The deadliest phase of the street fentanyl crisis appears to have ended, as drug deaths continue to drop at an unprecedented pace. For the first time, all 50 states and the District of Columbia have now seen at least some recovery.
A new analysis of U.S. overdose data conducted by researchers at the University of North Carolina at Chapel Hill also found that the decline in deaths began much earlier than once understood, suggesting improvements may be sustainable.
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"This is not a blip. We are on track to return to levels of [fatal] overdose before fentanyl emerged," said Nabarun Dasgupta, lead researcher on the project, which examined overdose records from the Centers for Disease Control and Prevention.
Dasgupta's team found deaths linked to fentanyl and other street drugs have already plunged in many states to levels not seen since 2020. That's when the spread of fentanyl and the COVID pandemic dealt a one-two punch, triggering a catastrophic surge of fatal overdoses.
"After all this time looking at overdose deaths, this is what we've been hoping for," Dasgupta said. "It has been a complete shock to see the numbers declining in the way they have been."
Overall drug deaths in the U.S. are down roughly a quarter, according to provisional CDC data. That includes fentanyl and other illicit drugs like cocaine and methamphetamine.
Dr. Nora Volkow, head of the U.S. government's National Institute on Drug Abuse, said the decline in fatal overdoses linked to fentanyl is even greater.
"From fentanyl it's a 30.6% [drop in deaths] in one year. That's a huge reduction," Volkow said. "It's very, very exciting to see."
Fewer deaths as drug users adapt and use Narcan
Drug deaths in the U.S. have now dropped from a peak of 114,000 in 2023 to just under 87,000, according to the latest provisional data from the Centers for Disease Control and Prevention.
In the Kensington neighborhood of Philadelphia, where drug use has long been a widespread public health concern, many people told NPR they believe the situation has improved.
"I can tell, you know, the numbers [of people dying] dropped a lot," said Elena, who regularly smokes fentanyl and xylazine, also known as tranq.
NPR agreed not to use the last names of people who were interviewed about their drug use because the activity is illegal under state and federal law.
"A lot more people started smoking instead of shooting [injecting fentanyl with needles] and I think that made a difference," Elena said. While still highly risky, research suggests smoking fentanyl is considered safer than injecting.
Elena's partner, Vadim, who also smokes fentanyl laced with xylazine, said people facing severe addiction have adapted to fentanyl's incredible potency, often using smaller quantities.
"I think people have adjusted. When fentanyl first came out, people were used to shooting heroin. That's why they were dying. You need a lot less [fentanyl]," he said.
One other factor, they said, is naloxone, also known as Narcan, which is much more widely available now. The medication is used to reverse overdoses. Elena and Vadim said they had both been "narcaned" repeatedly by friends, which might have saved their lives.
Public health experts say these factors — along with more readily available addiction treatment and a decline in the potency of street fentanyl — likely contributed to the rapid decline in fatal overdoses here and around the country.
Statewide in Pennsylvania, drug deaths are down roughly a third from the peak. At least 18 states have seen similar drops, with Arkansas (40% drop) and North Carolina (52.9% drop) achieving the biggest improvements.
"It's very, very exciting to see that it's dramatically decreasing," Volkow said.
Could the U.S. return to "normal" drug death levels not seen since fentanyl hit?
Volkow and Dasgupta said there's growing evidence this shift is long-term and sustainable, though they agreed it's still not clear why deaths are dropping so fast.
Indeed, Dasgupta's more precise analysis of CDC records found many states actually saw overdose deaths begin dropping in 2021 and 2022, much earlier than previously reported.
"It's a clear public health improvement no matter how you measure it. It has been sustained in some states for years," Dasgupta said.
Dasgupta and Volkow also said that if the current trend holds, the U.S. could return to a level of fatal overdose not seen since 2016, when fentanyl began replacing heroin in the street drug supply.
"It would be exciting if one could return to those values, because fentanyl just turned us upside down," Volkow said.
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The latest CDC provisional data did show five low-population Western states experiencing an uptick in drug deaths, including fentanyl, in 2024. The cumulative rise of roughly 260 fatal overdoses was clustered mostly in Nevada. But even those states are now below their peaks.
The result nationally is roughly 25,000 fewer deaths from fentanyl and other street drugs.
More survivors means more need for health care and addiction treatment
Still, Dasgupta — and other addiction experts interviewed by NPR — said this isn't a moment to declare victory. People surviving addiction to fentanyl and other toxic street drugs are often still profoundly unwell.
Christopher Moraff works for a nonprofit group in Pennsylvania called PA Groundhogs that tests street drug samples, monitoring for changes in the illegal supply sold by gangs and dealers.
According to Moraff, the latest samples show fentanyl potency dropping by as much as 50%, often replaced by powerful animal tranquilizers such as xylazine and medetomidine.
"Xylazine causes severe wounds on people but it requires a large amount of it to be fatal," he said, a sharp contrast with fentanyl, which can be deadly even in tiny doses.
Dr. Ben Cocchiaro, a Philadelphia physician who treats patients experiencing addiction in the Kensington neighborhood, agreed that new drugs being sold on the street appear to kill fewer people, while still causing serious harm.
"It does seem to be less lethal, but not less dangerous," Cocchiaro said. "We're seeing plenty of problems that come from [these substances]. Xylazine has really bad skin wounds. Medetomidine has just a terrible withdrawal syndrome."
As more people avoid fatal overdoses, experts said there could actually be a rise in visible drug use in neighborhoods like Kensington, accompanied by a sharp increase in need for health care, housing, recovery treatment and other support.
"In some ways, counting bodies is easier than counting the amount of trauma and infections and other harms that people are experiencing from an unregulated drug supply," Dasgupta said.
Back on the street, Elena and Vadim agreed that while fewer people are dying, the drugs they use often leave them dangerously ill.
"I did end up with some tranq sores, some wounds," said Elena, referring to xylazine by its street name.
She was also infected with MRSA, a medication-resistant strain of bacteria that spreads on contaminated street drug gear.
"I was hospitalized for that. It was pretty bad," she said.
Still, experts said the fact that tens of thousands of people like Vadim and Elena are still alive nationwide represents major progress. Addiction research shows people who use drugs often achieve long-term recovery, if they can avoid fatal overdoses.
"Recovery is possible, it's how much you want it," Vadim said. "We've both had clean time [between drug-use relapses] so you know, it's possible."
"I have hope," Elena said. "I have to, you know?"
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