For the first time in decades, public health data shows a sudden and hopeful drop in drug overdose deaths across the U.S.
"This is exciting," said Dr. Nora Volkow, head of the National Institute On Drug Abuse [NIDA], the federal laboratory charged with studying addiction. "This looks real. This looks very, very real."
National surveys compiled by the Centers for Disease Control and Prevention already show an unprecedented decline in drug deaths of roughly 10.6 percent. That's a huge reversal from recent years when fatal overdoses regularly increased by double-digit percentages.
Some researchers believe the data will show an even larger decline in drug deaths when federal surveys are updated to reflect improvements being seen at the state level, especially in the eastern U.S.
"In the states that have the most rapid data collection systems, we’re seeing declines of twenty percent, thirty percent," said Dr. Nabarun Dasgupta, an expert on street drugs at the University of North Carolina.
According to Dasgupta's analysis, which has sparked discussion among addiction and drug policy experts, the drop in state-level mortality numbers corresponds with similar steep declines in emergency room visits linked to overdoses.
Dasgupta was one of the first researchers to detect the trend. He believes the national decline in street drug deaths is now at least 15 percent and could mean as many as 20,000 fewer fatalities per year.
"Today, I have so much hope"
After years of wrenching drug deaths that seemed all but unstoppable, some researchers, front-line addiction workers, members of law enforcement, and people using street drugs voiced caution about the apparent trend.
Roughly 100,000 deaths are still occurring per year. Street drug cocktails including fentanyl, methamphetamines, xylazine and other synthetic chemicals are more poisonous than ever.
"I think we have to be careful when we get optimistic and see a slight drop in overdose deaths," said Dan Salter, who heads a federal drug interdiction program in the Atlanta-Carolinas region. "The last thing we want to do is spike the ball."
But most public health experts and some people living with addiction told NPR they believe catastrophic increases in drug deaths, which began in 2019, have ended, at least for now. Many said a widespread, meaningful shift appears underway.
"Some of us have learned to deal with the overdoses a lot better," said Kevin Donaldson, who uses fentanyl and xylazine on the street in Burlington, Vermont.
Carol Guzy for NPR / Kevin Donaldson, who lives with addiction, shown on a street corner in Burlington, Vermont, on September 16, 2024. He said members of his community have learned better ways to look out for each other as illicit drugs have grown more toxic.
"I think we have to be careful when we get optimistic and see a slight drop in overdose deaths," said Dan Salter, who heads a federal drug interdiction program in the Atlanta-Carolinas region. "The last thing we want to do is spike the ball."
But most public health experts and some people living with addiction told NPR they believe catastrophic increases in drug deaths, which began in 2019, have ended, at least for now. Many said a widespread, meaningful shift appears underway.
"Some of us have learned to deal with the overdoses a lot better," said Kevin Donaldson, who uses fentanyl and xylazine on the street in Burlington, Vermont.
According to Donaldson, many people using fentanyl now carry naloxone, a medication that reverses most opioid overdoses. He said his friends also use street drugs with others nearby, ready to offer aid and support when overdoses occur.
He believes these changes - a response to the increasingly toxic street drug supply - mean more people like himself are surviving.
"For a while we were hearing about [drug deaths] every other day. When was the last one we heard about? Maybe two weeks ago? That's pretty few and far between," he said.
His experience is reflected in data from the Vermont Department of Health, which shows a 22 percent decline in drug deaths in 2024.
"The trends are definitely positive," said Dr. Keith Humphreys, a nationally respected drug policy researcher at Stanford University. "This is going to be the best year we've had since all of this started."
"A year ago when overdose deaths continued to rise, I was really struggling with hope," said Brad Finegood, who directs the overdose crisis response in Seattle.
Deaths in King County, Washington, linked to all drugs have dropped by 15 percent in the first half of 2024. Fatal overdoses caused by street fentanyl have dropped by 20 percent.
"Today, I have so much hope," Finegood said.
Why the sudden and hopeful shift? Most experts say it's a mystery
While many people offered theories about why the drop in deaths is happening at unprecedented speed, most experts agreed that the data doesn't yet provide clear answers.
Some pointed to rapid improvements in the availability and affordability of medical treatments for fentanyl addiction. "Expansion of naloxone and medications for opioid use disorder — these strategies worked," said Dr. Volkow at NIDA.
