Drug Deaths Are Finally Declining. Nobody Really Knows Why.
Drug-related deaths in the United States—which have risen nearly every year for the last two decades, often by double-digit percentages—are expected to fall substantially this year. According to preliminary data from the Centers for Disease Control and Prevention (CDC), the death toll for the 12-month period ending in April 2024 was 101,168, compared to 112,470 for the 12-month period ending in April 2023. That 10 percent drop, assuming it holds up, is striking when compared to the previous trend.
Since the CDC is still reporting more than 100,000 drug-related deaths a year, compared to 20,000 or so at the turn of the century, it would be premature to celebrate. The current numbers, in fact, are still substantially higher than the death toll recorded in 2020, when drug-related fatalities surged by a record 30 percent. Still, a double-digit annual decrease would be unprecedented and may signal the beginning of a long-awaited reversal in ever-escalating drug fatalities, especially in light of the more modest 3 percent drop between 2022 and 2023.
There are several possible explanations for this development, some more plausible than others. But the bottom line is that no one really knows why this is happening now, although it is clear that we cannot credit the efforts of politicians who have been risibly promising to “stop the flow of illicit drugs” for more than a century.
Nabarun Dasgupta and two other drug researchers at the University of North Carolina found that the downward national trend indicated by the CDC’s provisional counts was consistent with state-level mortality data and with overdose cases reported by hospitals and emergency responders. They estimate that nonfatal overdoses are down by 15 percent to 20 percent nationwide, and they note that several states have reported big declines in drug-related deaths, emergency calls, and hospital visits.
“A 15-20% decrease in non-fatal overdose and a 10% decrease in fatal overdose is a major impact,” Dasgupta and his colleagues write. “There is barely any public health intervention that has credibly achieved this magnitude of decrease. Our conclusion is that the dip in overdoses is real, and not a data artifact. It remains to be seen how long it will be sustained. If it is sustained, whatever caused it would be one of the strongest ‘interventions’ ever witnessed in this domain of public health. Therefore, we need to next consider the possible causes.”
Dasgupta et al. say it is “unlikely” that anti-drug operations along the U.S.-Mexico border have played a significant role in reducing fatal or nonfatal overdoses. They note that recent border seizures have mainly involved marijuana and methamphetamine rather than illicit fentanyl, which is implicated in around 90 percent of opioid-related deaths and more than two-thirds of all drug-related deaths.
Instead of reducing those deaths, methamphetamine seizures may have had the opposite effect. “We detected a sudden increase in meth adulteration over the Summer, starting in May 2024, exactly corresponding to the increase in border seizures,” Dasgupta et al. report. “The number one adulterant of meth was fentanyl. So, the impact of the border seizures may be bi-directional: Decreasing fentanyl-only overdoses and increasing fentanyl-methamphetamine overdoses.”
More generally, Dasgupta et al. note that drugs seem to be “getting cheaper and cheaper across the board,” citing price and purity trends in North Carolina.
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