With the exception of a slight dip in 2018, fatal overdose had increased every year since the CDC began tracking the data in 1999, and risen dramatically with the onset of the COVID-19 pandemic. Then, after recorded overdose deaths peaked at 107,941 in 2022, they decreased slightly to 105,007 deaths recorded in 2023.

In 2024, that number dropped to 79,384—a decrease of 26.2 percent, bringing the mortality rate from 31.3 deaths per 100,000 people down to 23.1. (Since 2024, preliminary data point to the decrease slowing down somewhat.)

Deaths among people aged 15-24 dropped 37 percent, with the mortality rate decreasing from 13.5 deaths per 100,000 people to 8.5. Though this was the age group with the fewest deaths in both 2023 and 2024, the 37-percent decrease was the largest change.

The smallest decrease was seen in people over age 65, with the mortality rate per 100,000 people dropping from 14.7 to 13.4. People aged 35-44 remain the most vulnerable to fatal overdose, with the mortality rate dropping from 60.8 in 2023 to 44.2 in 2024.

Deaths involving synthetic opioids other than methadone, the category that includes fentanyl, dropped 35.6 percent.

Deaths also decreased across all racial and ethnic groups represented in the data.

The largest decrease—30.9 percent—was among the census category of Black non-Hispanic people, with a mortality rate per 100,000 dropping from 48.9 in 2023 to 33.8 in 2024. Deaths remain lowest among Asian non-Hispanic people, with the mortality rate falling from 5.1 to 4.4. Death investigation data are frequently inaccurate, and the report notes that misclassification of race and Hispanic origin on death certificates is known to result in an undercount for some groups—notably a 34-percent undercount for American Indian and Alaska Native non-Hispanic people, who still had the highest mortality rates in 2023 (65.0) and 2024 (51.6).

Deaths involving synthetic opioids other than methadone, the category that includes fentanyl, dropped 35.6 percent. The death rate per 100,000 for this category fell from 22.2 in 2023 to 14.3 in 2024. This coincides with an apparent drop in fentanyl purity, though some of the theories surrounding this have been a bit of a reach. While fentanyl was associated with the largest decrease, deaths associated with every type of drug went down from 2023 to 2024. 

The rate of deaths involving heroin decreased by 33.3 percent, from 1.2 to 0.8. The rate for methadone-involved deaths decreased 10 percent, from 1.0 to 0.9. With cocaine, it decreased 26.7 percent, from 8.6 to 6.3 deaths. For deaths involving “psychostimulants with abuse potential,” the category that includes methamphetamine, there was a 19.8-percent rate decrease from 10.6 to 8.5.

Shortly before releasing the new data brief on overdose deaths, the CDC separately released the final overall mortality data for 2024. That report shows that the US death rate has dropped across all demographics and by nearly 4 percent overall, while life expectancy has reached an all-time high. The average person born in 2024 is currently expected to live to age 79.

For the first time since 2020, COVID-19 is no longer in the 10 most common causes of death. The 10th leading cause of death is now suicide, with the rate per 100,000 people decreasing from 14.1 to 13.7.

Image via San Diego Office of Assessor, Recorder and County Clerk

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The United States has so far recorded 69,172 overdose deaths between August 2024 and August 2025, a preliminary figure the CDC predicts will ultimately level off at 72,836 deaths as the last of the data trickles in. The highest 12-month provisional death count was exactly two years earlier, with 111,451 predicted and 112,996 reported deaths in the year before August 2023. 

The death count has now been falling for more than two years, which is unprecedented in the nearly three decades the CDC has been tracking overdose mortality. The rate climbed steadily each year until around 2014, when it began to climb more rapidly as fentanyl supplanted heroin in the street opioid supply. Except for a slight decrease in 2018, overdose deaths had gone up each year until 2023. This latest update puts the death rate about where it was in 2017.

The new data show that the US death count is a staggering 23 percent lower than it was a year earlier. But it’s not as steep a slope as what we saw when the overdose trajectory first turned around.

In May 2025, for example, the CDC announced that its provisional death count for 2024 was 80,391, a decrease of almost 27 percent compared to the 110,037 deaths from its provisional data for 2023.

