What’s Behind the Decline in U.S. Drug Overdose Deaths?

For the first time in years, there’s good news about the U.S. drug overdose crisis - the federal data shows that drug-related deaths have been declining steadily for seven consecutive months. While awareness campaigns and improved access to treatment programs are credited for this progress, experts believe changes in the illicit drug market may also be playing a critical role.

Anne Milgram from the Drug Enforcement Administration (DEA) revealed that since 2021, fentanyl, which is an opioid up to 100 times more potent than morphine, has been showing reduced potency. She attributes this to government efforts to disrupt Mexican cartels and international drug supply chains. Just last year, DEA testing found that half of counterfeit pills contained life-threatening levels of fentanyl. Now, that number has dropped to 50 per cent.

Additionally, life-saving drugs like Narcan (a drug overdose reversal medication) are more widely available now, and medications that reduce opioid cravings are gaining traction. Public awareness campaigns warning about fentanyl-laced counterfeit pills have also made an impact.

Harm reduction efforts, such as syringe exchange programs and fentanyl test strips, are proving effective in saving lives. Meanwhile, stricter enforcement targeting the chemicals used to manufacture fentanyl has made its production more costly and less common.

Outreach workers are noticing shifts in drug use patterns. Fentanyl is increasingly being diluted or mixed with other substances, like xylazine—a veterinary tranquilizer that can cause severe skin ulcers but may also reduce the risk of overdose in certain cases. Unlike fentanyl, which can lead to repeated use throughout the day, xylazine’s sedative effects can make people less likely to consume more fentanyl immediately.

The spread of stimulants like methamphetamine and cocaine is another factor. While these drugs carry their own risks, they are generally less deadly than fentanyl. Some opioid users report that methamphetamine helps them avoid fentanyl by satisfying cravings or providing distraction. This shift could be contributing to the decline in fentanyl-related deaths.

According to the CDC, overdose deaths dropped to 97,000 in the 12 months ending in June, a 14.5 per cent decrease compared to the previous year. Nonfatal overdoses are also decreasing in many states. However, the progress is uneven. Fatal overdoses among Black Americans increased between 2022 and 2023, while they declined among white Americans. Geographically, Eastern and Midwestern states have seen the sharpest declines, possibly due to their earlier experience with fentanyl. In contrast, overdose deaths continue to rise in several Western states where fentanyl is a newer threat.

While the recent decline is promising, the overdose crisis is far from over. Thousands of lives are still being lost, and the battle against drug-related deaths requires ongoing vigilance and adaptation.