Drug overdose deaths may be decreasing — but not for everyone

Late last month, news outlets reported that drug overdose deaths across the country were “falling fast,” in a “promising” trend that is “saving thousands of lives — But many people working on the ground in harm reduction spaces say the national trend does not align with what they are seeing as they continue to watch people who use drugs in their community die at alarming rates.

In Ashland County, Wisconsin, for example, there were more overdose fatalities in the first half of 2024 than there were in all of 2023, and the majority of people who died were American Indian Alaska Natives, said Philomena Kebec, economic development coordinator for the Bad River Tribe.

“I think we need to celebrate the reduction in overall fatality but it has to be couched within this qualification that some racial groups are not experiencing a decrease in overdoses,” Kebec told Salon in a phone interview. “In fact, we’ve been seeing an increase in overdose fatality rates, and we’re also really hobbled by the data lag in getting this information.”

Provisional data released by the Centers for Disease Control and Prevention (CDC) show that overdose deaths declined nationally by about 10% between April 2023 and April 2024. Another analysis confirmed this decline, performed by researchers at the Street Drug Analysis Lab at the University of North Carolina at Chapel Hill, synthesizing emergency room visits and ambulance runs along with public health data. They also found that non-fatal overdoses were decreasing by an even greater rate of between 15 and 20% over the same time period. Interestingly, the decline seems to be spreading from east to west.

“There has not been a decrease of this magnitude since I started looking at these data from the mid-1990s,” said Dr. Nabarun Dasgupta, a drug policy researcher at the University of North Carolina who performed the analysis. “There was a year or two where it leveled off right before the pandemic, and we were hopeful, but then it went way, way up after that.”

Drug overdose death statistics from Jan. 2015 to Jan 2024. (Centers for Disease Control and Prevention)Theories on what could explain this unprecedented decline abound, but no one knows exactly what is causing it yet. As more people mix drugs like xylazine with synthetic opioids, their exposure to deadly doses of fentanyl could be reduced. Others attribute the decrease to the increased availability of naloxone and medication-assisted treatment like buprenorphine used to treat opioid use disorder. Still others think the trend is likely caused by changes in the drug supply itself.

Or, it could be that we have reached a sad point in the overdose crisis where the number of people who are susceptible to dying from drug use has reached its peak and the number of people impacted is simply starting to recede, said Dr. Daniel Ciccarone, a substance use researcher at the University of California, San Francisco.

“[The number of people using drugs] is not growing, it’s not expanding, it is dying,” Ciccarone told Salon in a phone interview. “The cohort is both going through treatment and through death, making it smaller over time, and that’s led to a small enough population that it looks like deaths are going down.”

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Harm reduction workers say each life lost to an overdose is preventable, which would hold true for the estimated 101,168 people who died from an overdose last year. Some are calling for more granular data analyses to get a clearer picture of who is being “saved” from whatever change is causing this decline — and who is being left behind.

Since 2021, overdose deaths showed signs of plateauing or declining overall in national data, but they continued to rise in Native American, Black and Hispanic communities. American Indian and Alaska Native populations had the highest fatal overdose rates in both 2020 and 2021, increasing by 33% between those years. While analyses of overdose trends by race for the 2023-2024 year have yet to be performed on the national level, it’s unlikely such stark upward trends would suddenly drop.

Some state data has begun to illuminate the racial disparities buried within the CDC data. In Maryland, the decline in overdose deaths in the past year occurred almost entirely among white people, whereas the number of overdose deaths among Black people rose during this time period. In North Carolina, Philadelphia, Massachusetts and Tennessee, among other states plus Washington, D.C, deaths similarly declined for white people and continued to rise among Black people. Dr. Nora Volkow, the director of the National Institute on Drug Abuse, has acknowledged this discrepancy.

“It’s also important to acknowledge that progress has not been equal for all groups,” Volkow told The Guardian earlier this week. “Unfortunately, for the most affected groups, namely Native Americans and Black American men, the death rates are not decreasing and are at the highest recorded levels.” 

“In Black communities across this country, the diminishing death rates are not the story,” said Tracie Gardner, co-director of the National Black Harm Reduction Network. “What the numbers don’t show are what I would say are the policy realities and the narratives of the communities that have been the hardest hit.”

The reasons behind these disparities are rooted in the origins of the overdose crisis, when illegal substances were planted in Black and brown communities to increase incarceration rates. The drug supply changed over time, and the number of people using drugs increased to include higher numbers of white people, some of whom became addicted to prescription opioids and other drugs.

Harm reduction programs and a federal response to curb the overdose epidemic — which has killed more than one million people since 1999  — were enacted. However, many of these interventions failed to reach the Black, Indigenous and Hispanic communities that were most impacted, said Ricky Bluthenthal, the associate dean for Social Justice at the University of Southern California.

“It’s been the case in the entire ‘War on Drugs,’ where the response to substance use disorder among Latino and Black folks has often been to put them in jail, and jail is not where people recover from substance use,” Bluthenthal told Salon in a phone interview.

Harm reduction originated in the movement to increase treatment access for gay men with HIV, Bluthenthal added, but many of these programs were not created with Black, Indigenous and Latino populations specifically in mind.

“I was one of two or three African-American people running the needle exchange program in the United States [in 1991], there were some Latinos, and the other folks were mostly white,” Bluthenthal said. “That reflects where the money was to support those kinds of activities … and we’re still trying to overcome that.”

The consequences of a racialized response to the overdose crisis along with the crisis being fundamentally rooted in a racist initiative, is playing out in the fatal overdose disparities we see today. Bluthenthal coauthored a 2021 study in the journal Drug and Alcohol Dependence, finding that Black and Latino populations in Los Angeles and San Francisco were less likely to have access to naloxone, the life-saving opioid overdose reversal medication. Across several studies, Black, Latino and Indigenous people who use drugs have been shown to have limited access to medications for opioid use disorder, driven in part by healthcare providers’ implicit bias and users’ distrust of the medical system.

Many Black communities might have reduced access to methadone clinics because they have police officers stationed outside, and Black people are disproportionately charged and criminalized for drug possession. Depending on their location, certain harm reduction services might be available in only English, which could discourage Spanish-speaking Latino people who use drugs from seeking care.

Kebec, of the Bad River Tribe, noted that Wisconsin invested in distributing naloxone boxes in 43 locations across the state, but the supply wasn’t accompanied with any sort of funds for educational materials teaching people how to use it. This is one example of how, even when resources are granted, they are not designed to maximize effectiveness in Indigenous and Black communities, she said. 

As a result, her community has continued to see rising overdose deaths among these two groups. One tribal member earlier this year died from a fatal overdose within county jail.

“There are so many disconnects and a lack of accountability for really protecting the lives of Indigenous and Black people in this state,” Kebec said. “It’s this colonial dynamic where they have created a problem and then are just leaving these under-resourced communities to deal with it on their own.”