Experts Credit Harm Reduction, Not Border Cops, for 27% Drop in Overdose Deaths

The Centers for Disease Control and Prevention (CDC) announced on May 14 that the number of drug overdose deaths in the United States dropped by nearly 27 percent in 2024. The number represents a significant decrease after more than a decade of steeply climbing drug-related fatality rates that billions of dollars in federal spending on policing and border enforcement failed to contain.

At the beginning of 2015, the CDC reported fewer than 50,000 overdose deaths annually. By 2021, that number had surpassed 100,000 before peaking at 111,451 during the summer of 2023. The CDC found massive racial disparities in the data, with the number of deaths recorded between 2019 and 2020 falling among white populations with better access to public health interventions while skyrocketing in Black and Indigenous communities where heavy policing trumped health care, for example.

Each of the 80,391 overdose deaths recorded in 2024 is a tragedy and policy failure, and overdose remains the leading cause of death for Americans ages 18 to 44. However, local data aggregated by the CDC shows decreases in drug fatality rates across all 50 states compared to peak levels, and from 2023 to 2024, deaths linked to fentanyl and other synthetic opioids fell from an estimated 76,282 to 48,422 nationally. The number of deaths linked to stimulants also dropped.

“If you look at the CDC graph, the peak month in the overdose death data was June of 2023 or July, so if we use the peak as the starting point, then we are down 30 percent off of the peak,” said Nabarun Dasgupta, a senior scientist at the University of North Carolina’s Injury Prevention Research Center and opioid data lab, in an interview.

Dasgupta, like other public health advocates, is hopeful that a major public health crisis may be finally turning a corner. But deep cuts to federal health agencies and spending on programs such as Medicaid under President Donald Trump and a Republican-controlled Congress threaten to slow the progress seen in 2024.

Dasgupta and other experts are not applauding U.S. lawmakers for spending billions of dollars every year fighting a global and deeply unpopular “war on drugs” that left lower-income communities devastated by mass criminalization, or for dragging their feet for years before voting to remove barriers to lifesaving addiction medications — although barriers to medications still exist, including inside jails and prisons.

They are also not crediting a broad law enforcement crackdown on opioid painkiller prescriptions that fueled the overdose crisis by pushing desperate patients toward an increasingly dangerous illicit opioid supply.

Instead, federal data suggests the decrease in fatal overdoses is linked to changes in the drug supply and the way people use powerful synthetics like fentanyl, along with increased funding and support for frontline harm reduction groups and health care clinics providing lifesaving services where people live.

“In every single community across the nation, there are people who have responded to this huge tragedy we’ve all been experiencing,” Dasgupta said. “And the work and the effort that is done on a day-in and day-out basis where people in communities are taking care of each other — that is at the heart of what is driving this decline.”

One such effort is Project Mayday, an all-volunteer harm reduction collective based in Charleston, West Virginia, the state with the highest overdose mortality rate in the nation. Despite unscientific restrictions on harm reduction services pushed by conservative state lawmakers, the group distributes first aid and other supplies that help drug users take control of their own health, including naloxone, the lifesaving medication that can reverse a potentially fatal opioid overdose.

Tasha Withrow, a co-founder of Project Mayday, said the group monitors social media and public health alerts for spikes in overdoses and delivers naloxone to people directly. The group has also set up free naloxone dispensers in newspaper boxes for two West Virginia communities, one of several scattered grassroots harm reduction efforts in the state. Withrow attributes the recent decrease in overdose deaths to an increase in the availability of naloxone and other supports.

“We’ve been getting more naloxone into the hands of people who use drugs. There are more community organizations that are distributing it and actually taking it to the people that need it most,” Withrow said in an interview. “It’s what we’ve got to do because there isn’t anything else. The infrastructure just doesn’t exist.”

The 27 percent drop is remarkable after roughly three decades of rising overdose deaths, but Dasgupta said drug police and federal policy makers cannot take credit for decline by pointing to specific actions taken in 2024. The nation has seen a gradual decline in fatalities since 2021, when overdose death rates skyrocketed as the COVID-19 pandemic caused major disruptions that isolated drug users from health care and community supports.