All these figures are national averages, and overdose has never been geographically uniform. In at least three states overdose deaths appear to be going back up.

Kansas, New Mexico and Arizona have already reported more deaths from between August 2024 and August 2025 compared to the same period a year earlier, and the CDC projects that Hawaii will follow once the rest of the data are added. North Dakota’s rate stated exactly the same, and though in all other states overdose appears to have decreased, a number of them may look very different in the final data than they do in the provisional data.

Massachusetts, for example, reported 1,904 deaths for the 12-month period prior to August 2024, and so far has reported 1,096 for the period before August 2025—a drop of nearly 42.5 percent. But the CDC predicts that the state will ultimately report another 467 deaths for the more recent period, bringing the rate of change down to just under 18 percent.

A handful of theories have been floated as to why the trajectory of overdose deaths suddenly turned around two years ago. The most recent one to get traction argues that the change was likely set in motion by China, as the result of a crackdown on the fentanyl supply chain. Supply interdiction is always popular with any administration, but no matter how loudly the Drug Enforcement Administration or Customs and Border Protection yell about how many pounds of fentanyl they’ve gotten off the streets and how many millions of hypothetical lives they just saved, the drug supply is not finite.

On the rare occasions that supply-chain disruption has produced evidence of fewer deaths or a smaller drug supply, these are invariably short-term results before the situation evolves into something different and worse. The CDC data might align with that.

By the time the CDC gets these numbers they’ve already been subject to a huge amount of distortion at the local level, and are then distorted further by the media. Some things are overcounted, some undercounted. But they do help us understand the overdose crisis in terms of overall trajectory and sense of scale, especially in the context of how much enforcement and criminalization the country has piled on over the years. In 1999, the earliest year for which CDC data are available, the reported death count was 16,849.

Images (cropped) via Centers for Disease Control and Prevention

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The August 8 decision was not a complete surprise. In a June ruling, Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill had indicated the city would not receive nearly as much as it had hoped. He found the city’s lawyers failed to prove their claim that opioid distributors McKesson and Cencora (formerly AmerisourceBergen) were responsible for 97 percent of opioid-related damages the city has experienced. In that ruling, Fletcher-Hill rejected the city’s $5.2 billion request for abatement and said he would allow for a new trial, effectively reversing a 2024 jury verdict that won the city $266 million for “public nuisance” damages.

Under an arrangement between the judge and the city, Baltimore now has until August 22 to decide whether to accept the proposed abatement award in addition to watered-down public nuisance damages, or opt for a new trial completely. If the city takes the deal, it will walk away with a total of about $152 million.

“The Court concluded … that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City.”

“The Court concluded, based on the evidence presented to the jury, that the largest verdict that would not be considered legally excessive would be premised on a conclusion that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City,” Fletcher-Hill wrote in his August 8 ruling.

It is not immediately clear whether the city plans to challenge the abatement ruling. Regardless of the outcome, Baltimore is still guaranteed to receive hundreds of millions of dollars from previous opioid settlements and the ongoing case.

“We have received the court’s abatement ruling and are considering all options at this time,” the office of Mayor Brandon Scott (D) said in a statement. “We remain committed to securing justice for all Baltimore residents disproportionately impacted by the opioid crisis. We will respond in due time in the appropriate judicial forum.”

The city has argued that the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives, at a rate higher than any other major city in the United States.

The projected abatement funds have been the cornerstone of the city’s plans to address the crisis. Officials put together a 15-year, five-point plan to use billions of dollars to bolster Baltimore’s harm reduction and treatment infrastructure—including by opening overdose prevention centers (OPC).

“If the City believes this [OPC] approach is valuable, it is up to City leaders both to resolve the legal issues … and to convince the community that these sites are valuable and appropriate.”

In the August 8 ruling, Fletcher-Hill directly addressed the city’s plans for the facilities, noting the fact that they remain illegal under state law after numerous failed attempts to pass legislation legalizing the sites in the General Assembly in recent years.

“The concept is extremely controversial. Defendants even argue that this feature could not be ordered by the Court because the sites are not legal under Maryland law,” Fletcher-Hill wrote.

