The latest national overdose figures from the CDC, released May 14, show that deaths fell by almost 27 percent in 2024—the third straight year of decline from a horrific peak. Yet there were 80,391 preventable overdose deaths in the United States in 2024—a scale of tragedy that seemed unthinkable a decade ago. And the national decline is not spread evenly, with some demographic groups and areas continuing to suffer increases.
The new Centers for Disease Control and Prevention data are provisional, so subject to change when final totals are confirmed. They show that deaths decreased in 48 out of 50 states, and in the District of Columbia and Puerto Rico. Nevada and South Dakota were the only states to suffer increases compared to 2023. Trends vary widely by region, with the largest decreases seen in West Virginia, Virginia, DC, Wisconsin, New Hampshire and Michigan.
“This drop does not mean the crisis is over … It means some of our strategies are working, and now is the time to really double down and not scale back.”
“It’s encouraging to see this slight decrease in overdose deaths,” Shreeta Waldon, executive director of the Kentucky Harm Reduction Coalition (KyHRC), told Filter. “But I caution we have to be careful to not misread the data. This drop does not mean the crisis is over … It means some of our strategies are working, and now is the time to really double down and not scale back.”
The data indicate that fentanyl-involved deaths fell from over 76,200 in 2023 to over 48,400 in 2024—the largest drop in any single drug category. Deaths where methamphetamine was present fell from 37,000 to 29,400, and those involving cocaine fell from 30,800 to 22,100. Deaths involving heroin and methadone remained stable, as they have for years now, totaling about 2,700 and 3,200 respectively.
The macro trend is moving in the right direction. The CDC’s death totals steadily increased almost every year from 2015 to 2020—then skyrocketed in the first year of the COVID-19 pandemic. Deaths reached an all-time high of 112,500 in the year 2022, but then began to fall. The 2024 total is almost back to the pre-pandemic level, to put the recent progress in grim context.
“It’s absolutely what we’re seeing on the ground,” Waldon said. “What’s confusing is we’re getting more data to justify the work, but it doesn’t seem our government and legislators in a position to make decisions about funding resources are paying attention. Our outreach, our harm reduction specialists getting out in the community to share fentanyl and xylazine test strips, especially in communities with less access [is reflected in this data].”
These CDC data don’t include demographic breakdowns. But other research has shown overdose deaths increasing in Black and Indigenous communities even as they declined among white people. Black and Indigenous people had the highest—and rising—fatal overdose rates among demographics in 2023, indicating the continuing, urgent need to raise awareness about prevention and address systemic barriers to resources in these communities.
The national decline is likely driven by a complex mix of factors. We know that the ongoing drug war increases overdose risk. There have been some reports of the drug supply shifting to become less potent in certain regions; while the DEA has claimed a drop in fentanyl purity in pills, this has not been proven on a national level.
“It took people meeting people where they’re at to make this decrease happen—it’s not that people aren’t using anymore, they’re learning how to use safely.”
Safer-use practices driven by harm reduction provision and awareness campaigns are having an impact. Waldon said that in her experience, people served by her organization in Kentucky are not choosing to stop using fentanyl—but they are doing so equipped with better information and safety practices than previously. Education, much more than changes to the drug supply, is the key factor in her eyes.
“The reason why we’re seeing overdose fatalities drop,” she said, “is because there are organizations like Vital Strategies that have helped us launch initiatives that center around Black communities, get information into the firehouses, have NaloxBoxes put in all over Jefferson County, and using the radio station, and making sure people who look like each other are showing up. It took people meeting people where they’re at to make this decrease happen—it’s not that people aren’t using anymore, they’re learning how to use safely.”
There have also been some meaningful actions at the national level. In 2021, the Biden administration launched the first federal harm reduction grant program through the American Rescue Plan, passed in response to the pandemic. It offered $30 million in funding—a very small amount, but historic nonetheless—for harm reduction providers. Under Biden, the FDA also acted to make naloxone available over the counter, so people can buy it at a pharmacy without a prescription.
Lawsuits against opioid manufacturers have also resulted in billions of dollars being distributed to state and local governments in recent years. Harm reduction advocates have pointed out the misuse of much of this funding by cities and counties—like paying for new equipment for police and jails. But money is also going towards addressing substance use disorder and overdose. To different degrees in different states, it has helped pay for naloxone distribution, medications for opioid use disorder, treatment for incarcerated people, and expanding syringe service programs.
“We’re going to see deaths start to climb again,” if Medicaid is cut.
A big question now is whether the national decline in deaths will continue, and if so, how fast. Unexpected factors can have devastating impacts, as the pandemic made all too clear. Much more predictably, the Trump administration is actively undermining harm reduction. Since President Donald Trump took office, he and Elon Musk, through “DOGE,” have led a campaign to dismantle key functions of the federal government, firing thousands of employees, decimating some agencies and cutting funds and programs.
Harm reduction has been specifically targeted by their attacks on naloxone distribution, research, the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC itself and even the AmeriCorps program, among others. Meanwhile the Republican-controlled Congress could strike a catastrophic blow to public health if it follows through on promises to slash Medicaid, the health care program on which millions of people rely for drug treatment, counseling and more.
“We’re going to see deaths start to climb again” if that transpires, Waldon warned. “Harm reduction keeps people alive long enough to access these pathways. If we lose support in one area, there will be a ripple effect. We will see how these Medicaid cuts impact people still stuck in the middle, trying to get to healing and wellness.”
Photograph by J. Ott via Flickr/Creative Commons 2.0
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