The Centers for Disease Control and Prevention (CDC) announced on May 14 that drug overdose deaths in the United States fell by an unprecedented 27 percent in 2024. With an estimated 80,391 lives lost, the number marks a historic reversal in a decades-long public health crisis that had steadily worsened, reaching a peak of 111,451 deaths in the summer of 2023.
“This is not a sudden decline. It is something that happened gradually over three years state by state,” said Nabarun Dasgupta, senior scientist at the University of North Carolina’s Injury Prevention Research Center and opioid data lab. Dasgupta emphasized that the apparent turning point did not stem from new federal policy, but from years of persistent, community-based harm reduction efforts.
Deaths fell in every state except Nevada and South Dakota, with some of the steepest declines recorded in hard-hit states like Ohio and West Virginia. Nationally, deaths linked to fentanyl and other synthetic opioids dropped from an estimated 76,282 in 2023 to 48,422 in 2024. Fatalities involving stimulants also declined.
These figures represent the largest one-year drop in overdose deaths recorded since the CDC began tracking the data 45 years ago. The previous record decline was just 4 percent in 2018.
Yet despite the welcome news, experts warn against attributing the decline to law enforcement or border control measures that have historically dominated federal drug policy. Customs and Border Protection seized roughly the same number of fentanyl doses in both 2023 and 2024—estimated at 1 billion annually—yet the dramatic drop in deaths only occurred last year.
Dasgupta and other public health experts say that’s no coincidence. “If you look at the CDC graph, the peak month in the overdose death data was June of 2023 or July, so if we use the peak as the starting point, then we are down 30 percent off of the peak,” he said in an interview.
The decline, they argue, reflects a shift in drug user behavior, improvements in harm reduction infrastructure, and community efforts to distribute lifesaving tools like naloxone—not a crackdown on drug users or border seizures.
“In every single community across the nation, there are people who have responded to this huge tragedy we’ve all been experiencing,” Dasgupta said. “And the work and the effort that is done on a day-in and day-out basis where people in communities are taking care of each other — that is at the heart of what is driving this decline.”
One such effort is Project Mayday, a grassroots harm reduction collective based in Charleston, West Virginia, the state with the nation’s highest overdose mortality rate. Despite facing restrictive state laws, volunteers with Project Mayday distribute naloxone and other health supplies directly to people who use drugs. They’ve installed free naloxone dispensers in old newspaper boxes and monitor social media and public alerts to respond to overdose spikes.
“We’ve been getting more naloxone into the hands of people who use drugs. There are more community organizations that are distributing it and actually taking it to the people that need it most,” said Tasha Withrow, co-founder of Project Mayday. “It’s what we’ve got to do because there isn’t anything else. The infrastructure just doesn’t exist.”
Withrow noted that even as deaths decline, the risk remains high. “People are scared. They have an unstable drug supply, and they do not have the resources, and the resources that are available are very minimal because that is all we are legally able to provide,” she said. “There is a lot of risk out there, but a lot of them really do want to take control of their own health and safety.”
Research supports these accounts. Studies in cities like Indianapolis and San Francisco found that law enforcement drug busts often trigger spikes in local overdoses by disrupting the drug supply. This phenomenon, known as the “drug bust paradox,” forces users to seek unfamiliar sources with unpredictable potency—raising the risk of overdose.
“These are two really different cities with really different responses on the public health side, but the effect of police interdiction is exactly the same in both,” Dasgupta said.
Harm reduction experts emphasize that the recent drop in deaths cannot be credited to Trump-era law enforcement policies, including the opioid commission created during his first term. That commission failed to meaningfully curb overdose rates, and its recommendations were largely ignored. Instead, many of the same lawmakers have since used the overdose crisis to promote anti-immigrant rhetoric and militarized border policies.
“The commission created by the first Trump administration to address opioid addiction failed to curb the overdose crisis,” one report noted. “The GOP then turned around and used that crisis as fodder for anti-immigrant propaganda.”
During Trump’s second term, those themes have intensified. He has declared multiple “national emergencies” to justify expanded federal power and used fentanyl smuggling as a pretext for aggressive trade and immigration policies aimed at Canada and Mexico.
In contrast, President Joe Biden’s administration has increased federal health funding for harm reduction in response to years of grassroots pressure. These funds, along with legal settlements against opioid manufacturers and distributors, have helped fuel public health efforts at the community level. One such settlement with the Sackler family, owners of OxyContin-maker Purdue Pharma, could result in up to $7 billion in payments.
Still, challenges remain. In states like West Virginia, restrictive laws criminalize even basic harm reduction practices, such as syringe distribution. “It’s hard to see people miserable because they can’t access resources that are available somewhere else,” Withrow said. “If they were in another state, I would just be able to hand them what I need to hand them, and not be put in jail.”
Some experts warn that reductions in federal public health funding and staffing could stall or reverse progress. Health Secretary Robert F. Kennedy Jr. said prevention efforts will continue, but lawmakers remain skeptical.
U.S. Rep. Madeleine Dean questioned Kennedy directly: “Why the hell” are these changes being made, she asked, when the data shows “we were getting somewhere.”
Dr. Tamara Olt, executive director of the advocacy group Broken No Moore, lost her 16-year-old son to a heroin overdose in 2012. She said the steep drop in deaths validates years of advocacy for a public health approach. “We believe that taking a public health approach that seeks to support — not punish — people who use drugs is crucial to ending the overdose crisis,” she said.
Kimberly Douglas, whose 17-year-old son died of an overdose in 2023, credited awareness raised by families like hers. “Eventually people are going to start listening,” she said. “Unfortunately, it’s taken 10-plus years.”
While the numbers offer reason for cautious optimism, experts say continued progress depends on resisting reactionary drug policies and investing in the people and programs that have already proven effective.
“Now is not the time to take the foot off the gas pedal,” said Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco.
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