Why overdose deaths are falling in the US

After spiking to record highs during the pandemic, the number of drug overdose deaths in the US has recently declined.

Between 2023 and 2024, the CDC reported that the age-adjusted overdose death rate dropped by 26.2%.

Evan Gumas, a senior research associate at the nonprofit health policy research firm Commonwealth Fund, wrote in an analysis published Sept. 3 there “is no single explanation” for the decline in overdose deaths. However, five factors have contributed to the trend:

1. Widespread availability of naloxone

The FDA in March 2023 approved Narcan, the brand name for Emergent BioSolutions’s naloxone, an opioid overdose reversal drug, for over-the-counter use.

States have also created a number of programs to increase access to the medicine. Some, including Ohio and Maryland, have installed naloxone vending machines in places like health department offices and highway rest stops.

New York created a website where people can request free naloxone kits and test strips. Since 2022, 600,000 kits have been given out, according to the New York State Office of Addiction Services and Supports website.

2. Increased access to harm reduction supplies

Test strips can detect the presence of fentanyl and xylazine in drug samples. Xylazine is an animal tranquilizer, not an opioid, that’s been increasingly found mixed with fentanyl in drug supplies in recent years. Both fentanyl and xylazine are linked to a significant number of overdose deaths.

Gumas noted the data on whether test strips are directly linked to fewer overdose deaths is varied, but “evidence strongly suggests that use of drug testing strips enables better risk reduction behaviors and engagement with other harm reduction strategies.”

3. Increased insurance coverage

Many people with opioid use disorder (OUD) are Medicaid beneficiaries. Medicaid expansion has been “the single most influential lever for coverage and access to” OUD treatments, Gumas wrote.

An analysis from nonprofit organization Brookings Institution found that, as of 2021, roughly 1.8 million people received OUD treatment through Medicaid, and over half of those people qualified for coverage through Medicaid expansion.

4. Integration of harm reduction strategies in prisons

Opioid overdose deaths are very common among people recently released from prison.

Some states have created initiatives to address the problem. In Ohio, for example, people are given naloxone upon release from prison, according to the Commonwealth analysis. And in Maryland, the Centers for Medicare and Medicaid Services approved a Section 1115 waiver so the state’s Medicaid program could provide people with coverage for OUD treatment up to 90 days before being released.

5. Improved surveillance data

Having timely access to data tracking overdoses “allows for more rapid deployment of prevention resources to communities most highly impacted by the overdose crisis,” Gumas wrote.

Rhode Island, for example, launched an overdose spike alert notification system. The state’s department of health tracks non-fatal overdoses. If the number of overdoses in any region of the state exceeds a predetermined number, it triggers an alert that gets sent to public health officials and others, notifying them of the increased overdose activity.

Virginia also shares overdose data with surrounding states so they can see changes in drug use patterns “before they manifest as local deaths,” Gumas wrote.

Not over yet. While these factors have collectively contributed to the decline in overdose deaths, Gumas warned that some states, including New Mexico, Arizona, and Colorado, saw the number of deaths rise again in 2025.

Medicaid cuts could also lead to “catastrophic gaps in coverage” that result in more deaths, he added.

“Mortality declines in the US and internationally are a step in the right direction, but continued efforts to reduce preventable deaths due to drug use are far from over,” Gumas concluded. “The most successful policies will prioritize supporting, sustaining, improving, and integrating models that have demonstrated they can help save lives.”