Overdose deaths decline sharply after years of fentanyl-fueled surges

Overdose deaths appear to be declining sharply in the United States, a sign that efforts to combat the scourge of lethal fentanyl may be paying off even as experts caution that the toll remains unacceptably high and could rise again.Preliminary data compiled by states and released by the Centers for Disease Control and Prevention show a 10 percent drop in deaths during the 12-month period ending in April 2024, with about 101,000 people succumbing to overdoses.Public health officials and researchers said the decline could reflect multiple forces, including widespread availability of the overdose-reversal medication naloxone, greater access to opioid addiction treatment and law-enforcement crackdowns on illicitly manufactured fentanyl, which had become the leading killer of 18-to-49-year-olds.Some experts said they suspect the illicit drug supply is shifting to include less fentanyl and that fewer people are using alone as the social isolation of the coronavirus pandemic has receded.And the decline could reflect a sobering reality: Because fentanyl carved such a deadly path in recent years, the population of potential victims has shrunk, said Daniel Ciccarone, a researcher at the University of California at San Francisco School of Medicine who studies street drugs and overdose trends."The overdose decline is both welcome and perplexing," Ciccarone said.News of the decrease arrives during the final weeks of the presidential campaign, with fentanyl emerging as a political flash point. The public health crisis sparked by the drug has resulted in hundreds of thousands of deaths in red and blue states across administrations from both parties.Former President Donald Trump and Republicans have tied the fentanyl crisis to the southern border, blaming President Joe Biden for immigration policies they say allow Mexican cartels to flood the country with the synthetic drug, which is up for 50 times more powerful than heroin. But officials say most fentanyl enters the United States through legal ports of entry, often with U.S. citizens acting as couriers.For Democrats, border security looms as a political vulnerability. The Biden administration this month enacted new border restrictions applying to migrants seeking asylum in the United States. During a border visit Sept. 27, Vice President Kamala Harris said stopping the flow of fentanyl would be a priority if she is elected to the White House.In touting the decrease in overdose deaths, the Biden administration points to record seizures of fentanyl at ports of entry, increased sanctions on people and companies tied to the global drug trade, the capture of Mexican cartel leaders and a pledge from China to curb export of chemicals used to make synthetic drugs.The Biden administration has provided billions of dollars to states as part of the campaign to reduce overdoses while embracing strategies to minimize the harmful effects of drugs on users. Grassroots organizations and state health departments have distributed millions of doses of naloxone. The Food and Drug Administration authorized Narcan, a nasal spray version of naloxone, for purchase without a prescription. Federal officials have also prioritized widening access to addiction treatment, making it easier for doctors to prescribe the opioid-use disorder medication buprenorphine.Rahul Gupta, director of the White House Office of National Drug Control Policy, described the drop as the largest on record and credited the administration's dual strategies of bolstering public health approaches while cracking down on suppliers."This has not happened by accident," Gupta said in an interview.The CDC data remains preliminary and could change. State data lags as coroners and medical examiners conclude death investigations.Overdoses had been increasing for decades but spiked at historic rates in recent years as fentanyl infiltrated - and largely took over - the nation's heroin supply. Overdose deaths in 2021 topped 100,000 nationally for the first time. In 2022, according to federal data, the spike slowed but still reached nearly 110,000 confirmed deaths, a record high.Last year, an estimated 108,318 people died in what federal officials described as the first annual decrease in deaths since 2018. That year, the dip was fleeting as fatalities rose again and spiked during the pandemic, said University of Pittsburgh School of Public Health researcher Donald S. Burke, who has analyzed decades of mortality data.Burke said he fears history will repeat itself and that the recent decrease will be reversed. "I don't want to be too pessimistic about this," Burke said. "Every time the curve goes down, there is a tendency to celebrate rightly, but unfortunately, every time it's gone down it has continued to resume an exponential trajectory."Still, the 2018 decrease was more gradual while the recent drop has been steep, said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill who in September published an analysis of recent trends. Overdoses not resulting in death have also decreased in many states, Dasgupta said.Dasgupta said he believes that by the end of 2024, there could be 20,000 fewer deaths than the year before."This will be a historic moment for public health. Something has changed - that I'm sure of," Dasgupta said. "Where the direction lines go from here, I have no idea."Dasgupta and other researchers speculated that changes in the illicit drug supply may play a major role.Other drugs are appearing alongside fentanyl depending on the region. In some cases, drug dealers add the tranquilizer xylazine to fentanyl, a combination that federal authorities have deemed an emerging threat. The tranquilizer prolongs the sedating effect and staves off opioid withdrawal so that users may consume less fentanyl each day, experts theorize.In North Carolina, some drug samples contain more xylazine and little fentanyl, said Jon E. Zibbell, a senior public health analyst at research nonprofit RTI International who has studied drug trends in the state. But he warned that xylazine brings other health risks: chronic skin wounds and "the social and economic effect of paralyzing drug sedation."Users have switched to methamphetamine and other drugs as they seek alternatives to fentanyl, he said. Longtime opioid users surveyed in North Carolina "did not want and totally despise fentanyl," Zibbell said.Different parts of the country tell different stories about overdoses and deaths.They began dropping earlier on the East Coast, where experts say fentanyl has been entrenched for longer. The provisional CDC estimates show that North Carolina recorded a 23 percent decline between April 2023 and April 2024. Ohio and Pennsylvania saw decreases of about 19 percent. Kentucky and West Virginia, two states with among the highest opioid death rates, also logged double-digit declines.Overdose deaths in D.C. dropped considerably in the first half of 2024 compared with the same period the previous year, according to the medical examiner's office.But Western states such as Alaska, Oregon and Washington have reported substantial increases in overdose deaths, the data shows.The latest CDC data does not include demographics. But an analysis published in September by KFF, a health policy research organization, compared fatal overdoses from the second half of 2023 to the same period the year before and found deaths decreased among most racial and ethnic groups.But White people experienced a more significant decline in deaths than other groups, said KFF policy analyst Heather Saunders, who wrote the analysis.The analysis identified a worrisome trend: Opioid overdose deaths increased for people 65 and older.