Drug Overdose Deaths Decline
Drug Overdose Deaths Decline
In reporting about alcohol and other drug abuse and addiction we have, per force, often painted a depressing picture. One must be honest in saying that as a nation we are not addressing SUD locally or nationally. It is heartening, then, to report good news. From the Centers for Disease Control press release (“U.S. Overdose Deaths Decrease Almost 27% in 2024”, CDC, National Center for Health Statistics, Office of Communication, May 2025) “Provisional data from the CDC’s National Center for Health Statistics indicates there were an estimated 80,391 drug overdose deaths in the United States during 2024—a decrease of 26.9% from the 110,037 deaths estimated in 2023. Annual drug overdose deaths are projected to reach their lowest level since 2019.”
The CDC reports, “Almost all states across the nation saw decreases; Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, and Wisconsin and Washington, D.C., experienced declines of 35% or more. In contrast, South Dakota and Nevada had slight increases compared to the same period in 2023.” While overdose mortality was reduced in most categories of schedule 1 narcotics, the reduction from opioid overdose was most dramatic. “The new data show overdose deaths involving opioids decreased from an estimated 83,140 in 2023 to 54,743 in 2024. Overdose deaths involving cocaine and psychostimulants (like methamphetamine) decreased as well.” Non-fatal overdose emergency room visits have also decreased but less dramatically.
The CDC attributes this decline to several factors (“CDC Reports Nearly 24% Decline in U.S. Drug Overdose Deaths”, February 2025). “Multiple factors contribute to the drop in overdose deaths, including widespread, data-driven distribution of naloxone, which is a life-saving medication that can reverse an overdose; better access to evidence-based treatment for substance use disorders; shifts in the illegal drug supply; a resumption of prevention and response after pandemic-related disruptions; and continued investments in prevention and response programs like CDC's flagship Overdose Data to Action (OD2A) program.”
Certainly, we should take heart in this data. However, it is far too soon to rest on our laurels. Continuing from the CDC, “While this national decline is encouraging news, overdose remains the leading cause of death for Americans aged 18-44, highlighting the importance of sustained efforts to ensure this progress continues. President Trump first declared opioid overdose to be a public health emergency in 2017, a designation that remains in place, and the subsequent public health investments to CDC from Congress have transformed the nation's ability to use data to save lives.” Further, the decline is not experienced evenly across the country. “In the most recent data, 45 states showed declines in overdose deaths, but five states—Alaska, Montana, Nevada, South Dakota, and Utah—still saw increases in overdose deaths, highlighting the continued need for rapid local data and tailored response.” We cannot account from the different reports about specific States from the same federal agency.
We are moving in the right direction and it will be important to continue and strengthen investments in prevention to reduce overdose deaths. Expanding access to evidence-based treatment for substance use disorders is essential in addition to building more community-driven interventions and promoting education and early intervention.
Federal agencies competing for Congressional appropriations sometimes tend to make their news reports into marketing tools. Allow us then to elaborate on three items in the releases. First, despite the CDC claim about treatment being more available, in previous articles we have shown that in this decade treatment availability has decreased. Writing in a “Research Letter” in the Journal of the American Medical Association(“Research Letter” Ligang Liu, Journal of the American Medical Association, January 2025) Ligang Liu and colleagues report, “Despite increasing treatment needs, the percentage of participants receiving treatment (all drugs including alcohol) decreased from 9.3% in 2013 to 6.5% in 2020. SUD (substance use disorder) treatment rates rebounded to 14.9% in 2022. AUD (alcohol) treatment decreased from 6.3% in 2013 to 4.3% in 2020, recovering to 7.6% in 2022. OUD (opioid) treatment decreased to 11.2% in 2020, rebounding to 22.1% in 2021 and decreasing to 18.3% in 2022.” Despite this decade comparison in treatment availability these data tells us that between 7.6% and 18.3% of those in need ever find treatment. Further, there has been a slippage in the previous gains in recent years.
Secondly, the report about reducing the flow of drugs into the country cannot be substantiated. Several sources report that arrests and confiscation of drugs crossing the southern border have increased. At the same time, the flow of drugs continues at elevated rates compared to previous years (Trafficking Statistics, Lauren Villa, Reviewed by Scot Thomas, MD, American Addiction Centers, December 2024). “Although the DEA and other government agencies are working to stem the tide of drugs crossing U.S. borders, drug trafficking operations continue to evolve. For example, organizations are using encrypted technology and social media platforms to communicate during drug shipments and recruit new members to their organizations. These new smuggling techniques are making it harder for drug enforcement agencies to monitor criminal activities and crack down on widespread operations such as the Mexican drug cartels.”
Data about the volume of illegal drugs crossing the border are difficult to find in part because of the ease of smuggling fentanyl as we have previously discussed. In “Illegals Immigration and Fentanyl at the U.S. Northern and Southern Borders” (“Illegal Immigration and Fentanyl at the U.S. Northern and Southwest Borders”, D'Angelo Gore, Fact Check.org, January 2025) Fact.Check reports, “While we don’t know the total amount of fentanyl that is smuggled into the country each year, because comprehensive data do not exist, the federal government does track how much of the drug gets seized from people entering the country at or between legal entry ports. Like illegal immigration, the seizing is overwhelmingly happening at the southwest – not northern – border.” They further report, “CBP data show that in FY 2024 there were 21,148 pounds of fentanyl seized by officials at the southwest border – the vast majority of which was intercepted from people, largely American citizens, coming through legal ports of entry. That figure was down from 26,718 pounds seized in FY 2023. The figures for both years are higher than the 14,104 pounds seized in FY 2022.” It is very positive that drug seizures at the border have increased, but that does not tell us about the drugs that do make it across the border and in what quantities.
Finally, the distribution of Narcan, the brand name for naloxone, to reverse overdose does seem to be the major contributor. An article in Vox (“Drug overdose deaths are in a free fall — for now”, Dylan Scott, Vox, April 2025) reports, “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.
Yet, as Washington focuses on deficit reduction through spending cuts, naloxone spending is targeted for reduction. Vox, continues, “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.”
There are objections about wide distribution of naloxone in the form of Narcan. One criticism is that naloxone not only enables further drug use but results in greater drug use. In a report on the myths about Narcan (“4 common myths about Narcan, the ‘antidote’ to opioid”, Jocelyn Solis-Moreira, Popular Science, April 2023) it is reported, “But Kathryn Cunningham, director of the Center of Addiction Research at the University of Texas Medical Branch, says research has shown no evidence that naloxone leads to more drug use. A well-known 2013 study in The BMJ journal found the number of opioid-related hospital visits did not increase in communities with programs distributing naloxone and those with less access to the nasal spray. Instead, naloxone helped in reducing the amount of risky drug activity in 19 communities that distributed it to residents.” We have been clear that we continue to support abstinence as the long term goal for substance use disorder given the tools currently available. However, failing to provide life saving alternatives such as Narcan when evidence shows that it does not cause further drug use seems cruel and inhumane.
We do not argue against further interdiction of drug supply at the border and the pursuing manufacture of drugs within our borders. We do take exception with claims that there has been an increase in treatment availability which seems to be untrue and, regardless, is wholly inadequate in any case. We emphasize that the reduction in overdose deaths is largely attributable to the availability of naloxone as an antidote to overdose when administered in a timely manner. It seems, then, that drastic cuts to the availability of naloxone is cruel, inhumane, and will lead to overdose deaths returning to previous levels. Simply put, that is wrong.
Gene Gilchrist
May 2025
