Federal data shows that overdose deaths in the United States are the lowest they’ve been in three years, and a new analysis suggests that some downward trends indicate “unprecedented” progress in the fight against the drug epidemic.
Overdose deaths soared during the height of the COVID-19 pandemic, jumping 30% between 2019 and 2020 and another 16% by the end of 2021, according to data from the US Centers for Disease Control and Prevention. But the latest provisional data shows that overdose deaths made a sharp turn at the end of last year and have been trending down for months.
There were about 101,000 overdose deaths in the year ending in April, CDC estimates. There are still far more lives being lost now than before the pandemic – in 2019, there were about 72,000 fatal overdoses – but the latest data shows that deaths dropped a marked 10% in one year and are the lowest they’ve been since the spring of 2021.
A steep drop in deaths from fentanyl is a key factor driving the overall decline.
Overdose deaths involving fentanyl and other synthetic opioids are down 20% year-over-year, CDC data shows. These drugs are now involved in about two-thirds of all fatal overdoses, down from more than three-quarters of all overdose deaths a year ago.
“An opportunity to feel hopeful after so many years of watching the death toll tick up and up is wonderful,” said Dr. Sarah Wakeman, senior medical director for substance use disorder at Mass General Brigham. “I think also it’s important to note that there are still more people dying from overdose than before the pandemic, and we’re still stratospherically higher than we should be in terms of people dying from a preventable cause of death.”
In a deep dive into the trends, street drug scientist Nabarun Dasgupta and colleagues at the University of North Carolina found that non-fatal overdoses have also fallen significantly and that trends are relatively consistent at the state level – all signs that help experts feel that the overall trend is solid.
Data compiled by the CDC on the rate of emergency department visits for overdoses shows a 24% year-over-year decline in April and a 13% annual decline through June. And data from 911 calls and other emergency medical services responses suggests that non-fatal opioid overdoses are about 17% lower this month than they were in September of last year.
“A 15-20% decrease in non-fatal overdose and a 10% decrease in fatal overdose is a major impact. There is barely any public health intervention that has credibly achieved this magnitude of decrease,” Dasgupta and his colleagues wrote in an analysis published Wednesday on the website for the University of North Carolina at Chapel Hill’s Street Drug Analysis Lab.
“Our conclusion is that the dip in overdoses is real, and not a data artifact. It remains to be seen how long it will be sustained. If it is sustained, whatever caused it would be one of the strongest ‘interventions’ ever witnessed in this domain of public health,” they wrote. “Yet, -15% to -20% decreases in overdose would be unprecedented. To our knowledge, no public health intervention in the United States has ever achieved this benchmark.”
There is not one single factor that can explain the rapid decrease or its timing, experts say. Instead, it’s probably the result of a wide range of persistent efforts starting to make an impact.
“If this is real – and I hope that it’s real and will continue – it’s because of the sustained efforts of many different multilayered interventions,” Wakeman said, citing interventions such as expanded access to naloxone to reverse overdoses, flexibilities with medications to treat opioid use disorder and promotion of fentanyl test strips. “Finally treating this like a public health condition after so many years of effort and attention may be starting to pay off.”
John Pamplin, an assistant professor of epidemiology at Columbia University who researches the effects of structural racism on substance use outcomes, said that there is a cyclical nature to the drug crisis in the US: Changes to the drug supply and new patterns in drug use require adaptations to knowledge and interventions, all of which takes time.
In fact, the CDC has categorized the opioid epidemic into three waves: the first spurred by the rise in prescription opioid overdoses that started in the 1990s, followed by a rise in heroin overdose deaths that started in 2010 and the latest involving synthetic opioids that started in 2013.
“We’ve been riding a better than 20-year peak in terms of the continuous increases of drug overdoses,” Pamplin said. “Generally speaking, you have these kind of rises and falls. It may be time that these are true declines.”
Although a 10% decline in overdose deaths may be unprecedented, Pamplin notes that the amount of support for change and intervention has also reached new levels.
“I think it shows why it’s important to actually give harm reduction approaches time to bear out, not only to have those potential effects take place but also enough time for us to fairly evaluate the policies to see if they are, in fact, working,” he said.
In any case, the magnitude of change signals a “very strong acting force,” Dasgupta and colleagues wrote. “Something has changed. And that this is happening without central coordination is a big deal. It had major implications for the way we think about overdose prevention interventions.”
Still, experts warn that it’s not time to be complacent. While national data shows a promising trend, it could obscure growing disparities in the burden of the drug overdose epidemic and populations that need particular attention.
“Unfortunately, for the most affected groups, namely native Americans and Black American men, the death rates are not decreasing and are at the highest recorded levels,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
“Understanding the causes for the different trends in overdose mortality is needed to tailor implementation and support of evidence-based strategies to prevent and reduce deaths. We must continue to prioritize efforts to prevent drug use, treat addiction, provide access to lifesaving harm-reduction services and support people in recovery that are equitable and accessible to everyone who would benefit from them.”
