Why have overdose deaths decreased? Widespread fentanyl saturation and decreased drug use among key drivers
Deborah Dowell, Nisha Nataraj, S. Michaela Rikard, Joohyun Park, Kun Zhang, Grant Baldwin
Abstract
While overdose deaths remain high in the United States (U.S.), national data show a 25.0% decline in overdose deaths from the year ending in March 2025 compared to the previous year. Reductions since 2015 in the population exposed to overdose risk through drug use may have until recently been offset by an increased per-person mortality risk, driven by replacement of heroin with fentanyl in the drug supply. We estimated overdose deaths and counterfactual scenarios from 2016 to 2023. An estimated 109,783 additional people would have died from opioid overdose if the population exposed to opioid overdose risk had remained constant rather than declining; an estimated 260,024 fewer people would have died from overdose if probability of fentanyl involvement in opioid overdose deaths had remained constant rather than increasing. Fentanyl's representation in the U.S. drug supply appears to be a key driver of overdose trends. A declining population exposed to overdose risk over the last decade may be related to prior deaths and to evidence-based efforts to prevent substance use and opioid use disorder.