“Without making any determination whether this strategy is valuable from a public health perspective, the Court will not require this feature in the abatement plan,” he continued. “If the City believes this approach is valuable, it is up to City leaders both to resolve the legal issues with this type of site and to convince the community that these sites are valuable and appropriate.”

Baltimore already has numerous harm reduction and treatment programs, but expert witnesses who testified at trial said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 residents at any given time have opioid use disorder.

Under the plan, the city could reduce overdoses by 50 percent and triple the number of people in treatment, witnesses said.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis.

The city’s aim to reduce opioid prescriptions by 55 percent is controversial, however—given damaging implications for pain patients, and the relationship between a national crackdown on opioid prescribing and the overdose crisis reaching unprecedented levels. Some advocates argue that opioid lawsuits themselves contribute to a harmful chilling effect on prescribing.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis. This ended more than a year of relative silence on the issue, as the mayor’s administration had argued that public discourse might jeopardize the litigation.

Public hearings were held by Baltimore City Council members, while the mayor’s new Office of Overdose Response held four community listening sessions specifically to garner feedback on its draft strategic plan to address the crisis. That sweeping plan has proved to be less ambitious than the abatement plan presented in court; it aims to reduce fatal overdoses 40 percent by 2040, without explicitly calling for OPC.

At least one Council member has recently reiterated his support of city-sanctioned OPC—the kind of step taken by New York City—when efforts seeking state authorization have repeatedly failed. But the plan makes no mention of the facilities. To date, the mayor has refused to use his powers to unilaterally open the sites.

The plan does, however, state that one of the city’s priorities is to “increase access to a full array of low-barrier harm reduction services (including naloxone distribution, drug checking, syringe service programs, and other evidence-based strategies.” The latter phrase might include OPC.

It’s unclear just how much the judge’s ruling on the case, which dates back to 2018 and has faced numerous delays, will impact the city’s overdose prevention plans—though city officials have conceded it will make things significantly more difficult.

Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

After the $266 million jury verdict in November, based on the “public nuisance” caused by the companies’ practices, the city had expected its overdose prevention war chest to come to nearly $670 million, excluding any abatement dollars. Now, Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

The city asserted in court that the overdose crisis was largely caused by “pill mills” dishing out opioids they received from companies like Cencora and McKesson. But defense attorneys said the city failed to identify faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model estimating OUD prevalence, which underpins the cost estimates for its abatement plan, and suggested the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses responded that funding for existing programs will run out, while the plan focused on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. They dismissed concerns regarding the statistical model and emphasized that the severity of the crisis demands a response of equivalent ambition.

Though Baltimore’s fatal overdose rate remains the highest in the nation, according to city officials, the number of deaths in the city has continued to decline, in line with trends seen nationwide.

Preliminary data recently published by the Maryland Department of Health showed the city recorded 777 deaths in 2024, a fall of nearly 26 percent from 2023. Subsequent monthly data suggest the downward trend has continued, with fewer than 600 deaths in the 12-month period ending in June.

While the trajectory is positive, the crisis continues to have a disproportionate impact on older Black men, and people living in areas such as West Baltimore.

Photograph of Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

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Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill said the city failed to prove that it needed McKesson and Cencora (formerly AmerisourceBergen), to pay $5.2 billion to cover the costs of redressing the damages they allegedly caused.

The city had previously argued that it needed the money because the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives.

“The court is struck by the fact that the City did not present any evidence of any unreasonable conduct by either Defendant after about 2019,” Fletcher-Hill wrote in the ruling. “The City also chose not to ask for an injunctive relief to change the practices of either Defendant in the future. Rather, any abatement remedy will be to deal only with the ongoing effects of Defendants’ conduct in the past.”

While the judge rejected the sum the city requested for abatement, his ruling indicates that the court will still make a decision on the final amount. But first, the city must decide by July 7 if it will accept or contest a massive cut to $266 million it won in a jury verdict in the first phase of the trial.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court.”

Fletcher-Hill wrote that the jury’s decision was predicated on the flawed assertion that 97 percent of opioid-related damages were caused by the two companies. In light of that, he instead proposed that the two defendants pay just under $52 million. McKesson would pay the bulk of that, at $37.4 million.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court,” Fletcher-Hill wrote.

