Fentanyl-related overdose deaths in the US dropped by 34 percent from 2023 to 2024, falling from nearly 73,000 to under 48,000. This decline, observed across demographics and regions, appears linked to reduced purity in illegal fentanyl supplies. While marking progress in the opioid crisis, experts caution that other drug deaths are rising and the trend may not last.
The US has faced a severe drug overdose crisis since 1999, with more than 1 million deaths recorded. After steady increases, total overdose deaths fell by about 3 percent in 2023 and then by 26 percent in 2024. Researchers Joseph Friedman at the University of California, San Diego, and Chelsea Shover at the University of California, Los Angeles, analyzed data from the National Vital Statistics System and the Centers for Disease Control and Prevention’s WONDER database to identify drivers of this shift.
Fentanyl deaths declined sharply, while those from stimulants like cocaine and methamphetamine without fentanyl rose by over 4 percent, from around 18,000 to nearly 19,000. The drop occurred uniformly across races, sexes, regions, and most age groups. Shover noted, “If it was about increasing broad access to harm reduction and treatment services, you might be expected to see more of an effect on other drugs.” She added, “But since we saw it across the board, that makes me think it is something in the drugs themselves.”
Supporting evidence comes from Daniel Busch at Northwestern University, who found declines in deaths involving fentanyl combined with other drugs, such as a 35 percent drop in cocaine-fentanyl cases. The US Drug Enforcement Agency reported fentanyl purity in seized powder peaking at 25 percent by weight in mid-2023 before falling to 11 percent by late 2024, possibly due to China’s crackdown on precursor production starting in November 2023. However, Shover questioned the timing: “I think the timing of when restrictions happened, and enforcement of such restrictions, doesn’t line up very cleanly [with falling overdose deaths].”
Friedman described the opioid epidemic as having four waves—prescription opioids, heroin, fentanyl, and fentanyl-stimulant combinations—all now declining. Yet, preliminary data suggests the fentanyl drop may be leveling off. Deaths from cocaine, methamphetamine, xylazine, and the veterinary sedative medetomidine are increasing. Sam Stern at Temple University Hospital reported routine intensive care admissions for medetomidine withdrawal in 2024, a new development since its detection in 2022.
Despite the progress, overdose deaths still totaled nearly 80,000 in 2024. Busch emphasized, “The fact it is coming down doesn’t mean that we’ve solved the crisis. We are still losing so many people.” Friedman warned, “We can’t just celebrate this [fentanyl] victory. We still need to pay attention to the way things are shifting.” Shover added, “We do not yet have good evidence that the changes in the supply we saw in 2023 and 2024 are durable.”
