America’s opioid epidemic continues to ravage communities nationwide, though recent data shows some hope. Drug overdose deaths dropped by 14.5 percent between June 2023 and June 2024. Yet the crisis remains severe, with provisional data showing 74,972 drug overdose deaths in the United States. We have a long way to go, but we can build on this progress. The harsh reality shows more than 107,000 people died from drug overdoses in 2023. Opioids like fentanyl caused almost 70 percent of these deaths.
The nation’s opioid crisis looks vastly different today than it did in 2000. Annual overdose deaths have multiplied six times from 17,500 to over 106,000 in 2021. Law enforcement’s seizure of over 115 million illicit fentanyl-containing pills in 2023 shows the massive scale of this synthetic opioid threat. Death rates vary by a lot between states, and the numbers paint a grim picture. Fentanyl and related synthetic opioids led to roughly 71,000 drug overdose deaths in 2021. In this piece, we’ll get into the latest opioid crisis data, look at regional patterns, and learn what these numbers reveal about this evolving public health emergency.
CDC Reports Record 2024 Overdose Deaths
CDC’s National Center for Health Statistics has released provisional data that shows a major change in America’s opioid crisis trajectory.
Over 115,000 deaths projected nationwide
The latest CDC data paints a different picture than expected. Drug overdose deaths in the United States dropped to an estimated 80,391 during 2024. This marks a substantial 26.9% decrease from 110,037 deaths recorded in 2023 [1]. The numbers show the first major decline since 2018 [1]. We have a long way to go, but we can build on this progress as these figures still mean about 220 lives are lost each day across the nation [2]. The provisional data suggests annual drug overdose deaths will reach their lowest level since 2019 [1].
States showed varying levels of improvement. Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, Wisconsin, and Washington, D.C. saw remarkable declines of 35% or more [1]. In stark comparison to this, South Dakota and Nevada went against the national trend and showed slight increases compared to 2023 [1].
Fentanyl remains the leading cause
The overall death rate has dropped, but fentanyl continues to fuel the opioid epidemic in the United States. Fentanyl overdose stands as the leading cause of death for Americans aged 18-45 [3]. This synthetic opioid proves 50 times stronger than heroin and 100 times stronger than morphine. It factored in nearly 70% of the United States’ drug overdose deaths last year [3].
The provisional data shows opioid-related overdose deaths dropped from an estimated 83,140 in 2023 to 54,743 in 2024 [1]. Fewer deaths from fentanyl drove this reduction. Fentanyl-related deaths decreased from over 76,000 in 2023 to just over 48,000 in 2024 [1]. The death rate linked to fentanyl remains high, as synthetic opioids factored in about 60% of all overdose deaths last year [3].
Comparison with previous years
This downward trend marks a major reversal after years of steady increases. Overdose rates shot up during and after the COVID-19 pandemic. The numbers jumped from a yearly plateau of roughly 70,000 to an all-time high of nearly 115,000 [1]. The United States hasn’t seen such a decrease in drug overdose deaths since 2018 [1].
Looking at the bigger picture reveals a crisis of historic scale. Today’s annual opioid overdose deaths are more than six times higher than in 1999 [2]. The opioid epidemic has claimed more than 645,000 American lives since it began [2].
The mix of substances causing overdose deaths has changed. Fentanyl deaths saw a significant drop, but deaths from stimulants like methamphetamine rose from 29,456 to 37,096 [1]. Deaths involving cocaine increased by about 8,000 year over year, reaching 30,833 in 2024 [1]. These changes suggest that while we’re making progress against fentanyl, other substances pose growing threats.
Which States Saw the Sharpest Increases?
State-level data tells a deeper story about America’s opioid epidemic than national numbers alone. The crisis affects different regions unevenly, and recent years show Western states face growing challenges while some Eastern states see better outcomes.