Fletcher-Hill’s much-anticipated ruling came after lawyers for the city and companies wrapped up their arguments in the second phase of the trial in December; he delayed his decision twice in recent months.

In November, in the first phase of the trial, a jury ordered the companies to pay the city more than $266 for the “public nuisance” caused by their practices. That brought the city’s anticipated litigation-funded overdose prevention war chest to nearly $670 million, but the city will now likely have to adjust its plans to operate on roughly $200 million less.

“This decision is disappointing to say the least. We are evaluating the decision and considering all of our options,” Baltimore Mayor Brandon Scott said in a statement. “Even with today’s decision, the settlements we’ve reached through this process far exceed what our city would have gained through the global settlement—making it clear that we made the right decision to continue this fight alone.”

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers.

The city had hoped the $5.2 billion would fund a 15-year, five-point abatement plan, which calls for increased investments in treatment; harm reduction; education; services for special populations such as pregnant women; and monitoring and implementation.

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers, which advocates have said are long overdue.

Baltimore already has numerous harm reduction and treatment programs, but those who testified said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 people at any given time have opioid use disorder.

The city could reduce overdoses by 50 percent and triple the number of people in treatment under the plan, witnesses said.

However, the city’s aim to reduce opioid prescriptions by 55 percent is deeply controversial—part of what some advocates say is a chilling effect that’s exacerbated by opioid lawsuits themselves.

While many people who use fentanyl or heroin began with pharmaceutical opioids, the vast majority of people who are prescribed opioids do not develop opioid use disorder (OUD). Nationally, a crackdown on opioid prescribing has been implicated in driving the overdose crisis to unprecedented levels. It has also been hugely detrimental to pain patients—a phenomenon that has spurred lawsuits elsewhere.

The city predicated much of its legal argument on the assertion that the overdose crisis was largely caused by “pill mills” that dished out millions of opioids they received from companies such as Cencora and McKesson.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Defense attorneys, however, said that the abatement plan failed to identify any faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model that estimated OUD prevalence, which is largely what its cost estimates are based on, and why the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses grew impatient with the defense, persistently arguing that funding for existing programs will run out, and that the plan focuses on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. Those on the stand dismissed concerns regarding the statistical model, and emphasized that the severity of the crisis requires an equally ambitious plan to address it.

With the final outcome of the case yet to be determined, it’s unclear to what extent the June 12 decision will impact the city’s overdose prevention initiatives. But funding for those initiatives looks certain to be far less than the city had hoped.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Data recently published by the Maryland Department of Health showed the city recorded 775 deaths in 2024, a decrease of nearly 26 percent from the year prior. Subsequent monthly data seem to indicate that the downward trend has continued.

The last time Baltimore saw fewer than 800 overdose deaths was in 2017. Though the numbers are preliminary and subject to change, the decline has prompted both newfound optimism and a recognition that more work must be done—above all in marginalized populations where the crisis remains at a devastating level.

Photograph of the Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

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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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Formerly known as the Rx Drug Abuse and Heroin Summit, this year it was located in Nashville. HMP Global, the health care marketing company that created the summit, advertises it as the premiere conference for stakeholders in the overdose crisis—where attendees can “learn about what is working in prevention, treatment and law enforcement.” Some of this year’s speakers are academics and public health researchers who focus their work on harm reduction, but it’s fair to say that’s not where the summit’s priorities lie.

Government agencies and for-profit partners have never exactly been at the forefront of harm reduction, and it’s clear what demographics the summit caters to; the registration fee is over $1,000. It’s always skewed to the right, and it’s not necessarily surprising that HMP Global is now platforming a man who famously wants to build hundreds of “healing farms” into which people facing drug charges can be sent indefinitely to “learn the discipline of hard work,” and who wants us to believe this is an alternative to incarceration. But when RFK Jr. is the overdose-crisis expert addressing an audience filled with many of the nation’s major players in drug policy, that’s still a good indication of a five-alarm fire.

