Fewer than 70,000 Americans died from a drug overdose in 2025, the third consecutive annual fall and the longest run of declines in decades. The figure is roughly where it sat in 2019, before the pandemic. The question of why overdose deaths are falling in the US has no single answer, and the answers on offer are not equally reassuring.

Provisional data released by the Centers for Disease Control and Prevention (CDC) on 13 May puts the 2025 estimate at 69,973, down from 81,313 the year before, a fall of almost 14 per cent. Deaths involving opioids, the largest single category by some distance, dropped to an estimated 44,564 from 55,296. The overdose deaths decline also showed up across cocaine and methamphetamine.

Against the peak, the shift looks substantial. Fatalities reached nearly 110,000 in 2022, a spike associated with social isolation and interrupted access to treatment during COVID-19.

Brandon Marshall, a Brown University researcher who studies overdose trends, told the Associated Press he was cautiously optimistic that the trajectory of the crisis had fundamentally changed. He also cautioned that a decline this rapid can reverse at a similar pace, and that a policy change or a shift in what is being sold could push the figures back up.

Why overdose deaths are falling in the US

Researchers point to several forces pulling in the same direction rather than one cause.

Naloxone, the opioid antidote sold widely as Narcan, is now far easier to obtain, and experts consistently name it as a significant contributor. Treatment capacity has expanded in places, funded partly by billions of dollars flowing from opioid litigation settlements. Regulatory changes in China have reportedly tightened access to the precursor chemicals used to manufacture fentanyl, constraining supply upstream.

Then there are two factors that sit uncomfortably alongside the good news, and they receive a fraction of the attention the others get.

The pool of people at risk has been shrinking. Some research points to fewer teenagers taking up drugs in the first place, which lowers the number of people who will ever stand in front of a lethal supply. The second reason is bleaker. Many long-term illicit drug users have already died. A death toll that falls partly because the population most likely to overdose has been depleted is not a success, and it says something about how long the response took to arrive.

This matters for how the trend is read. Of everything on the list, one factor prevents harm without first requiring someone to survive it. A young person who never starts using never needs naloxone, never needs a test strip and never needs a treatment bed. That part of the overdose deaths decline is quiet, it does not photograph well, and it is the only part with no body count attached.

Where the falls did not happen

Almost every state recorded a reduction. Alabama, New York, North Carolina, Rhode Island and Vermont each saw drug overdose deaths drop by 25 per cent or more. Seven states moved the other way, with Arizona, Colorado and New Mexico registering increases of 10 per cent or more between 2024 and 2025. Marshall suggested the rises in those three may reflect more combined use of fentanyl and methamphetamine.

The unevenness is not new. The epidemic has moved at different speeds in different regions for two decades, shaped by what reaches local markets and what people choose to use.

The supply is moving faster than the response

Alex Krotulski directs the Center for Forensic Science Research and Education in Horsham, Pennsylvania, a federally funded toxicology laboratory that forms part of the national early warning system for illicit drugs. His lab identified 27 new drugs across the whole of 2025. In under five months of 2026, it has already identified 23.

“The drug supply continues to change and evolve,” Krotulski said.

Among the substances on his radar is cychlorphine, a synthetic opioid described as up to ten times stronger than fentanyl. It is being used as a cutting agent, added to other illicit drugs without the buyer’s knowledge. Veterinary sedatives including xylazine and medetomidine have also entered the supply. They kill less readily than synthetic opioids, though they depress breathing, cause users to black out without warning, and in xylazine’s case produce severe wounds that can become infected or necrotic.

A market that adds a new compound every week is a market in which nobody, including the person using, knows what is in the bag.

Policy pulls in several directions

The Trump administration has pointed to the falling numbers as evidence that its crackdown on trafficking is working, while the White House continues to describe overdose as one of the country’s most urgent public health challenges. Claims from senior officials about lives saved through seizures, including FBI director Kash Patel’s assertion that his agency has seized enough fentanyl to kill more than 200 million Americans, and former Attorney General Pam Bondi’s figures running as high as 258 million, have been widely dismissed by experts as overblown.

Programmes aimed at reducing overdose have meanwhile been cut. The Substance Abuse and Mental Health Services Administration notified grant recipients in April that it would no longer fund test strips and kits used to detect fentanyl and xylazine. Shreeta Waldon of the Kentucky Harm Reduction Coalition told CBS News her organisation lost a $400,000 grant that had distributed tens of thousands of strips. Officials say they are moving away from services that facilitate illicit drug use, including clean syringe programmes and hotlines that users can call while consuming drugs.

A White House drug strategy running to almost 200 pages proposes wastewater testing to track illegal drug use in something close to real time, and artificial intelligence to detect smuggled substances and flag patients at high risk of overdose.

Maritza Perez Medina of the Drug Policy Alliance warned that funding cuts combined with the withdrawal of practical tools could increase drug-related harm.

Whether the decline holds

Two forces are now running against each other. The number of people exposed to illicit drugs appears to be shrinking, which pushes the toll down. What those people are exposed to is becoming more potent and less predictable, which pushes it up.

Nearly 70,000 deaths in a single year remains catastrophic, roughly the population of a mid-sized city. The three-year decline is real and worth acknowledging. But the fullest answer to why overdose deaths are falling in the US is partly that fewer people are using and partly that many who did are gone, and only one of those is a strategy. Whether the run continues depends less on how quickly overdoses are reversed and more on how many people are standing in front of the supply to begin with.

---

Sources

• Samantha Anderer, “US Drug Overdose Deaths Drop for Third Consecutive Year”, JAMA, published online 29 May 2026, 2026;335(24):2099, doi:10.1001/jama.2026.6199: https://jamanetwork.com/journals/jama/fullarticle/2849870 Used for: state-level declines of 25 per cent or more in Alabama, New York, North Carolina, Rhode Island and Vermont.
• CDC / National Center for Health Statistics, provisional drug overdose death counts (VSRR): https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
• CDC press release, 13 May 2026: https://www.cdc.gov/nchs/pressroom/releases/20260513.html

• Reuters, “US drug overdose deaths dropped for third straight year in 2025, CDC data shows”, 13 May 2026: https://www.reuters.com/legal/litigation/us-drug-overdose-deaths-dropped-third-straight-year-2025-cdc-data-shows-2026-05-13/ Used for: 69,973 and 81,313 totals, opioid-involved figures of 44,564 and 55,296, naloxone attribution, state increases.
• CBS News / Associated Press, “Overdose deaths fall for 3rd straight year amid a changing drug supply and funding cuts”, 13 May 2026: https://www.cbsnews.com/news/overdose-deaths-decline-2025-rate-cdc-data/ Used for: Krotulski and the Center for Forensic Science Research and Education, cychlorphine, xylazine and medetomidine, SAMHSA test strip letter, Shreeta Waldon and the Kentucky Harm Reduction Coalition, White House drug strategy, Maritza Perez Medina, opioid settlement money, fewer teenagers starting, Marshall’s caution about deaths rising again.
• Al Jazeera and Associated Press, “Drug overdose deaths drop in United States for third year in a row”, 13 May 2026: https://www.aljazeera.com/news/2026/5/13/drug-overdose-deaths-drop-in-united-states-for-third-year-in-a-row Used for: 2022 peak of nearly 110,000, Marshall’s “cautiously optimistic” remark, China precursor controls, Kash Patel and Pam Bondi seizure claims, White House “most urgent public health challenges” statement.