Top 5 states by overdose death rate
West Virginia remains the hardest hit by the opioid epidemic. The state recorded 90.9 fatal overdoses per 100,000 people in 2021 [4]. This number is nowhere near the national average, and opioids played a role in about 83% of West Virginia’s 1,501 overdose deaths [4]. Tennessee (56.6 per 100,000), Louisiana (55.9 per 100,000), Kentucky (55.6 per 100,000), and Delaware (54 per 100,000) rounded out the top five states with highest overdose death rates in 2021 [4].
The crisis has taken a new direction recently. Alaska now ranks second in drug overdose deaths nationally at 53 per 100,000 people, behind only West Virginia’s 73 per 100,000 [4]. Western states like Nevada (47 per 100,000), Washington state (46 per 100,000), and Oregon (45 per 100,000) have also moved into the top 10 [4].
Western states show a troubling uptick in overdose deaths. Nevada, Utah, and Alaska’s death rates kept climbing even as national numbers dropped in 2024 [5]. Alaska saw a sharp 42% rise in the year ending April 2024. Oregon followed with a 22% increase and Nevada with an 18% increase [4].
States with declining trends
Some positive news emerges from many states. Almost every state reported fewer overdose deaths in 2024 according to early data [6]. Seven states stood out with big improvements – Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, and Wisconsin, plus Washington, D.C., all saw deaths drop by 35% or more [6].
Nebraska led the way with a 30% reduction, followed by North Carolina’s 23% decrease. Vermont, Ohio, and Pennsylvania each saw 19% fewer deaths [4]. Drug overdose death rates in the Midwest and Northeast returned to pre-pandemic levels by October 2024. The Midwest hit 21.58 per 100,000 (lowest since 2016) while the Northeast reached 21.02 per 100,000 (lowest since 2015) [5].
How ‘opioid deaths by state’ data is compiled
The National Vital Statistics System’s mortality data provides the foundation for state-level opioid statistics. Drug overdose deaths are tracked using the International Classification of Disease, Tenth Revision (ICD-10) [7]. The system uses codes X40–44 (unintentional), X60–64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent) to classify these deaths [7].
Researchers use additional ICD-10 codes (T40.0, T40.1, T40.2, T40.3, T40.4, or T40.6) to identify opioid-specific cases [7]. These codes help track different types of opioids, from natural varieties to synthetic ones like fentanyl. However, they can’t tell the difference between prescribed and illegal fentanyl [7].
Early counts often end up lower than final numbers because investigations take time and reports come in late [8]. Researchers have developed ways to adjust these early counts by making predictions [8]. Death certificates can be updated even after the mortality file closes [7], which means the statistics might change as new information comes in.
How Drug Type Influenced the 2024 Surge
America’s drug crisis changed dramatically throughout 2024. Different substances created unique patterns in mortality rates that paint a complex picture of the opioid epidemic across the United States.
Synthetic opioids (fentanyl) dominate
Synthetic opioids—mainly fentanyl—proved the deadliest substances in America’s drug supply with 48,422 deaths in 2024. This shows a major drop from 76,282 deaths in 2023 [1]. Notwithstanding that, fentanyl causes about 60% of all overdose deaths [9]. Fentanyl’s strength—50 to 100 times more powerful than morphine—explains its major role in death statistics [10]. Illicitly manufactured fentanyl (IMF) has become a serious threat because dealers distribute it widely as fake prescription medications [11].
Rise in psychostimulant-related deaths
While opioid deaths decreased, stimulant overdoses rose at an alarming rate. Psychostimulants (including methamphetamine) led to 29,456 deaths in 2024, climbing from 37,096 in 2023 [1]. Cocaine-related deaths also increased to 22,174 in 2024 [1]. Psychostimulant death rates jumped from 3.9 to 10.4 per 100,000 people between 2018 and 2023 [3]. Stimulants caused nearly 60,000 overdose deaths by 2023, making up roughly 57% of total overdose deaths [12]. Some groups faced higher risks—non-Hispanic American Indian/Alaska Native communities saw psychostimulant death rates surge from 11.0 in 2018 to 32.9 in 2023 [3].
