Drug overdose deaths are in a free fall — for now

Vox

30-04-2025

covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017.
The broad availability of Narcan, the opioid overdose reversal, is credited by experts for the decline in overdose deaths. Al Drago/Bloomberg via Getty Images
Just two years ago, the US was suffering through the worst stretch of its long-running drug overdose crisis. More than 110,000 Americans had died in the previous 12 months from an overdose — almost twice the number of people who died in the all of the Vietnam War.
But late last year, the country got some unexpected good news: Overdose fatalities had fallen by 10 percent. It was the first drop of any kind since 2018, but here's the really good news: While in 2018, deaths only plateaued for a few months before rising again, the current decline appears to be sustaining and even accelerating. According to the most recent national data from the CDC, deaths in 2024 were down a whopping 26 percent, to less than 81,000 over the preceding 12 months. New county-level CDC data reveal some communities in the states hit hardest by the opioid epidemic — such as West Virginia, New Hampshire, and Ohio — have seen deaths fall by 40 percent to 50 percent over the past year.
Too many people are still dying preventable deaths, but the decline nonetheless represents a significant improvement in a problem that has bedeviled public health officials since the opioid epidemic began to take off in the 2000s.
America appears to be turning the corner on drug-overdose deaths. How?
Nobody is quite sure — and several of the experts I spoke to fear the downturn could be temporary. But there are a few plausible explanations.
First, the pandemic is over. Overdose deaths rose sharply during 2020 and 2021, likely for a combination of reasons. People were more isolated, for one, and health care providers were overwhelmed. That's no longer the case.
People who use opioids and other deadly drugs also now know about the particular risks of fentanyl and other synthetic opioids and are being more cautious. There is the contentious theory that the pool of potential victims has shrunk: More than 1.5 million Americans have died from overdoses since 2000, and many of the people who were most vulnerable to becoming dependent on opioids and overdosing may have, sadly, been among that group. It is also possible that people are shifting away from opioids like heroin and fentanyl and toward other drugs that are less deadly. More people are taking nonlethal drugs such as cannabis and psychedelics, and the use of cocaine and other illicit stimulants has also been growing; they still present a public health risk, especially with reports of cocaine laced with fentanyl, but these substances lead to fewer deaths on average.
The US has also invested billions of dollars into public health campaigns to reduce overdose deaths. We are not only increasing users' awareness about fentanyl, for example, but some public health departments have also provided millions of free testing strips so people who use opioids can easily check whether what they are using could quickly and unexpectedly kill them. Access to opioid addiction treatments like methadone and buprenorphine, too, has been greatly expanded through government and philanthropic investments.
And perhaps most importantly in the prevention of unnecessary overdose deaths, naloxone — Narcan, the nasal spray that rapidly reverses opioid overdoses — is omnipresent. You can find it in vending machines in police stations, libraries, and public schools around the country. Nearly 70,000 lifesaving doses were administered in 2021 by emergency responders.
'Increased naloxone distribution has saved countless lives by reversing opioid overdoses in real time,' Jessica Hulsey, founder of the Addiction Policy Forum, told Vox.
This was a hard-fought public health victory: While some people have at times objected to placing a drug overdose treatment in a public health setting, the harm-reduction argument that we should make these interventions widely available to save as many lives as possible has largely won out.
A meaningful drop in deaths — for now
Even as the good news rolls in, President Donald Trump's health department is currently working on plans to reduce federal spending on opioid treatments by millions of dollars.
A draft budget, recently obtained by several news organizations, including Vox, would specifically terminate programs that supply Narcan to health centers, doctors, and first responders, as well as programs to train first responders on how to use the drug during an overdose emergency. Other programs focused on drug abuse treatment and support would also be eliminated, according to the document.
To be clear, this is only a draft document, and the president's budget, even when finalized, is rarely adopted exactly as it is written. Congress will have its say, and lawmakers have shown support for substance abuse treatment in recent years.
But the proposal nonetheless raises the risk that the US will take a step backward after finally making progress in reducing the toll of opioids. If the programs were to ultimately be eliminated, some day, a health center might not have Narcan on hand when a patient comes through the front door experiencing an overdose. Or an EMT might find their supply runs out, and they don't have any naloxone spray available when an overdose call comes in.
The move by the Trump administration to cut these successful programs would seem to undermine their own goals to curb the opioid crisis. HHS Secretary Robert F. Kennedy Jr., who has spoken openly about his own heroin addiction, said just days ago that 'we need Narcan' — even as his department drafts plans to cut it.
In his first term, Trump promised to end the opioid epidemic, and he signed some of the first significant legislation to provide federal funding to combat it before the pandemic sent overdose deaths soaring. Now, within the early days of his second term, Trump framed his tariff policy around the goal of stopping fentanyl or its ingredients from being smuggled into the US.