Overdose fatalities fell last year, but the full picture is more complicated

Overdose fatalities declined 3 percent in the United States in 2023, marking the first significant decrease in these tragic deaths in five years.

More than 107,500 people died from drug overdose last year, according to preliminary federal data released Wednesday, compared to more than 111,000 deaths in 2022.

“It’s encouraging to see that in 2023 we are starting to see a decrease, finally,” said Farida Ahmad, a mortality statistician with the National Center for Health Statistics, which analyzes these data for the Centers for Disease Control and Prevention.

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The majority of fatal overdoses in 2023 were linked to fentanyl and other synthetic opioids, according to the CDC data, but deaths linked to these substances were down overall. Methamphetamines, cocaine and natural and semi-synthetic substances were also linked to overdose deaths.

“For the past three years, we have made unprecedented investments and taken historic actions to address this crisis head-on, and we are committed to doing everything we can to continue building on this progress and save lives,” said Dr. Rahul Gupta, director for the White House Office of National Drug Control Policy, in a released statement. “There is still much more to be done.”

The latest numbers are based on estimates and information states receive on individual death certificates. Because not all states have turned over data for 2023 overdose deaths, the CDC estimates how many deaths occurred that year based on data available so far and previous trends, Ahmad said. Final data for 2023, along with data showing disparities in overdose rates across generations and among racial and ethnic groups, will be available later this year.

“Our thoughts remain with those who have lost loved ones and those who are struggling with addiction or know someone who is,” said Dr. Debra Houry, the CDC’s chief medical officer, in a released statement. “Our country is committed to ending this epidemic and preventing unnecessary death and suffering.”

While these national figures offer a rare glimmer of good news on this grim issue, outcomes vary greatly in different states. Some places, including Indiana, Maine, Nebraska and Kansas, are estimated to have experienced a 15-percent decline in overdose deaths compared to what they reported in 2022, according to CDC analysis.

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However, areas of the western U.S. endured significantly more fatal overdoses. In Washington, Oregon and Alaska, those fatalities rose 27 percent or more in 2023 alone, according to the latest data.

Tao Sheng Kwan-Gett, chief science officer for the Washington State Department of Health, said more widespread use of fentanyl likely drove up overdose deaths. More than 3,000 people died from overdose in the state last year.

Fentanyl is cheap, easy to manufacture, far more potent than heroin and can be easily packaged in counterfeit medications or mixed with other substances, Kwan-Gett said. It is quickly processed by the body, leading to severe withdrawal effects that keep people on an ever-tightening loop of use, he said.

“Someone may start off using fentanyl to get high, eventually they’re using it to avoid these severe withdrawal symptoms,” Kwan-Gett said.

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Public health and state officials have been working on multiple fronts to reduce overdose deaths, he said. Their three strategies include:

• Increasing access to medication that treats opioid use disorder, with efforts focused on people who are at higher risk for overdose, including those who have been incarcerated or are unhoused.
• Increasing harm reduction programs, including distribution of naloxone, an antidote that reverses overdose and can save a person’s life.
• Communicating more about opioids, but to raise awareness and to reduce stigma.

“Decreasing stigma results in increasing treatment,” Kwan-Gett said.