Polydrug use complicates classification
There’s another reason that makes opioid epidemic statistics complex: widespread polysubstance use. Opioids played a role in 73% of stimulant-involved overdose deaths, which represents almost 45% of all overdose fatalities [3]. Opioids contributed to 43.1% of all stimulant-related deaths from January 2021 to June 2024 [3]. This significant overlap makes classification difficult for researchers and treatment providers. People often combine these drugs to ease opioid withdrawal symptoms or balance opioids’ sedating effects [3].
Medical professionals face unique challenges when treating these overdoses. Opioid reversal drugs like naloxone can’t stop stimulant effects, so they need extra treatments for agitation, seizures, or hyperthermia when both substances are involved [3]. Research indicates many overdose victims knowingly took separate stimulant and opioid products rather than contaminated drugs [3].
Why Provisional Data May Underestimate the Crisis
America’s opioid crisis is much worse than official numbers suggest. Data collection methods don’t capture the full scope of this epidemic, and the real impact could be nowhere near what current figures show.
Delays in death certificate processing
Death records take different amounts of time to process based on how someone died and where they lived. Overdose deaths take longer to document than other causes—usually 4-6 months from death until the data becomes available [8]. Drug-related deaths need thorough investigation, and some areas need 12 weeks or more to confirm and report the cause [2].
Different states handle this process differently. New York state’s completion rates after six months ranged from 69.7% to 86.3% (excluding New York City). Massachusetts showed better results at 97.0% to 100%, while Ohio ranged from 93.7% to 98.9% [2]. This creates gaps in national reporting accuracy. A 2019 comparison of early versus final data revealed that New York’s numbers were among the least complete, which means their initial counts likely missed many cases [13].
Pending investigations and reporting lags
Medical examiners often mark overdose death certificates as “pending investigation” while they wait for autopsy and toxicology results [2]. This status leads to undercounting overdose deaths [2]. A newer study, published by Northwestern Medicine, revealed that half of all injury death investigations in the U.S. lacked opioid testing information. This missing data affected one in ten unintentional overdose death investigations [14].
The situation gets worse when officials issue death certificates before they receive post-mortem toxicology results [15]. This rush leads to vague descriptions like “suspected acute drug intoxication” or “possible drug overdose” [15]. Many fatal overdoses involve multiple substances, but this detail often gets lost in the process [15].
How predicted counts are calculated
The CDC developed methods to adjust these early numbers for reporting delays [8]. They create “predicted provisional counts” to make up for missing data in preliminary reports [8]. This process uses multiplication factors to adjust the reported numbers [8].
Past reporting patterns help determine these factors. If early counts were typically 90% complete compared to final data, they’d multiply by 1.1 [8]. The math accounts for both the 12-month period and how many death records are still marked as “pending investigation” [8].
These adjusted numbers aren’t perfect. Early data completeness changes over time, and we won’t know the true extent of underreporting until 11-12 months after the year ends [16]. This means our current understanding of the opioid epidemic in the United States remains incomplete.
What the Data Tells Us About the Opioid Epidemic in the United States
Historical data shows alarming patterns in America’s ongoing struggle with opioid addiction.
Long-term trends since 2000
America’s opioid crisis has unfolded in three distinct waves since 1999. Prescription medications drove the original wave in the 1990s, and overdose deaths with prescription opioids steadily rose until 2011 [4]. Heroin sparked the second wave in 2010, and related deaths nearly tripled from 0.7 to 1.9 per 100,000 by 2012 [4]. The third wave began in 2013 and brought devastating spikes through synthetic opioids, mainly illicitly manufactured fentanyl [17]. Annual overdose deaths multiplied nearly six times during this period, jumping from 17,500 in 2000 to over 106,000 by 2021 [9].