"We've almost tripled the amount of naloxone out in the community," said Finegood. He noted that one survey in the Seattle area found 85 percent of high-risk drug users now carry the overdose-reversal medication.
Dr. Rahul Gupta, the White House drug czar, said the drop in drug deaths shows a path forward.
"This is the largest decrease on record and the fifth consecutive month of recorded decreases," he said.
Gupta called for more funding for addiction treatment and healthcare services, especially in Black and Native American communities where overdose deaths remain catastrophically high.
"There is no way we're going to beat this epidemic by not focusing on communities that are often marginalized, underserved and communities of color," Gupta said.
But even some researchers who support wider public health and harm reduction programs said it's unlikely those efforts alone are causing such a sudden decline in drug deaths.
"We don't have anything that would predict this magnitude of effect this quickly," said Dasgupta, the researcher at North Carolina University, who described the reversal as hopeful and also mysterious.
Addiction experts pointed to a number of possible factors, other than public health strategies, that could be contributing to the drop in fatal overdoses, including the changing make-up of the street drug supply.
Fentanyl may be harder to find and less pure in some areas because of law enforcement efforts targeting Mexican drug cartels.
The chemical xylazine is also being mixed with fentanyl by drug gangs. While toxic in humans, causing lesions and other serious long-term health problems, xylazine may delay the onset of withdrawal symptoms in some users. Dasgupta said it's possible that means people are taking fewer potentially lethal doses of fentanyl per day.
Other experts pointed to the end of the COVID pandemic, combined with the high number of people who have already died from drug overdoses, as possible causes of the abrupt change.
Dr. Daniel Ciccarone, a physician and addiction researcher at the University of California San Francisco, said a debate is already underway over what triggered the improvement and what might happen next.
"This is where we're all going to differ. Everyone is going to come out and claim that what they did is what caused the decline," he said.
But Ciccarone agreed that for now, the improvements appear real: "What makes it fascinating is the speed at which it's happening."
"Overdose deaths in Ohio are down 31 percent"
Indeed, in many states in the eastern and central U.S. where improvements are largest, the sudden drop in drug deaths stunned some observers who lived through the darkest days of the fentanyl overdose crisis.
"This year overdose deaths [in Ohio] are down 31 percent," said Dennis Couchon, a harm reduction activist. "The deaths were just plummeting. The data has never moved like this."
"While the mortality data for 2024 is incomplete and subject to change, Ohio is now in the ninth consecutive month of a historic and unexpected drop in overdose deaths," said the organization Harm Reduction Ohio in a statement.
Missouri is seeing a similar trend that appears to be accelerating. After dropping by 10 percent last year, preliminary data shows drug deaths in the state have now fallen roughly 34 percent in the second quarter of 2024.
"It absolutely seems things are going in the right direction, and it's something we should feel pleased about," said Dr. Rachel Winograd, director of addiction science at the University of Missouri St. Louis, who also noted that drug deaths remain too high.
"It feels wonderful and great," said Dr. Mark Levine, head of the Vermont Health Department. "We need encouraging data like this and it will help sustain all of us who are actively involved in trying to have an impact here."
Levine, too, said there's still "plenty of work left to do."
Some survivors of the overdose crisis said while the situation on the streets remains grim for many people, they believe the public health response is keeping more people alive.
Eric Breeyear, who lives in a recovery shelter called Good Samaritan Haven in Barre, Vermont, said he was given naloxone repeatedly after experiencing fentanyl overdoses.
In recovery for roughly a year, Breeyear takes a prescription medication called suboxone to reduce opioid-fentanyl cravings.
He told NPR there is "probably a 100 percent chance" he would have died without the medical help that is now far more widely available.
"I'm happy people's lives are being saved, but on every street I see somebody in the middle of an overdose that could potentially be fatal," Breeyear said.
He said being revived after repeated overdoses isn't enough. He wants more done to help people in severe addiction heal and enter recovery, as he has done.
Dasgupta, the researcher at the University of North Carolina, agreed more needs to be done to help people in addiction recover when they're ready.
But he said keeping more people alive is a crucial first step that seemed impossible only a year ago.
"A fifteen or twenty percent [drop in deaths] is a really big number, an enormous impact," he said, calling for more research to determine how to keep the trend going.
"If interventions are what's driving this decline, then let's double down on those interventions."
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