I joined the Rx and Illicit Drug Summit to speak about the opioid crisis plaguing our nation. We are fortunate to have an administration that is tackling this issue head on, and I will continue to work on legislation that will Make America Safe Again. pic.twitter.com/zqucqYnoAY

— Sen. Marsha Blackburn (@MarshaBlackburn) April 23, 2025

Other speakers included United States Attorney General Pam Bondi (R) and Tennessee Senator Marsha Blackburn (R). Several people who attended Blackburn’s panel told Filter that her thoughts on overdose prevention were mostly about the importance of border security, including that “all options are on the table” when it comes to President Donald Trump’s use of the Alien Enemies Act.

Attendees of Bondi’s session told Filter that she appeared to confuse stimulants with benzodiazepines, describing students “using Xanax to study.” And that she repeatedly claimed the majority of the illicit fentanyl in the US is brought in by migrants crossing the southern border. Yet there was still clapping and whooping coming from the audience.

The harm of this type of rhetoric isn’t that it’s partisan, but that it’s rife with misinformation, whether intentionally or out of ignorance. While the summit has had this problem in previous years, this year it’s a frighteningly dystopian indication of what the future may hold as the Substance Abuse and Mental Health Services Administration and other relevant federal agencies are dismantled. Surprise speakers announced at the last minute have not been the norm at past summits. And other than National Institute on Drug Abuse Director Nora Volkow and National Institutes of Health Director Jay Bhattacharya, all of the “featured” speakers highlighted by organizers were elected officials.

RFK Jr., who’s widely known to be in recovery from problematic heroin use in the 1980s and reportedly attends nine AA meetings per week, has spoken publicly about being influenced by the work of psychiatrist and philosopher Carl Jung. Jung wrote of man’s “spiritual thirst of our being for wholeness,” and how drugs and alcohol distract from this quest. Like the Protestant work ethic that teaches us how godliness and salvation are found through hard work and suffering, it all conveniently dovetails with the capitalist need to maintain the supply of human labor.

It’s difficult to guess the likelihood that the new industry he describes will actually be created. Building hundreds of “healing farms” would be expensive, but this has not stopped the US from letting private contractors continuously build new prisons to keep up with the incarcerated labor force. Especially as the Trump administration takes extraordinary measures to remove many of the most underpaid and exploited workers, there’s always a need for more warm bodies.

Image of RFK Jr. via Washington State House Democrats

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From Victory Square everyone marched westward for a teach-in at Canada Place, which houses the Vancouver offices for senior elected officials in government. The rally was organized by VANDU, the Surrey Union of Drug Users (SUDU) and the Coalition of Peers Dismantling the Drug War.

Among those who addressed the crowd was SUDU Board Member Dave Webb. He joined the union because people kept saying that it will take time to address the crisis.

“I don’t want it to ‘take time.’ There’s too many people gone already,” Webb told Filter. “If my friends were addicted to romaine lettuce, chances are they wouldn’t be dead. Because as soon as there’s a tainted batch of romaine … what does the government do? They go around, they gather up all of that, and they get rid of it.”

But even with a product this badly in need of regulation, Webb and everyone else are still waiting for the province to adequately respond. 

“The government is not really trying,” he said. “It’s probably better for them that we’re gone, because then there’s not a blight on the side of the road.”

Between 2016 and 2024, BC recorded 16,350 overdose deaths. Speakers at the rally noted that overdose began noticeably rising in 2014, which was also when law enforcement began reporting fentanyl in the unregulated supply.

That year the province recorded 370 overdose deaths. That increased to 529 in 2015, and 997 in 2016. Since 2016, more than 49,000 people across Canada have died of opioid-involved overdose.

In 2024, the death count began to decrease. However, the disparity between deaths among Indigenous people and deaths among other people in the province was the highest it’s ever been. First Nations people were 6.7 times more likely to die of overdose in 2024; for First Nations women, the rate was 11.6 times higher. First Nations people comprise about 3.4 percent of the population in BC, yet comprised 19 percent of overdose deaths in 2024.

Over the past nine years, the provincial government has scaled up certain harm reduction measures that people who use drugs have been calling for, after ignoring those calls for years or decades.

In addition to trialling a limited decriminalization pilot, BC has increased access to naloxone, overdose prevention sites and a safer supply of regulated drugs, though none of them to the level that’s actually needed.

And more recently, much of the province’s harm reduction policies have been reversed or scaled back, or otherwise targeted by right-wing backlash. 

