent dementia, and our review suggests that these can be enhanced if the role of stress is better understood. Whether you are a young, midlife or an older adult, it is not too early or too late to address the implications of stress on brain health and aging. Here are a few ways you can take direct actions to help manage your level of stress: -- Follow lifestyle behaviors that can improve healthy aging. These include: following a healthy diet, engaging in physical activity and getting enough sleep. Even small changes in these domains can make a big difference. -- Prioritize your mental health and well-being to the extent you can. Things as simple as talking about your worries, asking for support from friends and family and going outside regularly can be immensely valuable. -- If your doctor says that you or someone you care about should follow a new health care regimen, or suggests there are signs of cognitive impairment, ask them what support or advice they have for managing related stress. -- If you or a loved one feel socially isolated, consider how small shifts could make a difference. For instance, research suggests that adding just one extra interaction a day – even if it's a text message or a brief phone call – can be helpful, and that even interactions with people you don't know well, such as at a coffee shop or doctor's office, can have meaningful benefits. Walkable neighborhoods, lifelong learning A 2025 study identified stress as one of 17 overlapping factors that affect the odds of developing any brain disease, including stroke, late-life depression and dementia. This work suggests that addressing stress and overlapping issues such as loneliness may have additional health benefits as well. However, not all individuals or families are able to make big changes on their own. Research suggests that community-level and workplace interventions can reduce the risk of dementia. For example, safe and walkable neighborhoods and opportunities for social connection and lifelong learning – such as through community classes and events – have the potential to reduce stress and promote brain health. Importantly, researchers have estimated that even a modest delay in disease onset of Alzheimer's would save hundreds of thousands of dollars for every American affected. Thus, providing incentives to companies who offer stress management resources could ultimately save money as well as help people age more healthfully. In addition, stress related to the stigma around mental health and aging can discourage people from seeking support that would benefit them. Even just thinking about your risk of dementia can be stressful in itself. Things can be done about this, too. For instance, normalizing the use of hearing aids and integrating reports of perceived memory and mental health issues into routine primary care and workplace wellness programs could encourage people to engage with preventive services earlier. Although research on potential biomedical treatments is ongoing and important, there is currently no cure for Alzheimer's disease. However, if interventions aimed at reducing stress were prioritized in guidelines for dementia prevention, the benefits could be far-reaching, resulting in both delayed disease onset and improved quality of life for millions of people. Jennifer E Graham-Engeland is Professor of Biobehavioral Health, Penn State. Martin J Sliwinski is Professor of Human Development and Family Studies, Penn State. The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts. External Link © The Conversation

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