US drug overdose deaths saw an unprecedented drop in 2024, but federal cuts could threaten momentum

Drug overdose deaths in the United States made an unprecedented drop to the lowest they’ve been in five years, according to a new federal government estimate released Wednesday. During the Covid-19 pandemic, drug overdose deaths had surged to record levels. The new data shows that declines that started in the second half of 2023 continued through 2024. There were an estimated 80,391 overdose deaths in 2024, according to provisional data from the US Centers for Disease Control and Prevention – a 27% drop in one year, with about 30,000 fewer deaths than in 2023. Synthetic opioids – primarily fentanyl – continue to be involved in most overdose deaths, the data shows. But those deaths dropped at an even steeper rate, down about 37% between 2023 and 2024. Overall, more than 48,400 overdose deaths – about 60% of all overdose deaths in 2024 – involved synthetic opioids, the new CDC data shows. There were about 29,500 deaths involving psychostimulants such as methamphetamine, about 21% less than in 2023, and deaths involving cocaine fell 28%, down to 22,200 deaths in 2024. Experts say that it’s difficult to pinpoint exactly what is driving the promising trend, but it’s likely the result of a wide range of persistent efforts starting to make an impact – and those efforts must continue to avoid rolling back on the progress that’s been made. “We’re still at very high levels of overdose,” said Dr. Daniel Ciccarone, a professor at the University of California, San Francisco whose research has focused on illicit drug trends in the US. “We need steady pressure. To the degree that we stop paying attention or take our foot off the gas pedal, we will see a reversal.” The size of the population at risk of a drug overdose in the US is likely much bigger than we realize, Ciccarone said. But the number of people leaving the risk pool – either because of a fatal overdose or because they found treatment that works for them – may be higher than the number of new drug users who are joining the risk pool. “On the one hand, it may be that the epidemic is burning itself out or that there is some regression to the mean after the spike in overdose deaths during the Covid-19 pandemic,” he wrote in an editorial published in the New England Journal of Medicine last year. “More optimistically, we may be starting to apply enough funding and effort into scaling evidence-based responses to the size of the problem.” Population shifts would be relatively gradual changes, Ciccarone said, but the sharp downturn suggests that there must have been some shock to the system. It could be that the fentanyl supply was disrupted in late 2023, he said, but the evidence to support that is less than convincing. Nabarun Dasgupta and Adams Sibley, researchers at the University of North Carolina who are part of the Opioid Data Lab, disagree with the theory that a sudden shock to the drug supply could have been a driving factor in the drop in overdose deaths. Instead, they’ve tracked gradual declines, with cities and states seeing the shift start at different times over the past three years that finally started to culminate into a shift seen at the national level about a year and a half ago. In addition to shifts in the population of drug users, they identify two other key factors driving overdoses down: characteristics of the drugs themselves, including cost and effects, and behaviors, both of drug users and communities surrounding them. “The general dissatisfaction with the illicit opioid supply right now is surprisingly high,” Dasgupta said, referencing xylazine in particular, an animal sedative commonly known as “tranq” that can cause severe skin wounds. “This is not what people signed up for. It’s way more sedating. It’s way more unpredictable. It’s not as pleasurable.” Many drug users are now reaching an “inflection point” in their drug use because of the supply, Sibley said, and opioid settlement dollars and federal funding have helped support a range of harm reduction efforts that are ready to assist them. “The one thing that substance use treatment providers and people who use drugs alike will tell you is that people are ready when they’re ready, and there are a lot of people ready right now,” he said. “We want to argue that now is the time to double down on efforts to educate and recruit folks into harm reduction and treatment, whatever their version of safer use looks like.” While much of the work to address the drug overdose epidemic happens at the local level, support from the federal government is critical to success, experts say. Mixed messaging from the Trump administration raises concerns about the potential for the promising downward trend in overdose deaths to continue. In March, the US Department of Health and Human Services renewed a public health emergency on the opioid crisis, a formal declaration that was originally issued in 2017 under the first Trump administration. It allows for expanded authorities to dedicate resources and enact regulatory flexibilities to address the overdose epidemic. And last month, the Trump administration laid out their drug policy priorities for 2025, which include a mix of prevention, treatment and law enforcement objectives. But uncertainty around the federal budget and significant reductions in staff at federal health agencies threaten the viability of some of these goals. The first strategy listed under the first objective in the document from the president’s Office of National Drug Control Policy reads: “To combat the drug crisis and the opioid epidemic, largely driven by fentanyl, the Administration will expand access to overdose prevention education and life-saving opioid overdose reversal medications like naloxone.” Charlotte’s Mecklenburg County has naloxone vending machines, an epidemiologist focused on opioid trends, a robust data dashboard that has helped public health workers identify target response areas and develop an infrastructure to do so – all funded by the Overdose Data to Action grant that comes through the CDC’s National Center for Injury Prevention and Control. But the CDC center was heavily targeted by federal job cuts earlier this year and is among those the Trump administration says should be cut to eliminate “duplicative, DEI, or simply unnecessary programs,” according to the proposed budget for fiscal year 2026. “Any changes or impacts to those funding streams would mean that we either have to find other funding to support the team that works in that department, or we would have to lay them off. That would, of course, impact the work,” said Dr. Raynard Washington, director of the county health department. “Experts (at the Injury Center) work hand-in-hand with us on the strategies that we choose to implement on the ground, and then how we’re evaluating what’s working, and then how we share those best practices. That technical assistance is also just as invaluable as the actual grant dollars that we receive.” The federal budget proposal also includes a recommendation to slash funding for the Substance Abuse and Mental Health Services Administration, or SAMHSA. “This Administration is committed to combatting the scourge of deadly drugs that have ravaged American communities. Unfortunately, under the previous administration, SAMHSA grants were used to fund dangerous activities billed as ‘harm reduction,’ which included funding ‘safe smoking kits and supplies’ and ‘syringes’ for drug users,” the budget document says. On Monday, hundreds of researchers and health care providers sent a letter to Congress warning about the “dire consequences of dismantling lifesaving work” through budget cuts that would affect substance use and mental health programs. The proposed cuts would “certainly undermine the hard-fought progress we have made, especially in overdose prevention.” Protecting access to naloxone and substance abuse treatment through Medicaid are among the top priorities among those in the field. “The supply side of the equation has not worked. Even if we say a fentanyl supply shock caused this decline in overdose deaths, we can’t count on creating it again,” Ciccarone said. “Harm reduction keeps people engaged, and if we don’t keep this cohort engaged, they will do worse.”