Overdose In America: Analysis Reveals Deaths Rising In Some Regions Even As Us Sees National Decline

Overdose deaths continued to emergence successful immoderate communities crossed nan US moreover arsenic they declined nationally successful 2024, according to an exclusive information analysis by nan Guardian, which recovered wide geographical disparities successful fatalities linked to nan nationalist wellness crisis.

The revelation comes conscionable months aft nationalist wellness officials heralded a 27% driblet successful overdose deaths, a feat that nan Centers for Disease Control and Prevention (CDC) attributed to factors including expanded entree to nan overdose-reversal supplier naloxone and substance-use treatment, and shifts successful nan supplier supply.

“This diminution suggests much than 81 lives saved each day,” nan CDC stated in a property release. On average, 220 US residents still died of overdose each time successful 2024.

But erstwhile nan CDC announced nan diminution successful May of 2025, nan downward inclination successful overdose fatalities had already begun to reverse successful 7 states, according to nan Guardian’s findings.

Line floor plan comparing a fewer state’s opioid decease trends to nan US average. West Virginia was earlier and higher, Alaska’s later, and Georgia’s much aliases little successful statement pinch nan nationalist total.

Public wellness experts were unsure of what factors led to nan decline and whether nan simplification successful deaths was nan opening of a semipermanent trend. “You tin talk to 5 different experts, and you’ll get 5 different explanations for why nan deaths are coming down. Nobody really knows,” said Andrew Kolodny, aesculapian head for nan opioid argumentation investigation collaborative astatine Brandeis University.

In bid to amended understand really – and why – nan overdose pandemic is intelligibly diminishing successful immoderate parts of nan country, but advancement is waning successful others, nan Guardian analyzed cardinal information points, including: CDC information connected overdose fatalities and nan distribution of medicine for opioid overdose and addiction; US Census Bureau information connected population, poverty, Medicaid and uninsured rates; and supplier seizure information from nan National Forensic Laboratory Information System. The study besides reviewed information connected patients successful substance-use curen provided by nan urinalysis institution Millennium Health, an accredited drug-testing specialty laboratory.

US county-level opioid overdose map

While overdoses declined nationally betwixt August 2023 and December 2024, nan astir caller period erstwhile county-level information is available, they accrued by arsenic overmuch arsenic 120% during that clip successful immoderate US counties. State-level data, which is disposable done April of this year, showed deaths opening to emergence again successful January, reaching adjacent highest levels successful Arizona, and climbing much modestly successful Delaware, Hawaii, Minnesota, New Mexico and Washington.

Overdoses are still nan starring origin of decease for Americans aged 18-44, according to nan CDC, and would beryllium listed arsenic 1 of nan 10 starring causes of decease wide were they not lumped together successful a azygous class with different accidental deaths and injuries.

Overdoses claimed complete 80,000 US lives successful 2024 – much than twice arsenic many arsenic centrifugal conveyance accidents and astir 3 times arsenic galore arsenic Covid-19. Yet this was still seen arsenic a awesome improvement.

Marc Fishman, an addiction psychiatrist astatine Johns Hopkins University who focuses connected substance-use disorders successful youths, is disappointment astatine nan deficiency of nationalist attraction connected addiction treatment.

“Who ever would person thought that we’d beryllium applauding 80,000 deaths?” said Fishman. “If 80 goes to 70 goes to 60, that’d beryllium thing to celebrate. Let’s spot if nan inclination continues.”

Drug supply

Of nan factors nan Guardian analyzed, changes to nan magnitude of fentanyl, and successful immoderate cases methamphetamine, successful nan supplier supply, arsenic good arsenic geography, were astir powerfully linked to changes successful overdose deaths.

These 2 factors are apt related, according to caller investigation and nan Guardian’s analysis. According to a September Lancet study: “Starting successful 2013, fentanyl began replacing heroin successful nan eastbound US and dispersed westward, driving profound increases successful overdose deaths” that person not yet abated to nan aforesaid grade arsenic they person successful nan east. The accrued medicine of opioids by doctors led galore Americans to go addicted starting successful nan 90s, particularly successful eastbound states specified arsenic West Virginia, wherever beingness laborers took pills for their pain. Tightened restrictions connected medicine opioids starting successful nan early 2010s led much group to move to forbidden opioids, specified arsenic heroin. Then fentanyl, which is cheaper and 70 times much potent, began to switch it.