“This is not a sudden decline. It is something that happened gradually over three years state by state, and I think that is the strongest refutation of what is going to be presented as recent intervention in 2024,” Dasgupta said, anticipating that law enforcement may attempt to take credit for the drop.

Both the Trump and Biden administrations spent billions of dollars and installed high-tech equipment in an attempt to seize drugs manufactured in Mexico and smuggled across the southern border, but federal data suggests border enforcement has little impact on the number of overdose deaths. Customs and Border Patrol seized a similar number of fentanyl “doses” at the border in 2023 and 2024 — roughly 1 billion each year, likely an overcount — but the decrease in overdose deaths was much more dramatic in 2024 than in 2023.

In fact, research shows that drug seizures by law enforcement can actually make drugs more dangerous, at least in a local area, a phenomenon known as the “drug bust paradox.” Studies recently conducted in Indianapolis and San Francisco found spikes in overdoses after police made drug busts, which disrupted the local supply and forced users to find new sources or face debilitating withdrawals. This increases the risk of overdose by exposing people to drugs that vary widely in potency.

“These are two really different cities with really different responses on the public health side, but the effect of police interdiction is exactly the same in both,” Dasgupta said.

The decline in death does not reflect one specific policy. Trump issued an order in 2017 declaring the overdose crisis a public health emergency that remains in place, but his first administration focused federal resources on law enforcement and the painkiller crackdown while dismissing lifesaving innovations in harm reduction, including safe consumption sites where people can access basic health care and use drugs under medical supervision.

The Biden administration was applauded for directing federal health funding toward frontline harm reduction efforts after years of pressure from activists, though President Joe Biden faced backlash in the form of a baseless right-wing disinformation campaign as a result.

The commission created by the first Trump administration to address opioid addiction failed to curb the overdose crisis. The GOP then turned around and used that crisis as fodder for anti-immigrant propaganda. Now, Trump 2.0 is using the issue as a political battering ram. Since taking office a second time, Trump has declared multiple “national emergencies” in order to justify an authoritarian federal power grab. He has also pointed to fentanyl smuggling as an excuse to bully trading partners in Canada and Mexico.

Instead of federal policy, Dasgupta and his colleagues identified three main reasons for the decline in deaths after digging through the data. First, field studies suggest general dissatisfaction with the synthetic opioid supply. “Fentanyl” is a specific drug used in emergency rooms, but has become a catch-all term for powerful synthetics that replaced heroin in many communities over the past 15 years. In some areas, fentanyl is adulterated with additives such as the tranquilizer xylazine that can cause nasty side effects, pushing people away from a drug supply linked to a majority of overdose deaths.

“People are scared. They have an unstable drug supply, and they do not have the resources, and the resources that are available are very minimal because that is all we are legally able to provide,” Withrow said, adding that people are still dying of overdose in West Virginia despite the decline. “There is a lot of risk out there, but a lot of them really do want to take control of their own health and safety.”

Drug use is also falling among youth. The bulk of overdose deaths are occurring among middle-aged people, especially men, while fewer young people are initiating opioid use than in the past, according to Dasgupta’s analysis.

The third and perhaps biggest factor is changes in drug user behavior, with more people accessing harm reduction services and embracing strategies to stay healthy and alive. Along with the expansion of Medicaid under the Affordable Care Act, increases in funding from the Biden administration and legal settlements with corporate opioid manufacturers have supported a groundswell of community-level public health interventions, such as the distribution of naloxone and drug testing kits.

“If we make this just about government policy and federal funding, what we effectively do is cut out the voices of all the other people in the middle who have been doing the work on the ground,” Dasgupta said.

Still, the work on the front lines comes with its own set of challenges that Congress could easily eliminate with comprehensive harm reduction legislation. Back in West Virginia, Withrow and other volunteers with Project Mayday are continuing their work despite legal restrictions that no longer exist in other states. The restrictions include a draconian state law regulating syringe exchange services that makes it illegal for volunteers to carry and distribute clean needles, which are needed to keep people healthy and prevent the spread of disease.

“It’s hard to see people miserable because they can’t access resources that are available somewhere else,” Withrow said. “If they were in another state, I would just be able to hand them what I need to hand them, and not be put in jail.”