US drug deaths plunged in 2024. Trump cuts may reverse that, experts warn.

Boston Globe

14-05-2025

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The progress comes after drug deaths, which had been rising for more than a decade, soared to staggering levels during the coronavirus pandemic, surpassing 100,000 each year starting in 2021.
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'I would characterize this as a historically significant decrease in overdose deaths,' said Brandon Marshall, a Brown University School of Public Health epidemiologist who studies overdose trends. 'We're really seeing decreases almost across the entire nation at this point.'
The data published Wednesday charts a dramatic decline in deaths during then-President Joe Biden's final year in office. The Trump administration has espoused hard-line rhetoric on fentanyl, declaring traffickers a top national security threat and citing them as a key reason for launching trade battles with China and allies Canada and Mexico.
The administration has also touted large fentanyl seizures and asked Mexico to allow the US military to conduct counternarcotics operations on Mexican soil, a request denied by that country's president.
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The CDC, in a statement, noted that Trump during his first administration declared the opioid crisis a public-health emergency in 2017. The declines since 2023 are a 'strong sign that public health interventions are making a difference and having a meaningful impact,' the agency said. 'Despite these overall improvements, overdose remains the leading cause of death for Americans aged 18-44, underscoring the need for ongoing efforts to maintain this progress.'
The White House Office of National Drug Control Policy, in an April statement of policy priorities, emphasized curbing the flow of illicit fentanyl, along with expanding access to treatment and research into cutting-edge technologies to identify and address emerging drug threats.
But public health advocates are raising alarm that the Trump administration is undercutting those goals with plans to gut federal funding that helps states pay for overdose antidotes, addiction treatment and other measures. A survey conducted by the nonprofit research firm Rand published in May suggests that more people may be using illicit opioids than previously estimated, underscoring the need for better monitoring.
In a letter to Congress on Monday, more than 300 academics warned that the Trump administration's proposed cuts to the Substance Abuse and Mental Health Services Administration and CDC could 'undermine the hard-fought progress we have made, especially in overdose prevention.'
Experts also worry Republican plans to slash Medicaid could leave former drug users without access to medication, forcing them to turn to street drugs, said Chad Sabora, a drug policy expert who helped organize the letter. 'It will equal more people dying,' he said.
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What explains the drop?
The opioid crisis began decades ago with highly addictive prescription pain killers flooding states. Users later turned to cheaper street heroin, which was largely replaced by fentanyl manufactured by Mexican organized crime groups with precursor chemicals sourced from China. The synthetic drug can be up to 50 times more potent than heroin.
No single reason explains the sudden drop in deaths, researchers and health officials stress.
The Biden administration credited seizures of fentanyl at the southern border, arrests of high-level Mexican drug traffickers and cooperation from Beijing to crack down on unscrupulous Chinese companies exporting precursor chemicals. The administration also expanded access to addiction treatment medications such as buprenorphine, which wards off opioid withdrawals, and the overdose reversal drug naloxone. It also embraced harm reduction organizations that have saturated communities with free naloxone, fentanyl test strips and sterile needles to users.
Fewer deaths 'don't just happen overnight. And that's why we can credit them to the Biden administration's work,' said Sheila P. Vakharia, deputy director of research and academic engagement for the nonprofit Drug Policy Alliance.
Experts also believe that
the illicit drug supply, at least in some regions, may be shifting to include less fentanyl. Other drugs added to fentanyl - such as the tranquilizer xylazine - may prolong the sedating effect and
stave off opioid withdrawal so that users consume less fentanyl each day, researchers theorize.
Declines in deaths may also reflect the grim reality that fentanyl has killed so many regular users that there are fewer people at risk of overdose. The trajectory of deaths 'can't keep going up. It has essentially to kind of burn itself out,' said Caleb Banta-Green, an addiction expert and drug researcher at the University of Washington School of Medicine.
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During Biden's first three years, the death toll topped 100,000 each year.
Deaths during a 12-month period peaked in June 2023 at a staggering 114,670, making the rapid drop nationally all the more remarkable, said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill. He stressed that deaths had been falling in certain regions where fentanyl had been entrenched for longer.
'Americans have responded to the overdose crisis with powerful community efforts, from every small town to large city. What we are seeing is the fruit of all that collective labor. These local efforts are the heart of overdose prevention,' Dasgupta said.
A state-by-state look
The CDC data released on Wednesday is not definitive; final death statistics lag because toxicology testing often takes months to complete.
Deaths involving stimulants such as methamphetamine and cocaine - which users increasingly take alongside fentanyl - also decreased, the statistics show.
Two states, Nevada and South Dakota notched slight increases from the previous year. But nearly all states showed declines in 2024. States such as New Hampshire, West Virginia and Ohio recorded declines of 35 percent or more.
In Washington state, where fentanyl became entrenched years later than on the East Coast, suspected drug deaths dropped by nearly 12 percent, after years of increases, for a total of 3,167.
In King County, home to Seattle, health officials distributed 124,700 naloxone kits in 2024 and opened three vending machines for people to obtain the medication, fentanyl test strips and other supplies.
County officials and the University of Washington Department of Emergency Medicine also debuted a hotline for doctors to prescribe buprenorphine through free telehealth sessions at any time of day. The city's mayor in August announced an investment of nearly $3 million in opioid litigation settlement money to increase capacity for inpatient treatment.
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But the state health department's top medical officer, Tao Kwan-Gett, urged cautioned. Washington overdose deaths fell through much of 2024 but spiked during the final four months of the year.
'It's too early to say that we're seeing a sustained decrease,' Kwan-Gett said. 'I certainly hope we are, but I think we have to continue being vigilant.'
The encouraging statistics in Washington and nationwide belie the heartbreak of addiction - and death.
Among the victims nationwide in 2024: a 17-month-old Los Angeles boy who ingested fentanyl during a child welfare-monitored visit with his mother; a 15-year-old girl who fatally overdosed on fentanyl at her Georgia high school, nine people who fatally overdosed in Austin, during one day.
In Seattle, former movie set designer Wade Paradise battled an opioid addiction for years after taking prescription pain killers. He was largely estranged from his family, living in squalor and suffering from myriad ailments, according to his daughter, Nathalie Paradise, 24.
She said Wade Paradise had struggled to get addiction treatment because of problems with health insurance. In December, he died at age 68 in his home from a pill made of fentanyl. His death received little attention but for Nathalie's GoFundMe page in which she recalled cherished childhood memories of summer swims in a lake and bargain hunting at thrift stores - and detailed his addiction.
'I didn't want it to be a secret anymore. I felt like the people in his life deserved to know the truth,' she said in an interview. 'I also have a lot of friends who use drugs, and I hoped that by sharing my story, it might encourage them to stop.'
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