Falling fentanyl deaths drive historic drop in American drug overdoses

Researchers from the University of California San Diego have found that U.S. overdose death rates declined dramatically between 2023 and 2024, marking the first recorded drop in all four waves of the nation's overdose crisis. The study, published on June 2, 2026 in the journal Addiction, found that the nationwide decrease was largely driven by falling deaths involving illicit fentanyl, both alone and in combination with stimulants such as methamphetamine and cocaine. Despite the encouraging trend, researchers warn that overdose deaths involving stimulants without fentanyl, as well as xylazine-related deaths, continue to rise and racial disparities remain severe.

We are seeing a historic shift in the overdose crisis. But this is not the end. The substances involved are changing, some parts of the crisis are still growing, presenting new challenges. We need to avoid interpreting declining national numbers as a sign that the crisis has been solved."

 Joseph Friedman, MD, PhD, MPH, resident physician, Department of Psychiatry, UC San Diego School of Medicine and study's first author

The researchers analyzed national overdose mortality data from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (WONDER) database, examining every recorded overdose death in the United States between 1999 and 2024. The team tracked trends by substance involvement and race and ethnicity, allowing them to map how the overdose crisis has evolved over time.

The study found that the national overdose death rate fell by 24.4% between 2023 and 2024, dropping to 23.7 deaths per 100,000 people. The decline was primarily linked to decreases in fentanyl-related deaths. Deaths involving fentanyl without stimulants fell from 31,193 in 2023 to 19,673 in 2024, while deaths involving fentanyl combined with stimulants dropped from 41,583 to 28,062.

Researchers describe the U.S. overdose epidemic as unfolding in four waves: prescription opioids, heroin, fentanyl and, most recently, fentanyl combined with stimulants such as methamphetamine or cocaine. The new findings show that the fourth wave - considered especially lethal because of use of multiple substances - declined for the first time in 2024.

At the same time, the study identified emerging warning signs. Deaths involving stimulants without fentanyl continued increasing, rising from 18,142 deaths in 2023 to 18,907 in 2024. These deaths accounted for 17.3% of overdose fatalities in 2023 but grew to 23.8% in 2024. Xylazine, a veterinary sedative increasingly found in the illicit drug supply, was also implicated in a growing share of fentanyl-related overdose deaths.

Researchers warn that if these trends continue, stimulants such as methamphetamine and cocaine may soon surpass opioids as the defining addiction-related public health challenge in the U.S.

"Overdose deaths are only one part of the picture," said Steffanie Strathdee, PhD, senior author of the study and professor of medicine at UC San Diego School of Medicine. "Stimulants are also associated with long-term cardiovascular, neurological and psychiatric harms that can devastate individuals and communities."

The researchers also found substantial racial and ethnic disparities. Non-Hispanic Black individuals experienced the largest decline in overdose death rates between 2023 and 2024, with rates falling by 29.3%. However, the overdose death rate for Black Americans remained more than 1.5 times higher than the national average in 2024. Meanwhile, Non-Hispanic American Indian and Alaska Native populations had the highest overdose death rate of any group studied, at 50.8 deaths per 100,000 people - more than double the national average.

The study also showed that cocaine-related deaths disproportionately affected Black Americans, while methamphetamine-related deaths disproportionately affected American Indian and Alaska Native communities. Xylazine-related overdose deaths were also especially elevated among Black Americans.

Researchers say the causes of the recent decline in overdose deaths are likely complex and multifactorial. Possible explanations include a reduced number of susceptible individuals, greater awareness of fentanyl risks, expanded availability of naloxone, changes in drug use behavior and possible disruptions in the illicit fentanyl supply chain. The authors caution that provisional 2024 mortality data could still change slightly as final records become available.

Even with the recent decline, overdose deaths in the United States remain extraordinarily high compared with other countries. Even with the recent decline, overdose deaths in the United States remain a global outlier. Researchers note that approximately 80,000 people died from drug overdoses in the U.S. in 2024 - far more than would be expected if the country had overdose death rates comparable to Western Europe. Researchers say continued investment in addiction treatment, harm reduction programs and targeted public health interventions will be essential to sustaining progress and reducing persistent inequities.

"National trends can improve while vulnerable communities continue to suffer disproportionately," Friedman said. "The next phase of the response needs to focus not only on lowering overall deaths, but on making sure those gains reach the populations that have been hit hardest."