Why has the number of deaths from drug overdoses suddenly dropped sharply?

For years, drug overdose deaths in the United States had been rising. This year, data suggests they have suddenly declined. The reason for this decline is a mystery.

Overdose deaths fell by about 10% between last April and this April, according to data from the U.S. Centers for Disease Control and Prevention updated this month. Earlier this year, the CDC reported that overdose deaths in 2023 also fell, by 3% compared to the previous year. It was the first annual decline in overdose deaths since 2018.

NPR said this week that the sudden decline was the first in decades.

“This is exciting,” said Dr. Nora Volkow, director of the National Institute On Drug Abuse [NIDA]the federal laboratory charged with researching addiction, according to the outlet. “This looks real. This looks very, very real.”

Before this decline, the number of fatal overdoses had doubled.

Audacy previously reported that drug overdose deaths increased an estimated 15% in 2021 compared to 2020, with a total of 107,622 deaths. According to the CDC, deaths from overdoses involving synthetic opioids such as fentanyl contributed to the increase in fatal overdoses. According to the Drug Enforcement Administration, fentanyl is 100 times more potent than morphine, and as little as 2 mg is considered a lethal dose.

However, experts point out that overdose deaths remain a serious problem in the country, with over 100,000 deaths from drug overdoses still occurring each year.

“Let's be clear: Too many people we love are still dying from overdoses. Any reduction comes too late for them,” said an analysis published this week by Dr. Nabarun Dasgupta, a street drug expert at the University of North Carolina Chapel Hill, as well as Colin Miller and Adams Sibley.

NPR said Dasgupta was one of the first researchers to spot the trend, and he believes those deaths may have dropped by 15% nationwide. In fact, Dasgupta said some states are seeing a 20% to 30% drop. Emergency room visits related to overdoses have also dropped.

“And everyone we spoke to had a different explanation for why this might be happening,” said Dasgupta's analysis. “Most began by saying that any decline was due to what they were working on. It's great that so many people are finding meaning in their work. But we need to get some truths out there and get the conversation going. And for all of our sakes, don't let up on what you're doing!”

Several factors may play a role, including the changing composition of street drugs, possible tolerance to fentanyl and the increasing availability of medications that can prevent overdoses.

Kevin Donaldson, a man who uses fentanyl and xylazine on the street in Burlington, Vermont, told NPR that many fentanyl users now carry naloxone, a drug that can reverse most opioid overdoses. A report Saturday in The New York Tomes said that 22 million doses of Narcan (the best-known brand of naloxone) were distributed in the U.S. and Canada last year, and that the U.S. Food and Drug Administration began allowing its sale without a prescription last year.

Dr. Yngvild Olsen, an addiction expert with the U.S. Drug and Health Administration, also said the use of test strips that can detect both fentanyl and xylazine has increased, according to The Times. Last March, Audacy reported on the DEA's warning that xylazine, an addictive sedative and animal tranquilizer, could cause flesh rot.

This drug is certainly dangerous, but it may play a role in rapidly reducing overdose.

“Although xylazine is toxic to humans and causes lesions and other serious long-term health problems, it can delay the onset of withdrawal symptoms in some users,” NPR's report said. “Dasgupta said it's possible that this means people are taking fewer potentially fatal doses of fentanyl per day.”

According to the New York Times, Brandon Marshall, an epidemiologist and drug policy expert at Brown University, said many drug users have developed a tolerance to fentanyl over the years as it is increasingly found in street drugs. At the same time, fentanyl may be harder to find due to law enforcement efforts to target its distribution.

Another possible factor could be the end of the COVID-19 pandemic. As Axios reported, “Many of the pandemic-era circumstances — like social isolation, increased stress and people using drugs alone — no longer matter.”

Experts and people living with addiction cited by NPR believe the era of huge increases in overdose deaths is over, for now. Still, Gupta said more resources are needed to combat addiction and overdose deaths in Black and Native American communities, where those deaths are still high.