The Mystery of the Massive Decline in Drug Overdose Deaths

There's something strange and wonderful happening on the mean streets of America. Drug overdose deaths are down by as much as 30% in some states. And no one can put their finger on a specific reason.

It's probably a combination of factors that are contributing to the massive drop in ODs. The wide availability of naloxone, a life-saving medication that can reverse the effects of an overdose of opioids, including heroin, fentanyl, and prescription opioid medications, is cited as one big reason for the drop in overdose deaths. Naloxone was approved for over-the-counter sale in March 2023. But the drop in the number of overdose deaths predates the FDA's approval.

The crackdown on mid-level dealers and the war on fentanyl manufacturers may also have contributed to the decline, although many in the law enforcement community doubt that the current efforts at interdiction have played a major role.

Whatever the reasons, the decline in the number of overdose deaths is unprecedented. Some addiction experts think we may have turned the corner on the OD crisis.

"The trends are definitely positive," said Dr. Keith Humphreys, a nationally respected drug policy researcher at Stanford University. "This is going to be the best year we've had since all of this started."

NPR:

Dr. Daniel Ciccarone, a physician and addiction researcher at the University of California San Francisco, said a debate is already underway over what triggered the improvement and what might happen next.

"This is where we're all going to differ. Everyone is going to come out and claim that what they did is what caused the decline," he said.

But Ciccarone agreed that for now, the improvements appear real: "What makes it fascinating is the speed at which it's happening."

"This year overdose deaths [in Ohio] are down 31 percent," said Dennis Cauchon, a harm reduction activist. "The deaths were just plummeting. The data has never moved like this."

The Ohio chapter of Harm Reduction said in a statement, "While the mortality data for 2024 is incomplete and subject to change, Ohio is now in the ninth consecutive month of a historic and unexpected drop in overdose deaths,"

Not everyone is jumping for joy. Street Drug Analysis Lab @ UNC, a public service of the University of North Carolina at Chapel Hill, cautions against getting overly excited by the drop.

But we've been here before. Excitement about dips in overdose indicators end up being transient or explained away by data artifacts. So pardon our skepticism.

Let's be clear: Too many people we love are still dying from overdose. Any decrease is too late for them.

Yet, -15% to -20% decreases in overdose would be unprecedented. To our knowledge, no public health intervention in the United States has ever achieved this benchmark. For example, NIDA spent $343.7 million (!) to show that it was possible to reduce overdoses by 9% in four states in one year. A reduction of this magnitude across the entire country translates to a very strong acting force. Something has changed. And that this is happening without central coordination is a big deal. It had major implications for the way we think about overdose prevention interventions.

"A fifteen or twenty percent [drop in deaths] is a really big number, an enormous impact," said Dr. Nabarun Dasgupta, an expert on street drugs at the University of North Carolina. Dr. Dasgupta is calling for more research to determine how to keep the momentum of reduced drug overdose deaths going.

"If interventions are what's driving this decline, then let's double down on those interventions."

The problem with throwing money at the crisis is that you can't force an addict to enter treatment. Addicts will only seek treatment when they hit rock bottom and are receptive to the idea of entering rehab.

The problem with that is obvious: "rock bottom" for many addicts is the grave. And with a 90%+ recidivism rate for opioid addictions, even if they get treatment, they're very likely to relapse and be at risk again.

The drop in overdose deaths is good news. But we need to wait and see if this is just a transient improvement or if something dramatic and wonderful is happening.