For the first time in the recorded history of the US overdose epidemic, death rates have declined across all four defined waves of the crisis. A study published in June 2026 in the journal Addiction, led by researchers at the University of California San Diego, found that the national overdose death rate fell by 24.4% between 2023 and 2024, dropping to 23.7 deaths per 100,000 people. That is, by any measure, a significant shift.

But the picture is more complicated than the headline suggests. Even as fentanyl-related deaths tumbled, overdose deaths involving stimulants without fentanyl continued to climb, and racial disparities remain stark. Understanding what these trends mean, and where the risks are now concentrated, matters enormously for communities, families and those working to protect public health.

What Are the Four Waves of the US Overdose Crisis?

The US overdose epidemic has unfolded in phases, each defined by a shift in the substances driving deaths. The first wave, beginning in the late 1990s, was driven by prescribed opioids. The second saw a sharp rise in heroin-related deaths. The third wave arrived with illicitly manufactured fentanyl flooding the drug supply. The fourth and most deadly wave involved fentanyl used in combination with stimulants such as methamphetamine and cocaine, a pattern characterised by particularly high lethality.

The new data show that all four waves are now in decline. Deaths involving fentanyl without stimulants fell from 31,193 in 2023 to 19,673 in 2024. Deaths involving fentanyl combined with stimulants dropped from 41,583 to 28,062 over the same period. The fourth wave had never previously declined.

Overdose Death Rates: Progress That Must Not Be Mistaken for Resolution

The 24.4% fall in the national overdose death rate is the kind of number that can easily be misread. It reflects genuine progress. But approximately 80,000 people still died from drug overdoses in the United States in 2024. To put that in perspective, if the US had the same overdose death rate as Western Europe, around 9,000 lives would have been lost rather than 80,000. The US remains a global outlier.

“We are seeing a historic shift in the overdose crisis,” said lead author Dr Joseph Friedman. “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.”

The causes of the decline are likely multiple. Researchers point to greater public awareness of fentanyl’s risks, shifts in how opioids are consumed, possible disruptions to the illicit fentanyl supply chain and changes in the size of the at-risk population due to years of premature mortality not being replaced by new individuals entering fentanyl use. Provisional 2024 data may also be subject to slight revision as final records are released.

The Stimulant Problem Is Growing

While fentanyl-related overdose death rates fall, a different concern is rising. Deaths involving stimulants without fentanyl increased from 18,142 in 2023 to 18,907 in 2024. These deaths accounted for 17.3% of all overdose fatalities in 2023 but rose to 23.8% in 2024.

Researchers warn that if this trajectory continues, stimulants such as methamphetamine and cocaine could surpass opioids as the primary addiction-related public health challenge in the United States. Stimulant use carries its own serious long-term risks beyond overdose, including cardiovascular damage, neurological consequences and psychiatric illness. Substance-induced psychosis linked to methamphetamine use has also risen in recent years.

This shift means that focusing solely on overdose death counts as the key measure of the addiction crisis may increasingly miss the broader picture of harm. Researchers suggest that more comprehensive indicators, such as disability-adjusted life years, may better capture the full scale of what stimulant use is doing to individuals and communities.

Racial Disparities in Overdose Death Rates Remain Severe

The study found important variation across racial and ethnic groups, and the disparities it documents are sobering.

Non-Hispanic Black and African American individuals experienced the largest relative decline of any group assessed, with overdose death rates falling by 29.3% between 2023 and 2024. That improvement, though real, leaves their overdose death rate at 36.0 per 100,000, which is 1.51 times the national average.

Non-Hispanic American Indian and Alaska Native individuals had the highest overdose death rate of any group in 2024, at 50.8 per 100,000, more than double the national average of 23.7. Their rate fell by 20.1%, a below-average relative decline despite an above-average absolute drop.

Non-Hispanic White individuals saw a rate and decline broadly in line with the national average, at 24.8 per 100,000 and a 23.9% reduction respectively.

These disparities reflect long-standing structural inequities, and the data make clear that they are not resolving on their own. Cocaine-involved overdose deaths disproportionately affected Black Americans, at 3.13 times the national average by 2024. Methamphetamine-involved deaths disproportionately affected American Indian and Alaska Native communities, at 3.24 times the national average. Xylazine, a veterinary sedative increasingly present in the illicit drug supply, was also disproportionately implicated in deaths among Black Americans, at 1.66 times the national average.

“National trends can improve while vulnerable communities continue to suffer disproportionately,” said Dr Friedman. “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.”

What These Overdose Death Rate Trends Mean Going Forward

The decline in all four waves of the US overdose crisis is, on the evidence, unprecedented. The fentanyl-driven emergency that dominated public health discourse for a decade is showing genuine signs of retreat. That is significant, and it reflects the real consequences of sustained effort across many sectors.

At the same time, the data carry clear warnings. Stimulant-related deaths are rising as a share of the total. Xylazine involvement in fentanyl deaths grew from 8.3% in 2023 to 12.6% in 2024. And the communities that have suffered most throughout this crisis continue to bear a burden well above the national average.

The challenge now is to build on the progress, direct resources where disparities are most pronounced, and resist the temptation to treat falling national numbers as a finished story.

Source: dbrecoveryresources