While the U.S. has recently seen a welcome downturn in drug overdose deaths, a new study from Northwestern Medicine is the first to pinpoint when the tide began to turn - identifying August 2023 as the national inflection point in the crisis.
"This is an unprecedented shift in the modern drug crisis," said corresponding author Lori Post, director of the Institute for Public Health and Medicine's Buehler Center for Health Policy and Economics at Northwestern University Feinberg School of Medicine.
"Even with this promising decline, drug overdose death rates remain near historic highs. Things are better but still not good. For context, current mortality surpasses previous national crises dating back to the mid 1800s."
The study was published June 12 in JAMA Network Open.
The findings reveal that fentanyl-related deaths are declining two to three times faster than stimulant-related deaths, and that methamphetamine overtook cocaine as the dominant stimulant involved in overdoses by 2020.
The study further breaks down drug overdose deaths by region, substance type and demographics.
The Midwest began decelerating in 2022; The West in 2024
The Midwest began decelerating a full year earlier than the national average - in 2022 - but this shift went largely unnoticed, Post said. In contrast, the West did not enter deceleration until 2024, marking a two-year regional lag.
"Different regions mean different outbreaks and recovery time periods," Post said. "These differences are not simply disparities in outcomes; rather, they reflect distinct epidemic timelines. The West 'caught fentanyl' later than other regions, with widespread exposure not occurring until 2019-2020. They were the last to catch fentanyl, so the last to recover."
This is the first study to distinguish between a sustained decline and a temporary plateau, Post said. After years of rising deaths, brief plateaus occurred approximately in 2018 to 2019, and again in 2022 to 2023. Recognizing these as pauses - not turning points - allowed the study authors to identify the true onset of decline beginning in August 2023.
Not sure what drove the decline
The study did not examine which policies, programs or interventions drove this decline.
"The supply side likely explains much of the downturn - pointing to upstream drivers like shifts in the drug supply rather than downstream fixes such as harm-reduction strategies and treatment," Post said. "But without identifying what worked, we risk losing ground."
The scientists controlled for seasonal noise - such as annual spikes in deaths around the winter holidays - to distinguish temporary declines from sustained downturns.
The study is titled, "Decline in US Drug Overdose Deaths by Region, Substance, and Demographics." Other Northwestern study authors include Maryann Mason, Soyang Kwon, Alexander Lundberg and Shivangi Sharma.
Funding for the study was provided by the National Institute on Drug Abuse (grant 1R21DA058583-01), part of the National Institutes of Health.
