Fentanyl overdose deaths in the U.S. appear to have peaked in the summer of 2023, according to a new study from the University of North Carolina at Chapel Hill. Researchers found that while many states saw declines in 2022 and early 2023, larger states didn’t start seeing a downturn until mid-2023.
But before anyone breathes a sigh of relief, experts warn that these gains are fragile.
“Abrupt changes in drug policy could perturb the balance and reverse these encouraging gains,” the researchers wrote.
So what’s behind the decline? To find out, researchers analyzed state-by-state data, looking for patterns and policies that may have contributed to the shift.
As Emily’s Hope reported in November, opioid overdose deaths in the U.S. dropped to their lowest levels since 2020, marking a full year of monthly decreases. The Drug Enforcement Administration (DEA) attributed the decline to its crackdown on drug cartels. But the UNC researchers aren’t convinced.
“Most states had already reached peak OD well before major cross-national DEA actions (Operation Blue Lotus, Operation Apollo, Operation Plaza Strike, etc.). The declines started before the 2024 arrests of Sinaloa Cartel bigwigs,” researchers wrote.
While shifts in the drug supply may have played a role—such as the rise of xylazine around the same time deaths began falling—researchers say other factors were likely more significant.
In Louisiana, an initiative helped patients with substance use disorder access buprenorphine in emergency rooms, alongside widespread community naloxone distribution. In Arizona, the drop in deaths coincided with a major increase in reported naloxone use. And in Indiana, overdose deaths doubled in Indianapolis when law enforcement ramped up drug seizures in 2020 and 2021—suggesting that busts may actually drive overdose rates up. However, a surge in treatment providers aligned with a decline in deaths.
Researchers also noted that overdose deaths in many states surged during COVID, had a sustained or quick peak, then declined.
However, Washington, Oregon and Alaska have seen a linear increase in deaths that’s just peaking (or yet to peak). Some states also have unique trend lines, such as Arizona with a clear seasonal trend, and South Dakota where data is too sparse and noisy to detect a pattern.
Researchers says one thing is clear: there’s no single explanation for the national drop in fentanyl deaths. Researchers say more access to local-level data—often restricted or unavailable—could help piece together a clearer picture of what’s working
