Deadly overdoses fell in U.S. for first time in five years, new estimates show

Deaths from drug overdoses fell last year in the United States as fewer people lost their lives to fentanyl and other opioids, marking the first time the death toll had dropped in five years, according to newly released estimates from the Centers for Disease Control and Prevention.

Federal officials said the numbers show a 3% decline in the estimated overdose fatalities between 2022 and 2023. That downturn equates to nearly 3,500 fewer deaths across the U.S. than the year before.

The new figures are tentative and could still be updated. Even a slight decline could be a balm for a country where drug overdoses have taken a devastating toll: In one survey, more than 40% of adults said they knew someone who lost their life to a drug overdose, according to a Rand study published this year.

“I’m thrilled that there wasn’t an increase, but we’re still talking about 107,000 people dying, which is completely unacceptable,” said Beau Kilmer, co-director of the Rand Drug Policy Research Center. Kilmer said better data on drug use are needed to untangle exactly what is driving the changes.

Community groups and health officials grappling with the devastating toll of fentanyl have pushed to equip more people with naloxone, a medicine that can stop opioid overdoses and is commonly sold as a nasal spray under the brand name Narcan. Los Angeles County officials, for instance, credited an effort to hand out Narcan on the streets when they announced last week that overdose deaths had stopped surging among homeless people. To try to reduce the deadly risks, people who use drugs have also turned to test strips to detect fentanyl and avoided using drugs by themselves, among other strategies.

Health researchers have also noted that broader changes in the population could be affecting the numbers: Many heroin users who switched to fentanyl have died, and if fewer people are newly turning to fentanyl use, that could mean fewer people are now at risk, said Dr. Daniel Ciccarone, a UC San Francisco addiction medicine professor.

“Based on utterly anecdotal, street-level observations, I’ll say there aren’t a lot of newbies,” Ciccarone said. “We’re looking for them, but we don’t see them. We don’t see the 22-year-old who says, ‘Hey, I want to use fentanyl.’ This is an aging cohort.”

Even as U.S. deaths linked to fentanyl and other opioids dropped between 2022 and 2023, the country saw an uptick in deaths tied to stimulants such as methamphetamine and cocaine, according to the new estimates. Drug researchers said that in recent years, many deaths involving meth have also involved opioids.

And not all parts of the country saw an overall drop in fatal overdoses. “In the East Coast and in the Midwest, we are seeing declines, but on the West Coast — particularly in the upper Northwest — we’re still seeing increases,” said Farida Ahmad, a health scientist at the National Center for Health Statistics.

The federal figures show that in California, the estimated number of overdose deaths continued to rise in 2023 compared with 2022, increasing by 4.1%. In Oregon and Washington, increases were significantly steeper — roughly 30% and 27% respectively.

Drug use can differ from region to region, shaping ensuing overdoses and deaths: Fentanyl hit the Eastern U.S. before spreading west, and methamphetamine use generally has been more common on the West Coast.

Ciccarone lamented that the West Coast should have been better prepared for fentanyl after seeing it hit other parts of the country years earlier, calling it a “failure of public policy.”

“We saw this coming. So why didn’t we prepare for it better?”

Ciccarone credited states in the Midwest and on the East Coast that had seen notable decreases in overdose deaths, saying that although the exact reasons are unclear, there has been a panoply of efforts that could play a role, including ramping up naloxone distribution and easing access to buprenorphine to treat opioid addiction.

“These are places that were hard hit by fentanyl,” Ciccarone said. “So they’re doing something right.”

The federal estimates released Wednesday do not detail how many deaths linked to methamphetamine also involved other drugs, a phenomenon that has gained growing attention as Americans mix drugs knowingly and unknowingly.

Researchers drawing on federal and local data have found substantial overlap in methamphetamine and opioid use: In L.A. County, for instance, a recent report indicated that in 2022, nearly half of overdose deaths among homeless people involved both methamphetamine and fentanyl.

People who use fentanyl may turn to stimulants to get through daily activities, said Chelsea Shover, an assistant professor at UCLA’s David Geffen School of Medicine. For those facing the dangers of living outside, “you know what helps you stay up at night and stay vigilant? Meth.”

Shover said in recent years, national data have consistently shown the majority of methamphetamine deaths also involve opioids. Those findings were echoed in local research by Shover and other researchers, which found that between 2012 and mid-2021, the bulk of meth-related deaths in L.A. County also involved other drugs or medical conditions, rather than being driven solely by the stimulant.

To help prevent such deaths, “we need to keep doing what we’re doing for opioid-related deaths — because a lot of meth-involved deaths are also opioid-involved,” Shover said.

Scholars have also urged more attention to methamphetamine itself: As it stands, there are no medications approved by the Food and Drug Administration to treat addiction to meth, although some existing medicines have shown promising results, as has offering incentives such as gift cards for people to stay off stimulants.

“The massive investment in reducing overdose deaths has been almost exclusively targeted to opioids,” said Steven Shoptaw, director of the UCLA Center for Behavioral and Addiction Medicine. “There’s been no systematic investment to reduce methamphetamine deaths” — a lapse that Shoptaw said had hindered effective interventions from being widely adopted.

Americans have been eager for any signs of hope amid the overdose crisis, but experts have cautioned against declaring victory too soon in reaction to year-to-year changes in overdose deaths.

For instance, University of Pittsburgh researchers found that the last time fatal overdoses dropped nationally in 2018, the downturn coincided with stricter regulations in China on carfentanil, a highly potent synthetic opioid. The following year, deaths from drug overdoses rose again.

Dr. Donald Burke said that the estimated number of overdose deaths in 2023 was still above the level that researchers had forecast, based on the historic trajectory of such fatalities. The death numbers had jumped higher than expected during the COVID-19 pandemic, Burke said — and may just be returning to the same levels that would have happened in its absence.

“You can make a case that it’s come down, but it’s come down because the COVID impact is less now,” said Burke, dean emeritus of the University of Pittsburgh School of Public Health.

“Without knowing what are the drivers, it’s really hard to tell whether a reduction is a return to the expected trajectory or some other change,” said Dr. Hawre Jalal, an associate professor at the University of Ottawa who has partnered with Burke on such research.

Ciccarone was reluctant to even characterize the newly released estimates as a decrease in overdose deaths, instead referring to “a flattening of the curve.”

“Can we sing hosannas over that? No,” Ciccarone said. “We’re still fighting. We still have a lot of work to do to bend this overdose curve down.”