After a steep rise during the Covid-19 pandemic, preliminary data shows that drug overdose deaths in the United States ticked down in 2023 for the first time in five years.
About 107,500 people died from a drug overdose in 2023, according to data from the US Centers for Disease Control and Prevention’s National Center for Health Statistics — about 3,500 fewer than in 2022.
Last year’s decrease is the first since 2018, but the 3% drop is far less substantial than the surges that pushed overdose deaths to record levels in recent years. Overdose deaths spiked 30% between 2019 and 2020 and rose another 15% between 2020 and 2021, CDC data shows.
Preliminary data is subject to change as death certificates are reviewed and records are assessed, but estimates suggest that, despite the decline, overdose deaths in 2023 were still almost twice as high as they were five years ago, according to the CDC data.
“It is a hopeful trend in some ways,” said Dr. Katherine Keyes, a professor at the Columbia University Mailman School of Public Health whose research focuses on substance use epidemiology. “We know that this drug epidemic is dynamic and changes quite quickly, so any time you see a leveling off or a slight decrease, it is promising. It is certainly not a sign that we need to take the foot off the gas of overdose prevention.”
The US Department of Health and Human Services launched a coordinated national strategy to prevent overdoses two years ago.
“This progress over the last 12 months should make us want to reinvigorate our efforts knowing that our strategies are making a difference,” CDC Chief Medical Officer Dr. Deb Houry said in a statement, but “there are still families and friends losing their loved ones to drug overdoses at staggering numbers.”
“Our thoughts remain with those who have lost loved ones and those who are struggling with addiction or know someone who is. Our country is committed to ending this epidemic and preventing unnecessary death and suffering,” she said.
Fentanyl has been driving the latest wave of overdose deaths, with synthetic opioids involved in more than two-thirds of overdose deaths. These highly potent narcotics continue to play an outsized role: they were involved in nearly 70% of overdose deaths in 2023. However, there were about 1,500 fewer overdose deaths involving fentanyl and other synthetic opioids in 2023 than in 2022, the new data shows.
Still, the deadly threat of fentanyl — which is about 50 times more potent than heroin — remains. In one indicator of its pervasiveness, a study published Monday shows that law enforcement seizures of illicit fentanyl have surged in recent years.
More than 115 million pills containing illicit fentanyl were seized by law enforcement in 2023, compared with about 71 million in 2022 and less than 50,000 in 2017.
“Fentanyl has continued to infiltrate the drug supply in communities across the United States and it is a very dangerous time to use drugs, even just occasionally,” Dr. Nora Volkow, director of National Institute on Drug Abuse, said in a statement. She was not directly involved in the new study, but the research was funded by the federal agency. “Illicit pills are made to look identical to real prescription pills, but can actually contain fentanyl. It is urgently important that people know that any pills given to someone by a friend, purchased on social media, or received from any source other than a pharmacy could be potentially deadly — even after a single ingestion.”
The number of deaths due to fentanyl remains “alarmingly high,” Keyes said. But the more promising trends reflect significant, multi-pronged efforts from many different sectors, she said, including use of treatments for opioid use disorder, expanded access to naloxone and other harm reduction programs and reducing opioid prescribing.
“I think that has been a real success story for public health,” she said.
While overdose deaths involving opioids declined, those involving cocaine and psychostimulants such as methamphetamine increased, according to the preliminary data from the CDC.
There were more than 36,000 deaths involving psychostimulants in 2023, a 2% increase from the year before. And deaths involving cocaine rose 5%, to nearly 30,000. About a third of all overdose deaths in 2023 involved psychostimulants, and cocaine was involved in more than a quarter.
Much of this increase is likely due to the proliferation of fentanyl throughout the drug supply, Keyes said. “We know that when stimulants mix with opioids, it’s particularly lethal,” she said. But expanded surveillance can help those who are working to address the overdose crisis understand its rapidly changing epidemiology and adapt their efforts in real-time.
Vast disparities in overdose deaths remain, including state-level differences; the latest CDC data shows “notable” increases in some Western states such as Washington and Oregon, with overdose deaths increasing at least 27% year-over-year. In other states, including Nebraska, Kansas, Indiana and Maine, overdose deaths dropped by at least 15%.
“State-to-state differences point to the need for continued expansion of these efforts,” Keyes said. “But I think the trends you see nationally are indicative of how it can work. We can address the opioid epidemic. This is not inevitable.”
For many state and local governments, funds from opioid settlements have been “instrumental” to overdose prevention efforts and increased access to treatment and recovery support, Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health said in a statement.
“Moving forward, jurisdictions will continue to prioritize investments in harm reduction, prevention, and addressing the social determinants of health across communities that have been hardest hit by the overdose crisis,” he said. “Also, state and territorial health agencies will continue to coordinate with partners to build a comprehensive response to this complex public health issue. Lastly, jurisdictions will continue to monitor and prepare to respond to changes in overdose rates and emerging threats within the drug supply.”
Recent surveys suggest that drug use among teens in the US has been relatively low and trending down. But overdose deaths have been rising in this age group and millions of adults and adolescents have a drug use disorder.
“Research has shown that delaying the start of substance use among young people, even by one year, can decrease substance use for the rest of their lives. We may be seeing this play out in real time,” Volkow said. “This trend is reassuring. Though, it remains crucial to continue to educate young people about the risks and harms of substance use in an open and honest way, emphasizing that illicit pills and other substances may contain deadly fentanyl.”