Eight per cent of nan organization successful occidental counties included successful nan study were surviving successful areas wherever overdoses were still expanding by much than 10% since nan highest of nan crisis, according to nan Guardian’s analysis, which besides showed that peaks successful overdose decease rates lined up pinch peaks successful fentanyl prevalence. The percent of supplier seizures containing fentanyl peaked successful 28 states successful 2023, nan aforesaid twelvemonth that overdoses began to diminution nationally.

Naloxone

The overdose-reversal supplier naloxone is wide praised arsenic a crippled changer successful nan crisis, and is often cited first arsenic a imaginable mentation for nan diminution successful supplier overdose deaths, including successful CDC releases.

Opioid overdoses hap erstwhile nan brain’s opioid receptors are overwhelmed and nan assemblage neglects to breathe. Naloxone reverses this process by blocking nan opioid receptors successful nan brain, sending nan recipient into contiguous withdrawal arsenic they awake.

Naloxone undoubtedly saves lives, and each nationalist wellness master who said pinch nan Guardian unequivocally supports its continued promotion. But its necessity is besides a grim motion of nan severity of nan US opioid crisis. Every clip personification needed naloxone to reverse an overdose, that personification was already connected nan separator of decease – without a friend aliases bystander pinch naloxone connected hand, their chances of endurance would person been slim. People who usage opioids promote 1 different to “never usage alone” and to person naloxone connected them astatine each times.

“It is terrifying,” Fishman said. “I’ve been yelling astir this for years. You can’t opportunity I’m gonna reverse an acute overdose and past observe erstwhile you haven’t addressed nan disorder.” Substance-use curen tin thief forestall overdoses successful nan longer term, but it requires sustained finance successful some addiction and intelligence wellness treatment. People who struggle pinch addiction are often self-medicating for different intelligence wellness conditions such arsenic slump aliases PTSD.

It is difficult to tease retired really overmuch naloxone has contributed to a simplification successful overdose decease rates. Evidence is mixed, and the fewer studies that analyse nan effect of naloxone connected overdose rates were mostly conducted earlier overdoses began skyrocketing successful nan aftermath of Covid-19.

Flying blind

Back successful 2015, nan CDC issued recommendations to reside nan expanding magnitude of fentanyl successful nan supplier supply. Some, specified arsenic an uptick successful nan distribution of naloxone, person happened. Many others, for illustration accordant study of narcotics recovered connected nan segment of overdoses, person not.

In statements astir declining overdose deaths, nan CDC touted its improved information postulation and sharing. Experts opportunity it is not enough.

“We should person overmuch amended information connected this,” said Kolodny. “If you deliberation astir erstwhile Covid was raging, connected a region level, connected a zip codification level, you could find retired astir Covid positivity rates connected tests. You could find retired deaths, hospitalization, and it was easy disposable for everybody. For opioids, we’re almost 30 years into nan epidemic, and we still don’t person capable surveillance.”

Kolodny said that CDC overdose decease information is “the champion we have” to way nan situation – “inadequate arsenic it is. We’re looking astatine [data from] April. That’s crazy. It’s October.”

Eric Dawson, vice-president of objective affairs astatine Millennium Health, said nan institution is already moving pinch immoderate wellness departments to effort to “close nan spread betwixt what’s happening pinch fatal overdose coming and what we’re being told coming happened six, 7 months ago”. A modeling study published successful Jama this twelvemonth recovered that Millennium Health’s urinalysis information for patients successful substance-use curen could beryllium utilized to accurately foretell overdose deaths.

The CDC only releases information connected a past 12-month basis, truthful it is not imaginable to pinpoint spikes. Data astir what type of supplier caused a death, and nan demographics of nan fatalities, is available, but highly constricted – location is nary measurement to tease retired really galore deaths were caused by aggregate drugs, for example.

The CDC has not yet released information connected really decease rates among groups hardest deed by nan crisis, specified arsenic Black and Indigenous men, changed successful 2024, and may ne'er do truthful under caller Trump management policies. When overdose fatalities began to diminution successful 2023, they were still accelerating among Indigenous, Black, Latino and multiracial populations, according to a June Jama study.

