How the US turned the tide on drug overdose deaths

Vox

17-05-2025

is an editorial director at Vox overseeing the climate, tech, and world teams, and is the editor of Vox's Future Perfect section. He worked at Time magazine for 15 years as a foreign correspondent in Asia, a climate writer, and an international editor, and he wrote a book on existential risk.
The Trump administration has proposed major cuts to naloxone distribution, which could take the most potent tool for stopping overdose deaths out of the hands of those who need it most. Michael Siluk/UCG/Universal Images Group via Getty Images
In 2020 and 2021, before I came to Vox, I worked as the future correspondent at Axios — yes, that was the actual job title — and I found myself writing almost solely about the Covid-19 pandemic, or major trends that appeared to be driven by the pandemic.
One of those trends was an alarming rise in drug overdose deaths. The trajectory was already bad before Covid: Between the widespread prescription and misuse of legal opioids and then the introduction of the ultra-powerful drug fentanyl to the illicit drug supply, overdose deaths in the US began taking off in the early 2010s. But the closure of treatment facilities during the pandemic and the isolation of users led to a sudden spike in deaths: In the year leading up to September 2020, as I wrote in April 2021, more than 87,000 Americans died of drug overdoses, a higher total than any 12-month period of the opioid epidemic up to that point.
Despair, and then hope
After publishing that piece, I received a letter from a reader, who said her son had been one of those 87,000 deaths. She begged me to give this issue more coverage, to remind my readers that behind the Covid pandemic, there was a shadow epidemic of drug deaths, of lost sons and daughters and husbands and wives. People had to stop closing their eyes to the toll of death and pain.
In the years that followed, the toll only continued to grow, however, with deaths reaching 110,000 in 2023. There seemed to be no answer for one of the worst public health crises in a generation.
But now, at long last, we finally appear to be turning the corner on the drug overdose crisis.
Provisional figures from the Centers for Disease Control and Prevention's National Vital Statistics System released this week show that some 27,000 fewer Americans died of a drug overdose in 2024 than in 2023. That year-on-year drop is the steepest single-year decline since the government first began keeping track of overdose deaths 45 years ago. It means that drug deaths are now finally coming back down to pre-pandemic levels — and that we can make progress on what can seem like the most intractable social ills.
27,000 lives
To put that 27,000 drop in deaths into perspective, think of it this way: It adds up to three lives saved every hour for an entire year.
What's remarkable about the rapid drop in overdose deaths is just how widespread the trend is. Forty-five states recorded declines in deaths, with Ohio and West Virginia — two states that have suffered more than almost any other from the opioid epidemic — leading the way. Only a handful of states, mostly in the Northwest, where the epidemic started later, experienced increases.
While synthetic opioids, which mostly means fentanyl, are still responsible for the vast majority of overdose deaths, deaths from such drugs are falling faster than any other, declining by 36 percent year over year.
Reversing the overdose epidemic
One of the biggest factors behind the decline is the growing availability of naloxone, an opioid antagonist. If administered in the immediate aftermath of an overdose, naloxone has been shown to be close to 99 percent effective in preventing death. The key is speed — even the fastest emergency medical responders may not make it to the scene in time to save someone suffering an overdose. But recent policies to make naloxone available over the counter, and to advise users to have it on hand, have made it possible to bring back thousands of people who otherwise would have died.
While the pandemic directly led to a significant spike in overdose deaths, policies that came out of Covid have helped curb the toll, including telehealth access to medicine-based treatment options for addiction like buprenorphine. All of these programs have been paid for in part by the billions of dollars in opioid-settlement cash from drug companies like Johnson & Johnson, which began flowing to state and local governments in 2024. Tougher enforcement on fentanyl has played a role as well.
Lastly — and less positively — the sheer number of overdose deaths in the past few years has depleted the number of people at highest risk. Like an infectious disease epidemic that slows down as it begins to run out of new people to infect, the overdose epidemic burned so hot and killed so many that drug users who were left were less vulnerable to fatal overdoses.
What comes next
The news isn't all good. While synthetic opioids like fentanyl appear to be in a steep decline, deaths actually rose last year from stimulants like meth and cocaine, with production of the latter surging to new highs. The increase in deaths in a handful of states like Alaska and Washington demonstrates that in some parts of the country, at least, there are still populations that remain highly vulnerable to fatal overdoses.
Most worryingly, the Trump administration's draft budget proposes major cuts to naloxone distribution, which could take the most potent tool for stopping overdose deaths out of the hands of those who need it most.
Still, we should recognize this new data for what it is — evidence that, with effort, we can reverse the course of one of the biggest public health threats the US faces. Thousands of people are alive today who, if nothing had changed since I was writing about this epidemic in 2021, might have suffered a worse fate.
Drug addiction is a horrible disease that can destroy futures, families, and lives. But where there is life, there is hope. Every overdose victim brought back by a spray of naloxone has another chance to change their future, and ensure that they won't become another statistic.
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