U.S. Overdose Deaths Are Declining, Just Not for Everyone

This article explains that drug overdose deaths in the United States began to fall steadily around August 2023 after many years of increases, especially during the fentanyl era. This is encouraging news, but the decline has not happened evenly across the country, across all drug types, or across all groups of people.

In the study, published in JAMA Network Open, researchers examined 800,645 drug overdose deaths between January 2015 and October 2024 using data from the National Center for Health Statistics, CDC WONDER, the National Vital Statistics System, and the U.S. Census Bureau. The analysis included overdoses involving opioids, cocaine, and stimulants such as methamphetamine.

Main Takeaway:

The national overdose death rate increased from 14.54 deaths per 100,000 people in January 2015 to a peak of 33.24 per 100,000 in August 2023. It then declined for 15 consecutive months, reaching 24.29 deaths per 100,000 people in October 2024—a decrease of approximately 27%.

Overall overdose deaths are going down, but some communities are still seeing deaths rise or decline more slowly. The study shows that national improvements can hide important differences by region, substance, age, and race or ethnicity.

Differences by Region:

The timing of the decline varied across the country. Overdose death rates peaked earlier in the Northeast, Midwest, and South, around October 2022. In the West, rates peaked about a year later. This means some regions began improving sooner, while the West experienced a later and more prolonged rise before deaths started to slow.

These differences may partly reflect how fentanyl and other changes in the illicit drug supply spread across the country. Fentanyl became widespread earlier in the Northeast, Midwest, and South than in many western states.

Differences by Substance:

Deaths involving opioids, including fentanyl, declined faster than deaths involving stimulants such as cocaine and methamphetamine. This suggests that progress may be stronger for opioid-related overdoses than for stimulant-related overdoses, and prevention efforts may need to address different drug trends separately.

Differences by Demographics:

Even as overdose deaths declined nationally, deaths continued to increase among adults aged 55 years or older and among several racial and ethnic groups, including American Indian or Alaska Native, Black or African American, Hispanic or Latino, and multiracial people. Although the rate of increase was slowing for these groups, the findings show that they were not benefiting equally from the national decline.

Why This Matters:

The decline in overdose deaths may reflect changes in the illegal drug supply, expanded treatment access, harm reduction efforts, and other public health actions. However, because the decline is uneven, the article emphasizes the need for targeted strategies that reach the regions and communities still experiencing high or rising overdose death rates.

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The Article

Post, L. A., Ciccarone, D., Unick, G. J., D'Onofrio, G., Kwon, S., Lundberg, A. L., Sharma, S., & Mason, M. (2025). Decline in US Drug Overdose Deaths by Region, Substance, and Demographics. JAMA network open, 8(6), e2514997. https://doi.org/10.1001/jamanetworkopen.2025.14997