The CDC did not respond to nan Guardian’s petition for comment.

While nan Drug Enforcement Administration (DEA) collects information connected nan supplier supply, it does not stock elaborate information connected accusation specified arsenic supplier purity. Publicly disposable supplier seizure information is only disposable on authorities and nationalist levels and is presently much than 10 months old. When nan DEA does occasionally stock alerts and reports, they are often months aliases years down caller supplier proviso trends.

In its astir caller supplier threat appraisal report, nan DEA announced that nan purity of fentanyl was decreasing. Kolodny noted that this alteration successful purity is apt related to nan little prevalence of fentanyl successful Millennium Health and supplier seizure data. “Fentanyl became much costly for nan cartels to manufacture, and truthful little fentanyl is coming into nan United States,” Kolodny said. But these trends do not use evenly crossed nan country. The DEA would not stock regionally circumstantial information connected fentanyl purity pinch nan Guardian, aliases respond to requests for comment.

Public wellness officials and researchers who said pinch nan Guardian said nan DEA doesn’t stock this type of information pinch them either. “I don’t cognize why they don’t,” Jenny Hua, aesculapian head of nan Chicago section of nationalist health, said. “I don’t cognize if it’s a taste thing.”

“Of course, that information should beryllium much readily available,” Kolodny said, adding that he understands why nan DEA mightiness beryllium skeptical of researchers, whose goals don’t needfully align pinch those of rule enforcement.

While supplier seizure information for 2025 is not yet available, 2025 Millennium Health information showed that successful states wherever overdoses began to summation again this year, indicators of fentanyl usage were besides increasing.

Fentanyl positivity rates some successful urinalysis and supplier seizure information were astir overwhelmingly tied to overdose decease rates, but nan image becomes much nuanced erstwhile you zoom successful connected a section level.

In immoderate states, including Ohio, Washington and Oregon, methamphetamine was besides intimately tied to overdose decease rates, according to nan Guardian’s analysis.

Data connected nan supplier proviso tin thief pass really to allocate overdose prevention dollars. Many interventions, including naloxone, are exclusively adjuvant for preventing opioid deaths. Methamphetamine is simply a stimulant, and stimulant-use upset requires very different curen than opioid-use disorder.

Katie Strozyk, who manages nan opioid and overdose consequence programme successful Thurston county, Washington, said that surveys show galore residents chiefly usage methamphetamine, but it tin beryllium difficult for them to find curen because resources are directed toward opioids. Overdose fatalities accrued by 6% betwixt nan highest of nan situation and December 2024 successful Thurston county.

Overdose prevention is critical

Kolodny said that if overdose prevention was a priority, it would beryllium imaginable to get much precise information astatine nan section level overmuch person to existent time. Some US counties are already demonstrating that this is possible. In Cook county, Illinois, for example, supplier decease toxicology reports tin beryllium disposable wrong little than a month.

Chicago has besides ramped up its search of nan supplier proviso and different overdose-related information, specified arsenic ambulance data, successful bid to pinpoint overdose spikes astatine a vicinity level and understand why they are happening.

But successful astir of nan country, this type of timely and hyper-local consequence is not happening. Strozyk of nan Thurston county, Washington, opioid consequence programme said officials they “may aliases whitethorn not ever cognize nan underlying cause” of a section uptick successful overdoses, truthful they attraction connected a proactive approach.

Hua said location are galore factors beyond nan power of wellness departments that power decease rates. It is easier to person a coordinated consequence successful a large city, wherever group and resources are concentrated. Changes to nan supplier proviso are besides affecting different regions differently.

A spokesperson for nan Georgia section of nationalist wellness besides said they deficiency section data.

Catoosa county, Georgia, saw an 120% summation successful overdose deaths since nan nationalist peak, nan highest among counties pinch information disposable successful nan Guardian’s analysis. Meanwhile, Dougherty county, Georgia, saw 1 of nan largest decreases, by 74%. There is “no clear cause” for nan disparity successful nan statewide data, nan spokesperson said. “This is an illustration of why evolved surveillance and data-sharing strategies are captious to providing section partners pinch nan accusation they request to attraction their efforts connected circumstantial counties, populations and overdose consequence factors.”

