Overdose Deaths Fell Slightly in 2023, Per CDC, But Emergency Continues

May 17, 2024

New provisional data from the Centers for Disease Control and Prevention indicate that fewer people in the United States died of overdose in 2023, compared to 2022. But the projected decline, at 3 percent, is small, and the total remains devastatingly high. The decrease doesn’t hold across all 50 states—some saw an increase—and overdose remains the leading cause of accidental death, more than traffic accidents and firearm fatalities combined.

The CDC projects that 107,543 US residents died of overdose in 2023, down from over 111,000 people in 2022. (The number of confirmed deaths is lower, because death investigations are often ongoing, so the agency uses a method to project a final number.)

A big question is whether this decrease, the first since 2018, is the start of a new downward trend, or just a temporary fluctuation. Either way, it’s still a full-on crisis. In 2015, over 52,000 people died of overdose, and total deaths increased in almost every subsequent year—with a major spike in 2020, as the COVID-19 pandemic took hold. The record high to date came in 2022.

Total projected overdose deaths declined in many states in 2023. The biggest drop by percentage was seen in Nebraska, followed by Indiana, Kansas, Maine, North Carolina and Arkansas. But many states saw increases, especially in the West. The biggest percentage increases were in Alaska, followed by Oregon, Nevada, Washington State, Alabama, Utah and Hawaii. Deaths also increased in Washington, DC.

“What we’re seeing in the regional variation is a response to the shifting drug supply.”

“What we have to remember is the emergence of fentanyl west of the Mississippi is something that started before COVID, and really took off during the early years of COVID,” Dr. Sheila P. Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance, told Filter. “What we’re seeing in the regional variation is a response to the shifting drug supply … Here on the East Coast, we saw that shift unfold between 2014 and 2017. [Western states] are just seeing it now a few years later.”

The CDC data also indicate which drugs are involved in deaths. “Synthetic opioids,” including fentanyl, remains the most frequent drug category involved, with over 74,000 instances. This has been the case for years, with fentanyl-involved deaths rapidly rising since 2015. The next next category is “psychostimulants,” including methamphetamine, which were reportedly involved in about one in three overdose deaths. This continues a trend of steady increase since 2015, though at a slower rate than with synthetic opioids. Cocaine is the next substance most frequently involved in deaths, at over one quarter of the total. Most other substance categories remained flat or declined slightly—like heroin, which was involved in fewer than 4 percent of deaths, continuing a steady decline since 2017.

But these figures are an oversimplification. The CDC doesn’t yet tell us how many people had used two or more drugs at the time of their death. Such information won’t be available for at least several more months as the CDC compiles and cross-references death certificates. It’s a big current blind spot; one North Carolina study published in 2021, for example, found that over a decade, more than half of opioid-involved deaths and one fifth of non-opioid-involved deaths had more than one substance present.

The current US overdose crisis is a polysubstance phenomenon, Dr. Vakharia noted, which complicates perceptions. “Some people interpret these polysubstance deaths as pure contamination deaths,” she said, “[it’s] this fear of fentanyl adulterating cocaine and meth, and these opioid-naive users dying. What the actual data tells us is, when testing seized samples from the street or users, fentanyl contamination is relatively low and it’s likely people are [deliberately] using these drugs together or within a timeframe before the death, so they test positive for both.”

The small decrease in overdose deaths is unlikely to fall equally among all racial and ethnic groups. We don’t yet have a full demographic breakdown in the CDC data, but Vakharia theorized that overdose deaths may have decreased primarily for white people, while increasing for Black, Hispanic and Latino, and Indigenous people. Research indicates a similar phenomenon in 2017-2018, the last time overdose deaths decreased. And in 2022, the most recent year with full CDC overdose data available, fatal overdose rates increased for all racial and ethnic groups except non-Hispanic white, Native Hawaiian and Pacific Islander people.

“Sadly, we still have so many states where paraphernalia laws mean that harm reduction programs can’t give out safer smoking equipment.”

As deaths involving stimulants continue to increase, it’s important that harm reduction efforts don’t focus solely on opioids. But this expansion faces barriers.

“Sadly, we still have so many states where paraphernalia laws mean that harm reduction programs can’t give out safer smoking equipment to engage stimulant users in harm reduction,” Vakharia said. “I think we haven’t seen enough movement to decriminalize safer smoking equipment so we can bring them into programs where they can learn about fentanyl test strips, naloxone, get support and get help.”

There are also currently no medications like buprenorphine or methadone to treat stimulant use disorder. Some progress is being made here, but Vakharia said it must be sped up. Meanwhile, there are many steps state governments should take to facilitate harm reduction for people who use stimulants.

Vakharia also warned of the consequences of widespread actions by state and local lawmakers, both Republicans and Democrats, to shut down or weaken harm reduction programs.

Idaho lawmakers, for example, have advanced a bill to repeal its syringe exchange law; there’s an ongoing political and bureaucratic attack on syringe providers throughout West Virginia; Philadelphia’s mayor is refusing to use opioid settlement dollars to fund syringe service programs; and New York’s governor has rejected the use of opioid settlement funds to roll out overdose prevention centers.

Federal lawmakers, too, continue to implement damaging and misguided policies, at a time when wider access to lifesaving health care and harm reduction services must remain an urgent priority.



Photograph by Nathan Rupert via Flickr/Creative Commons 2.0

Dr. Vakharia is a member of the board of directors of The Influence Foundation, which operates Filter. The Influence Foundation previously received a restricted grant from the Drug Policy Alliance.

Alexander Lekhtman

Alexander is Filter's staff writer. He writes about the movement to end the War on Drugs. He grew up in New Jersey and swears it's actually alright. He's also a musician hoping to change the world through the power of ledger lines and legislation. Alexander was previously Filter's editorial fellow.

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