Before coming to Vox in 2020 and 2021, I was working as a future correspondent at Axios – yes, it was a real position – and I realized that I'm almost simply writing about the Covid-19 pandemic, or a major trend that appears to be pushed by Pandemic.
One of these trends was the surprising increase in deaths caused by drug overdose. The trajectory was already worsening before COVID: between widespread prescriptions and misuse of legal opioids, and the introduction of the super-powerful drug fentanyl into the supply of illegal drugs, overdose deaths in the US began taking off in the early 2010s. However, as I wrote in April 2021, treatment facilities closures and user quarantine during the pandemic led to a sudden surge in deaths over the year leading up to September 2020.
After publishing the work, I received a letter from a reader. Readers said his son was one of the 87,000 deaths. She asked to give more coverage on the issue. It reminded readers of the drug deaths, the shadow epidemic of lost sons and daughters, husbands and wives, behind the community pandemic. People had to stop closing their eyes to the sacrifices of death and pain.
Over the next few years, the victim continued to grow, but death reached 110,000 2023. It appears that there is no answer to one of the worst public health crises of a generation.
But now, at last, we seem to be turning the corner of the drug overdose crisis.
Preliminary figures from the Centers for Disease Control and Prevention's National Important Statistical System released this week show that around 27,000 Americans died of drug overdose in 2024 than in 2023. That means drug deaths are finally returning to pre-pandemic levels.
Think of it like this to put those 27,000 deaths in mind. It saves up to three people on the lives saved every hour for a year.
What's noticeable about the rapid decline in overdose deaths is how widespread the trend is. Ohio and West Virginia (two states suffering more than most other states due to the opioid epidemic) led the way, with 45 states recording a decline in deaths. Only a handful of states in the northwest, where the epidemic began, increased.
Synthetic opioids, primarily meaning fentanyl, are still responsible for most of overdose deaths, but deaths from such drugs have fallen faster than any other drug, down 36% year-on-year.
Reversing the overdose epidemic
One of the biggest factors behind the decline is the increased availability of the opioid antagonist naloxone. When administered immediately after an overdose, naloxone has been shown to be nearly 99% effective in preventing death. Speed is important. Even the fastest emergency care responders may not reach the scene in time to save those suffering from overdose. However, a recent policy to make naloxone available at the counter and advise users to have it on hand has allowed us to revive thousands of people who would otherwise have died.
The pandemic has directly led to a massive surge in overdose deaths, but policies that emerged from Covid have helped to curb tolls, including telehealth access to medical-based treatment options for addictions like buprenorphine. All of these programs are paid in part by billions of opioid-based cash from pharmaceutical companies like Johnson & Johnson, which began flowing to state and local governments in 2024. Fentanyl's stricter enforcement also played a role.
Finally, and not so positive, deaths from overdose over the past few years have exhausted the number of people at risk. Just like the infectious disease epidemic, it becomes slower when new people start to get infected, the overdose epidemic gets so hot that so many people have been killed that the remaining drug users were not vulnerable to fatal overdose.
Not all the news is good. Synthetic opioids like fentanyl appear to be on a sharp decline, but in reality, they died from meths like meta and cocaine last year, and the production of the latter skyrocketed to new highs. The rise in deaths in a handful of states like Alaska and Washington indicates that there are still populations that are highly vulnerable to fatal overdose, at least in some parts of the country.
Most worryingly, the Trump administration's draft proposes a significant reduction in the distribution of naloxone. This can take the most powerful tool to stop overdose deaths from the hands of those who need it the most.
Still, we need to be aware of this new data about what it is. With efforts, it is evidence that one of the biggest public health threats facing the United States can reverse. Thousands of people are alive, even if nothing has changed since I wrote about the epidemic in 2021.
Drug addiction is a horrible disease that can destroy your future, your family, and your life. But where there is life there is hope. All overdose victims brought back by the naloxone spray have another opportunity to change their future and ensure that they don't become different statistics.
This version of the story originally appeared in Good News Newsletter. Sign up here!