Multiple programs that increased distribution of harm reduction supplies, including by mail and through vending machines, were canceled in 2024.

The decrim pilot was effectively shuttered halfway through the three-year trial period, despite the fact that its personal-possession threshold was too low to functionally decriminalize to begin with. 

The Drug User Liberation Front, which operated an unsanctioned compassion club providing a safe supply of tested heroin, methamphetamine and cocaine to its 43 members, was defunded and raided by police.

Involuntary treatment gained ground, despite no evidence of any benefits and clear evidence of its harms. And the province ended take-home safe supply. 

“They’re wasting lives, they’re wasting time, and they’re wasting money,” Webb said. “All it is is just fear-mongering and trying to get elected.”

Photographs via Dustin Godfrey

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It represents an unprecedented 23.7 decrease from the 113,919 deaths in the provisional data from in the previous 12-month period. It’s on track to be the lowest death count since July 2020, when the final tally for the previous 12 months was 85,236.

Whatever it is will still be historically high, and represent lives lost rather than lives saved, even though various media may characterize it as the latter. A death count of 80,000-plus is a crisis; death counts of 100,000-plus are not the norm.

The national average reflects uneven progress at the state level. In some jurisdictions, overdose deaths continue to increase. Overdose is still the leading cause of accidental deaths in the US, killing nearly as many people each year as the second and third causes combined (falls and car accidents, respectively).

Compared to the predicted (not final) data from the 12-month period leading up to September 2023, the state with by far the greatest decrease was in North Carolina, where deaths dropped by over 50 percent—from 4,307 people to 2,142. Alaska showed an increase of 16.92 percent. Other states where the overdose rate appears to still be going up are South Dakota (+3.66 percent); Montana (+3.91 percent); Utah (+4.99 percent); and Nevada (+11.3 percent).

Nationally, provisional death counts tend to be about 3,000 higher than the final tally.

Because percentages are not numbers, it’s easier to give the impression of a dramatic change in states that record very few overdose deaths. In South Dakota, the state with the lowest numbers, a 3.91 percent increase in the 12 months leading up to September 2024 reflects a change from 82 deaths to 85.

California predicted the highest number of deaths at 10,286, a 20.4-percent decrease compared to the 12,918 deaths predicted from the same time period the year before. Population size is obviously the biggest factor, but it’s also important to keep in mind that all of this data originate at the local level, which in most states means they’re submitted from individual counties that don’t share any kind of standardized system. So some figures inevitably reflect data collection that’s less thorough in some jurisdictions than others, and not just a low number of overdose deaths.

The data didn’t include demographic breakdowns, but did include additional details about classes of drugs associated with the deaths. The decrease corresponds primarily to fentanyl-involved deaths.

Nationally, the CDC’s provisional death counts tend to be about 3,000 higher than the final tally that comes a few months later. As of February 25, the number of deaths that have actually been reported for October 2023 to September 2024 was 84,334.

The first reports of a national decrease in overdose deaths appeared in September 2024, when the CDC published data for the 12-month period ending in April 2024. In the remaining months of the Biden administration, the Office of National Drug Control Policy repeatedly took credit for the turnaround (President Donald Trump, still campaigning at the time, promptly claimed that overdose had gone up 18 percent thanks to opponent Kamala Harris).

Trump has not yet commented publicly on the new data. Nor has the ONDCP, as its website was archived when he took office.

Image via Centers for Disease Control and Prevention

The post CDC: Overdose Deaths Now Down 24 Percent, Back to Pre-Pandemic Crisis appeared first on Filter.

As ordered by President Donald Trump, the National Institutes of Health (NIH) is aiming to reduce spending by capping the “indirect costs” covered for any research it funds at just 15 percent of the total funding for a given project. It’s part of a larger campaign by Musk and DOGE to gut federal public health agencies; already, 5,200 probationary employees of the department of Health and Human Services (HHS), the parent department of NIH, have been fired.

Indirect costs, or overheads, make up a large portion of the funding the NIH provides to universities conducting medical research. Harvard, for example, received $135 million to cover indirect research costs in 2024, according to NPR—69 percent of the total funding the university received from NIH. These taxpayer dollars help pay for items including building and lab maintenance, equipment and supplies, and administrative staff salaries.

