For the first time in years, U.S. public health data1 is showing a decrease in overdose deaths2; from April 2023 to April 2024, CDC aggregate data shows a roughly 10% decrease in reported drug overdose deaths. Academic research has shown an estimated 15-20% decrease in non-fatal overdoses.3
This substantial decrease comes after years of overdose death increases spurred by highly potent fentanyl flooding the U.S. drug market. In some states the declines are even more dramatic: Resilient's home state of Pennsylvania saw a nearly 20% drop in overdose deaths over this time period. University of North Carolina researcher Dr. Nabarun Dasgupta explained the significance of the overall decline in non fatal overdose rates stating:
A “15% to 20% decrease in overdose would be unprecedented. To our knowledge, no public health intervention in the United States has ever achieved this benchmark. For example, NIDA [National Institute on Drug Abuse] spent $343.7 million to show that it was possible to reduce overdoses by 9% in four states in one year. A reduction of this magnitude across the entire country translates to a very strong acting force. Something has changed. And that this is happening without central coordination is a big deal. It has major implications for the way we think about overdose prevention interventions.”
Dr. Dasgupta provides a fascinating and comprehensive examination of the current declining overdose trend here
A change of this magnitude is quite heartening but it is unclear exactly what combination of variables has caused this change and if the downward trend will continue. There are many theories about what exactly is driving the decline, with possible answers including improved access to treatment, the widespread availability of naloxone, increased border security operations, or some combination of factors. However, nobody can yet say for certain why this is occurring or if it will persist.
One plausible explanation could be the increased distribution of naloxone, an opioid antagonist that can reverse the effects of an overdose. This recent decline in overdose deaths comes after large initiatives beginning in 2022 aimed to make naloxone widely available while, at the same time, competition from generic naloxone producers is putting downward pressure on naloxone prices. In July 2023, naloxone nasal spray became available over the counter (OTC)4 making it even easier to acquire (although "standing orders" in many states had already made naloxone largely available).
In a recent interview with NPR, Kevin Donaldson, a fentanyl user from Vermont said that many fentanyl users he knows now carry naloxone with them. He and others are also more frequently using drugs with people nearby so that they can administer naloxone should an overdose occur.5 The combination of carrying naloxone and using with others is an effective way to reduce the risk of accidental overdose death.
If this decline is truly due to greater naloxone availability, we may see a limit in how many lives we can save. Despite the care that some individuals take to use with others around, data from an unpublished 2021 overdose fatality review in Knox County, TN suggested that over 80% of overdose deaths occur without anybody else in the room. Without a bystander to witness an overdose and deliver naloxone, there’s no way to help the overdose victim; generally, overdose victims are unconscious and therefore unable to narcan themselves.
This is why Resilient Lifescience is developing technology to detect and reverse overdose - we believe that reversal agents won’t be enough to bring this number close to zero; we need to get better as a society at detecting overdose for cases when individuals do use opioids alone.
It goes without saying that there are still far too many overdose deaths occurring in the United States. Even with a 10% decrease in overdose deaths, nearly 100,000 Americans lose their lives annually due to drug overdoses. The recent decline brings overdose fatalities to around the same level (though still higher) than were reported in 2020 and is still roughly 60,000 deaths greater annually than in 2012, right before the “third wave” of the opioid epidemic, driven by synthetic drugs, began.6
It is too early, and likely too complicated, to definitively state which variables are contributing most to declining overdose rates. Regardless, reversing the horrifying overdose fatality trend in the U.S. is a great public health victory, but over the long term, we hope for a decrease in the number of people who report misusing opioids and other illicit drugs. Recent data as of 2023 has shown the number of drug misusers and those with OUD have remained relatively stable over the past three years.7 Even so, the current data provides hope where there had previously been very little and suggests that it might be possible to reverse the decades-long rising overdose trend seen in the United States.