Impact of COVID-19 on overdose patterns
The pandemic substantially worsened overdose trends across the country. Overdose deaths surged approximately 30% between 2019 and 2020 [18]. Depression, anxiety, and stress among other mental health challenges combined with treatment disruptions contributed to this increase [19]. People faced housing instability, financial strain, or early release from correctional facilities without proper substance use disorder care [19]. The pandemic ended up causing about 15,400 additional opioid-related deaths beyond expected numbers [20].
Disparities by race, age, and region
Demographic analysis reveals substantial variations in opioid mortality. Overdose death rates climbed 44% among Black Americans and 39% among American Indian/Alaska Native populations from 2019-2020 [18]. Young Americans face growing risks—opioid toxicity caused 10.2% of all deaths among those aged 15-19 years and 21.7% among those aged 20-29 by 2021 [6]. Regional data shows income inequality associates with racial disparities in overdose rates [18].
Conclusion
The opioid crisis still looms large over America despite some recent improvements. National data shows overdose deaths dropped by 26.9% from 2023 to 2024, yet this epidemic still takes about 220 lives every day. This first major decline since 2018 brings hope, but the crisis remains much worse than it was twenty years ago.
Several key factors shape where we are today. Fentanyl remains the deadliest threat and causes about 60% of all overdose deaths, even with recent declines. Deaths from stimulants keep rising, which shows how substance abuse patterns change even as overall numbers drop. These shifts mean we need prevention and treatment approaches that can adapt quickly.
The crisis hits different regions in unique ways. Western states like Alaska, Nevada, and Oregon now see rising numbers while many Eastern and Midwestern states show big improvements. These regional differences show how communities across the country face varying challenges.
We need to watch our data carefully. Death certificates take time to process, investigations stay pending, and reporting runs behind schedule. Current numbers likely don’t show the full picture, which makes it harder to track progress and give resources to the right places.
COVID-19 showed us how public health crises can make each other worse. Mental health problems, disrupted treatment, and money troubles during lockdowns led to a devastating 30% jump in overdose deaths between 2019 and 2020.
Since 1999, this epidemic has moved through three distinct waves – from prescription medications to heroin and finally synthetic opioids. Recent drops in deaths give us hope, but the huge number of lives we still lose means we can’t let our guard down. We must keep pushing for new solutions with care and compassion.
Each number represents someone’s life cut short and families changed forever. Moving forward requires strategies that tackle prevention, treatment, harm reduction, and the social issues that drive substance use disorders in America.
References
[1] – https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250514.htm
[2] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10905759/
[3] – https://www.cdc.gov/mmwr/volumes/74/wr/mm7432a1.htm
[4] – https://www.cdc.gov/nchs/data/hestat/drug_poisoning/drug_poisoning.htm
[5] – https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835230
[6] – https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807054
[7] – https://www.kff.org/mental-health/state-indicator/opioid-overdose-deaths/
[8] – https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
[9] – https://www.shadac.org/opioid-epidemic-united-states
[10] – https://www.yalemedicine.org/news/fentanyl-driving-overdoses
[11] – https://www.oregon.gov/oha/ph/preventionwellness/substanceuse/opioids/pages/fentanylfacts.aspx
[12] – https://www.cdc.gov/overdose-prevention/about/stimulant-overdose.html
[13] – https://www.osc.ny.gov/reports/continuing-crisis-drug-overdose-deaths-new-york
[14] – https://news.feinberg.northwestern.edu/2025/03/24/opioid-testing-data-unavailable-in-half-of-u-s-injury-death-investigations/
[15] – https://pubmed.ncbi.nlm.nih.gov/37879666/
[16] – https://www.cdc.gov/nchs/nvss/vsrr/prov-county-drug-overdose.htm
[17] – https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
[18] – https://www.cdc.gov/mmwr/volumes/71/wr/mm7129e2.htm
[19] – https://www.cdc.gov/overdose-prevention/media/pdfs/SUDORS-Data-Brief-2.pdf
[20] – https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00023-5/fulltext