On February 21, Judge Kelley extended the restraining order as she weighs a final decision.

The cuts are on hold, for the moment. After the administration’s policy was announced on February 7, 22 states, including California, New York and Illinois, sued the NIH and HHS to prevent the order from taking effect.

On February 10, a federal judge in Massachusetts, Angel Kelley, issued a temporary restraining order for federal agencies to take no action to implement the plan. On February 21, Judge Kelley extended the restraining order as she weighs a final decision. She considered issuing a preliminary injunction, and said she would work “as quickly as I can.”

Another two active lawsuits against the NIH to stop the cuts advancing involve challenges from the Association of American Medical Colleges and from the Association of American Universities.

The administration’s current plan is actually a rehash of something Trump tried during in his first time in office. His first proposed budget for fiscal year 2018 involved a 22 percent cut to NIH funding and targeted indirect costs even more aggressively, limiting them to 10 percent. A former NIH director warned then that this would “disembowel” key medical research nationwide.

The Republican-controlled Congress at the time rejected Trump’s plan, passing legislation on a bipartisan basis to prevent indirect-cost reimbursements to research institutions being capped.

Research on drugs and drug use is an important tool in the nation’s efforts to address the worst overdose crisis in its history. And the NIH, through programs like the “Helping to End Addiction Longterm Initiative” (HEAL), has played a major role. In fiscal year 2019—during Trump’s first term—the NIH HEAL program awarded $945 million in “grants, contracts, and cooperative agreements” to researchers in 41 states, whose work focused on areas like improving treatments for chronic pain, curbing rates of opioid use disorder and achieving long-term recovery.

Under President Biden, the National Institute on Drug Abuse (NIDA, part of the NIH) established a research network to test community-based harm reduction strategies. Launched in 2022, this five-year, $36 million initiative involved nine research centers and a coordinating center. Its projects included looking at how to expand harm reduction through mobile vans, digital services and peer outreach workers.

For Dr. Pho’s harm reduction research, about 50 percent of the NIH funding covers indirect costs.

Dr. Mai Tuyet Pho is an infectious disease researcher at the University of Chicago, currently working on an investigation that’s fully funded by the NIH. Pho works with three harm reduction providers in Illinois, covering 35 predominantly rural counties with less access to harm reduction services and supplies.

She is studying how participants in services like syringe service programs can help get supplies out in their communities—by receiving extra syringes, naloxone or other tools, which they can then share with their friends and families. Pho is also investigating how to innovate in rural harm reduction through vending machines, locker drop-offs and mail order services.

For Pho’s research, about 50 percent of the NIH funding covers “direct” costs—paying participants and research assistants, procuring certain supplies, conducting testing for diseases like HIV and hepatitis C, and working with community partners. The other 50 percent of her funding covers indirect costs.

“The indirect costs, those are the infrastructural costs required to do any of this research,” Pho told Filter. “To keep the lights on at the university in terms of budget administration—getting the funds from NIH and disbursing them. A really important piece is participant and study safety, that includes supporting the institutional review board that reviews all the work we do. Every single survey, instrument, protocol, has to go through intensive review before we would ever expose anyone to that.”

“It’s something that’s so hard to imagine happening, but it’s very real. We would probably have to shut down the study.”

If Trump’s plan goes forward, it would therefore threaten Pho’s harm reduction investigation.

“It would slow everything down, certainly,” she said. “I’m not sure how long we could go. The infrastructure indirect costs support are essential to our day-to-day. If we don’t have a functioning review board, we can’t do our research. If we don’t have the data collection platform, we can’t collect any data … It’s just as essential as the direct costs. It’s something that’s so hard to imagine happening, but it’s very real. We would probably have to shut down the study.”

Pho praised the NIH as an effective partner, and said there is no other institution providing as much funding to harm reduction research. In the event of NIH funding being pulled, she said she wouldn’t want to have to compete with direct harm reduction providers for any independent funding sources.

There’s a climate of fear among many researchers as they wait to see whether their work will be impacted by cuts. While some have spoken out to media about the threat, others reached by Filter didn’t want to speak on the record, worried about the implications of drawing attention to their projects.