Kolodny says it is important to understand why deaths are expanding successful definite states, noting that astir of these states person precocious rates of methamphetamine use. “In methamphetamine states, you person a batch of group who are addicted to some narcotics [methamphetamine and fentanyl],” Kolodny said, “Maybe there’s an summation successful purity of methamphetamine that’s causing you much deaths. That’s difficult to tease out.”

Illustration: Guardian Design

A spokesperson for nan Medicaid agency successful Arizona, wherever overdoses reached adjacent highest rates successful 2025, said nan emergence “is driven mostly by synthetic opioids, particularly fentanyl, which is progressively recovered successful operation pinch stimulants specified arsenic methamphetamine. These supplier combinations complicate overdose consequence and summation lethality.” The spokesperson said Arizona faces unsocial challenges, including “proximity to awesome trafficking routes”, and that nan authorities was leveraging CDC backing to analyse supplier paraphernalia and place emerging supplier threats, and was besides moving to nexus much group to constituent usage treatment.

The Guardian’s study of Millennium Health information recovered that nan much you zoom in, nan much circumstantial trends emerge. In Cook county, location is simply a overmuch stronger relation betwixt cocaine-positive urine samples and overdose deaths than successful immoderate authorities level data. Fentanyl is besides associated pinch overdose deaths successful Cook county. Hua’s squad is already responding to cocaine’s fame successful nan city.

“Whether it’s meth aliases cocaine, we dainty these arsenic stimulant-use disorders,” Hua said. As portion of this focus, nan wellness section has formed a business pinch Northwestern University to supply “contingency management” – a highly effective curen strategy successful which patients are rewarded for abstaining from supplier use.

According to Kolodny, 1 of nan reasons that nan situation became truthful alarming is because nan attraction is connected deaths, alternatively than prevention.

A crisis of addiction

While decease and supplier proviso surveillance successful nan US is lacking, location is moreover little bully information connected addiction, said Kolodny. “It’s very, very rudimentary, and it was wholly useless until a mates of years ago. It’s called nan National Survey connected Drug Use and Health, truthful you tin extrapolate from astir 70,000 face-to-face interviews, but that’s not adequate.”

In Portugal, there is an agency devoted to search and intervening successful addictive behaviors. The agency aggregates information from wellness agencies, rule enforcement, organization surveys and moreover narcotics recovered successful wastewater study to get a afloat picture. Portugal’s per capita overdose decease complaint is little than 1/30 of that successful nan US.

The US nationalist study is conducted by SAMHSA, an agency whose early nether nan Trump management is uncertain. New rules that will require Medicaid recipients to activity 80 hours a period could besides discuss patients’ expertise to entree curen – it tin beryllium very difficult to activity while successful intensive substance-use recovery. These rules will go into effect successful 2027 nether nan One Big Beautiful Bill Act, signed into rule successful July.

Deaths should beryllium considered a denotation of nan crisis, not nan main outcome, Kolodny explained. “At nan tallness of nan Aids crisis, tens of thousands of group were dying from PCP pneumonia,” he said, “If you had Aids, it knocked retired your immune system, you sewage this type of pneumonia.”

But, Kolodny continued: “We didn’t attack nan Aids situation by calling it a PCP pneumonia epidemic. We realized it was HIV, an infectious illness that tin beryllium prevented done cleanable syringes and condoms, and it tin beryllium treated pinch antiretroviral therapy. But for nan opioid crisis,” he said, we person it backwards. “This is simply a situation of addiction: if you really understand that astir of these deaths are occurring successful group who are addicted, not group saying, ‘Hey, shooting up fentanyl would beryllium a nosy measurement to walk a Friday night.’ It’s group who are really struggling.”

• Contributors
  Visuals: Andrew Witherspoon
  Data editing: Will Craft
  Copy editing: Rusha Haljuci
  Illustration: Angelica Alzona
  

• This article was produced arsenic a task for nan USC Annenberg Center for Health Journalism’s 2025 Impact Fund for Reporting connected Health Equity and Health Systems