Drug Overdoses Are On the Decline, in Charts

Drug Overdoses Are On the Decline, in Charts

Fatalities from drugs including fentanyl are down from recent peaks

By Julie Wernau and Brianna Abbott | Graphics by

Josh Ulick, WSJ

March 20, 2025 12:01 am ET

The U.S. is making progress against one of its most devastating public health threats: drug overdoses.

Over the 12 months ending in October 2024, the country saw a 25% decline in overdose deaths compared with the same period the year prior, according to the latest preliminary estimates from the Centers for Disease Control and Prevention. About 82,000 overdose deaths were reported.

The leading factor? A falling number of fatalities involving synthetic opioids, a drug class in which bootleg fentanyl is the big killer.

Those numbers are still significantly higher than they were a decade ago, reflecting just how deadly the drug crisis has become in the fentanyl era. Unintentional drug overdose death rates tripled from 2003 to 2019, according to data published Thursday by the CDC, surpassing the death rate from motor-vehicle traffic and becoming the leading cause of unintentional injury deaths.

The drug overdose death rate jumped another 58% from 2019 to 2022, as the Covid-19 pandemic exacerbated an already out-of-control crisis. Then, the rate declined 4% from 2022 to 2023. The early 2024 data shows a continued drop.

Part of the shift could be a return to pre-Covid rates as the world has normalized. But researchers don’t fully know why it is happening and suspect changes in policies and drug use are also at play.

The decline is at least in part due to a drop in opioid use. A 2022 report found that opioid-use disorder increased from 2010 to 2014, then stabilized and slightly declined each year thereafter.

Throughout individual states, the story is different. Trends are partly tied to when fentanyl was introduced. As fentanyl has entered the drug supply and moved west across the country, the places that have been dealing with fentanyl longer acclimatize to having it in their supply, said Brandon Marshall, professor of epidemiology at the Brown University School of Public Health.

That shift occurs in part because the most vulnerable people have died and others have adapted. Many fentanyl users are now smoking the drug instead of injecting it, and some research shows that smoking fentanyl could come with lower risk of overdose, infections and other complications.

Some states and communities are likely being helped by policy changes, such as the relaxed federal prescribing requirements for the opioid treatment buprenorphine, and prevention efforts. Places including Rhode Island have greatly boosted distribution of the overdose-reversing drug naloxone, for example.

The amount of fentanyl seized by federal officials—which can be a marker of drug supply size—has seen some change in the past few years, increasing in 2023 and then declining slightly in 2024, data from the U.S. Customs and Border Protection show.

The combination of substances that people are using has also shifted.

Total fentanyl

Fentanyl with stimulants

The rise of xylazine, an animal tranquilizer known as “tranq,” in the drug supply might be a factor. The drug seems to protect against overdose, some researchers said, though it creates horrific wounds.

More people are also taking fentanyl with stimulants such as methamphetamine or cocaine. The mix is deadly and presents its own set of problems, including heart damage and worse treatment options.

Write to Julie Wernau at julie.wernau@wsj.com, Brianna Abbott at brianna.abbott@wsj.com and Josh Ulick at josh.ulick@wsj.com