The extent to which Trump and Musk may succeed in gutting federal research funding remains to be seen, with lawsuits yet to be resolved. But if the cuts are blocked in the courts, Trump may well find Congress more compliant than he did in his first term.

Photograph via Picryl/Public Domain

The post “It’s Very Real”—Harm Reduction Research Facing DOGE Funding Cuts appeared first on Filter.

With those past hardships, I could at least somewhat grasp the personal, socioeconomic and legal factors that imposed them, despite the injustices.

On October 8, humiliated and distraught at the corner of 17th and G Street, I couldn’t even begin to process what had just happened.

The invite had come a week prior. It congratulated me for the hard work and dedication of the overdose-prevention nonprofit I founded: This Must Be the Place. In under three years, with almost no funding, we have distributed over 80,000 free naloxone kits across the country, resulting in over 1,500 known opioid-overdose reversals.

The CDC had just issued new statistics showing overdose death rates were falling overall. So the Biden administration and the White House Office of National Drug Control Policy (ONDCP) decided that recognition was in order for some of those engaged in overdose prevention. I was one of a select few accorded the honor of attending the White House event. Or so the invitation read.

I told some of my friends who I did time with, and they said it meant a lot to them. In a way, my invitation was theirs as well.

I should have said no. This simple kid from Columbus, Ohio, had no business in Washington. But I called the only person who has never left my side, and whose opinion I value most in this world.

“There are some people who live their entire lives without ever seeing the White House, and even fewer are invited inside,” my mother told me. “Do it for me, do it for yourself, do it so that you do not live the rest of your life wishing you had gone.”

Ok, Mom says so. The invitation, by the way, required an immediate RSVP. So I committed. I told some of my friends who I did time with, and they said it meant a lot to them. In a way, my invitation was theirs as well.

I bought a plane ticket, last minute. I booked a hotel in DC, last minute. And I bought a suit, because I wanted to show respect, even though I had never worn one before in my life.

The money is not really an important part of this story. I come from none, so I know how to exist with none. What matters is, the respect I tried to show was met with contempt.

I flew to Washington and arrived in good time for the event. It was only then, 45 minutes before the event was due to begin, that I was informed that I would not be admitted to the White House that day.

I had not cleared the Secret Service background check, the officials said. They would give me no other information.

“You represent the very best of our Nation,” it said. But I am not allowed in your house.

I was left outside the gates. Still, they hadn’t completely forgotten me, because after a bit of a wait, I was hand-delivered a letter signed by Joseph R. Biden himself.

“To all those who stepped up to the White House Challenge to Save Lives From Overdose: Thank you,” it read. “You represent the very best of our Nation, and it is because of leaders like you that I’ve never been more optimistic about the future of our country.”

But I am not allowed in your house. 

I went to a cafe on K Street and cried. I called my mom. She cried with me. I am, and always will be, a convicted felon. I believe in forgiveness, but I am not sure that others do, no matter what their words say. Actions speak louder.

I went to prison for nonviolent crimes that centered around my addiction issues. During the time I was away, I lost nearly every friend I had, as fentanyl-involved overdose devastated communities. I can never undo my misdeeds, but through This Must Be the Place I strive to make every day my living amends to society.

For about a week, I believed that the White House recognized this.

If we continue to be locked out and branded less-than, then our overdose crisis will have no end.

Why would they invite me? Why would they put out a press release that very day, specifically highlighting my organization’s great work, only to turn me away at the door?

You knew who I was when you asked me to come.

I will not quit fighting to end overdose in this country. I do it for the people, not for the recognition—and definitely not for recognition from the government.

I am well aware that finding myself shut out of the White House is a minor blip in the grand scheme. But it serves as a metaphor for greater problems that must be addressed. Because there are millions of people like me: doing drugs, doing time or trying to move past either. Our voices must be heard. If we continue to be locked out and branded less-than, like I was on that day, then our overdose crisis— and all of the systemic problems that created, perpetuated and stem from it—will have no end.

Top photograph (cropped) by Pom’ via Flickr/Creative Commons 2.0. Inset photograph by William Perry.

The post A White House Invite for OD Prevention… Then They Shut Me Out  appeared first on Filter.