Why have drug overdose deaths suddenly started to plummet?

For years, drug overdose deaths in the U.S. had been on the rise. This year, data indicates they've suddenly started to decline. The reason behind the drop is a mystery.

According to U.S. Centers for Disease Control and Prevention data updated this month , overdose deaths dropped around 10% between last April and this April. Earlier this year, the CDC reported that overdose deaths also decreased in 2023, down 3% compared to the previous year. It was the first annual decrease in overdose deaths since 2018.

NPR said this week that the sudden drop is the first in decades.

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

Before the drop, fatal overdoses were increasing by double dig percentages.

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

However, experts note that overdose deaths are still a serious issue in the country. There are still more than 100,000 drug overdose deaths occurring annually.

"Let's be clear: Too many people we love are still dying from overdose. Any decrease is too late for them," said an analysis published this week by Dr. Nabarun Dasgupta, an expert on street drugs 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 realize the trend and that he believes these deaths might be down 15% nationally. In fact, Dasgupta said some states are even seeing declines of 20% and 30%. There has also been a drop in the number of emergency room visits linked with overdoses.

"And everybody we talked to had a different explanation why this could be happening," said Dasgupta's analysis. "Most started off by saying any decrease was due to whatever they themselves were working on. Great that so many people find meaning in their work. But we have a job to do in establishing some truths and get the conversation started. And for the love of us all, do not ease up on whatever it is you are doing!"

There are several factors that might be playing a part, including the changing makeup of street drugs, possible tolerance to fentanyl and increased availability of medication that can stop overdoses.

Kevin Donaldson, a man who uses fentanyl and xylazine on the street in Burlington, Vt., told NPR that many people who use fentanyl now carry naloxone, a medication that can reverse most opioid overdoses. In a Saturday report, The New York Tomes said that 22 million doses of Narcan (the most well-known brand of naloxone) were distributed last year in the U.S. and Canada and the U.S. Food and Drug Administration began allowing it to be sold without a prescription last year.

Dr. Yngvild Olsen, an addiction expert at the federal Substance Abuse and Mental Health Services Administration, also said there has been increased use of test strips that can detect fentanyl as well as xylazine, said The Times. Last March, Audacy reported on the DEA's warning that xylazine, an addictive sedative and animal tranquilizer could cause rotting flesh .

This drug is certainly dangerous, but it may be playing a part in the rapid overdose decrease.

"While toxic in humans, causing lesions and other serious long-term health problems, xylazine may delay the onset of withdrawal symptoms in some users," said NPR's report. "Dasgupta said it's possible that means people are taking fewer potentially lethal doses of fentanyl per day."

According to the NYT, Brandon Marshall, an epidemiologist and drug policy expert at Brown University, said many drug users have developed a tolerance to fentanyl over the years that its been increasingly found in street drugs. At the same time, fentanyl might be harder to find due to efforts to target its distribution by law enforcement.

Another potential 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 – are no longer factors."

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