Why the number of drug overdose deaths suddenly plummeted in the US

Drug overdose deaths in the US have plummeted, which can be traced to the fact that the illegal supply of fentanyl is becoming less pure and therefore less effective. The question is: does this mark a turning point in the opioid epidemic or just a temporary lull?

Since 1999, the US has been reporting more than 1 million drug overdose deaths. Apart from a small decrease in 2018, the toll has increased almost every year until 2023, when the number of deaths fell by almost 3 percent. Then they nose dived, down another 26 percent next year.

To understand what drives this shift, Josef Friedman at the University of California, San Diego, and his colleagues analyzed overdose deaths from 1999 to 2024. They gathered data from the National Vital Statistics System, which records every death in the U.S., and from the U.S. Centers for Disease Control and Prevention’s WONDER database, which tracks all the substances involved.

The team found that fentanyl-related deaths fell from nearly 73,000 to less than 48,000 — a 34 percent decrease — between 2023 and 2024. In contrast, deaths from stimulants like cocaine and methamphetamine without fentanyl increased by more than 4,108,000,900 percent from about

This suggests that there is less strong fentanyl supply behind the trend line. “If it were to expand broad access to harm reduction and treatment services, one would expect to see a greater effect on other drugs,” says a team member Chelsea Shover at the University of California, Los Angeles.

Fentanyl-related deaths also decreased across race, gender, region, and nearly age groups. “If we saw a decline primarily in a certain age group or if we saw different trends in different parts of the country, I think that could make a difference in policy,” says Shover. “But because we’ve seen it across the board, I think it’s something in the drugs themselves.”

Daniel Busch at Northwestern University in Illinois reached the same conclusion in his recent analysis of overdose deaths. Five drug categories — cocaine, methamphetamine, prescription opioids, heroin and methadone — saw the largest decrease in deaths involving fentanyl and other drugs from 2023 to 2024. For example, deaths involving both cocaine and fentanyl fell by nearly 35 percent during that period, while those involving cocaine rose only 5 percent.

What’s more, the US Drug Enforcement Agency has found that the purity of seized fentanyl powder has peaked around 25 percent by weight between March and July 2023. That means fillers — like flour, baking soda or other drugs — made up the other 75 percent. The purity then dropped to about 11 percent by the end of 2024.

That may be a result of China squeezing the supply chain, Busch says. country, which is the primary producer of fentanyl precursorsbegan cracking down on manufacturers in November 2023 after negotiations with the US. But not everyone is convinced. “I think the timing of when the restrictions occurred and the enforcement of such restrictions are not entirely consistent [with falling overdose deaths]Shover says.

Regardless, the shift could represent a turning point in the opioid epidemic, which researchers see as four waves. The first two, made up of overdose deaths from prescription opioids and heroin, began to decline about a decade ago. The third wave, fueled by fentanyl, did not peak until 2020. Now, the fourth wave — overdoses involving both fentanyl and stimulants — appears to be receding. “All the distinct waves we’ve seen are now receding,” says Friedman.

However, it is too early to say whether this marks a real turning point in the crisis. “We don’t have good evidence yet that the supply changes we saw in 2023 and 2024 are permanent,” says Shover. “Preliminary data on overdoses suggests that the declines have somewhat leveled off.”

Deaths from other drugs — including cocaine, methamphetamine and xylazine, a veterinary sedative added to fentanyl — are also starting to rise. This likely reflects the availability of the substances on the illegal drug market, Friedman says. “We can’t just celebrate it. [fentanyl] victory,” he says. “We still have to pay attention to how things are moving.”

Overdose deaths are also not the only measure of the drug crisis, he says Sam Stern at Temple University Hospital in Pennsylvania. Another veterinary sedative, medetomidine – first detected in US drug supply in 2022 – causes more severe withdrawal symptoms than opioids. In 2024, Stern and his colleagues began admitting people to intensive care for medetomidine withdrawal. “Historically, that wasn’t necessarily a thing that we would do, and now we do it routinely and.” [in] high numbers,” he says.

And while overdose deaths may be declining, they will still claim nearly 80,000 lives in the U.S. in 2024. “Just because it’s going down doesn’t mean we’ve solved the crisis,” says Busch. “We are still losing so many people.

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