Podcast
Joseph Friedman, University of California San Diego - US Overdose Deaths Dropped in 2024 Amid Uneven Progress
The fourth wave of the opioid crisis may be receding, but progress is still uneven overall.
Joseph Friedman, resident physician at the University of California San Diego School of Medicine, examines this.
Faculty Bio:
Joseph Friedman, MD, PhD, MPH joined UC San Diego School of Medicine as a Psychiatry Research Medical Resident from the University of California, Los Angeles, where he completed his MD and PhD in Social Medicine. Before that, he undertook a master’s in public health and a three-year data science fellowship at the Institute for Health Metrics and Evaluation at the University of Washington. His research combines epidemiological and anthropological approaches to studying substance use, drug overdose, mental illness and other socially-bound causes of mortality and morbidity. He has a particular interest in the US-Mexico border region, and has spent several years living and working in Tijuana, Mexico.
Transcript:
After years of record-breaking increases, drug overdose deaths in the United States fell sharply between 2023 and 2024. In our new study, we found that the national overdose death rate declined by almost a quarter, driven largely by decreases in deaths involving illicit fentanyl.
These findings represent a significant turning point in the overdose crisis. Researchers often describe the epidemic as unfolding in four waves: prescription opioids, heroin, fentanyl and, most recently, fentanyl combined with stimulants such as methamphetamine and cocaine. For the first time, we observed declines in deaths involving both fentanyl and stimulants, suggesting that the fourth wave of the crisis may also be beginning to recede.
This is a historic shift. After years of watching overdose deaths climb higher and higher, it is encouraging to see evidence that the trend is moving in the opposite direction.
At the same time, the findings offer important reasons for caution. Deaths involving methamphetamine and cocaine without fentanyl continued to increase and accounted for a growing share of overdose fatalities. If these trends continue, stimulants may soon surpass opioids as the defining addiction-related public health challenge in the United States. We also found that xylazine, a veterinary sedative increasingly found in the illicit drug supply, was involved in a growing proportion of overdose deaths.
The study also highlights persistent inequities. Although Black Americans experienced the largest decline in overdose death rates between 2023 and 2024, their rates remained substantially higher than the national average. American Indian and Alaska Native populations continued to experience the highest overdose death rates of any group we examined.
The recent decline in overdose deaths is encouraging, but it does not mean the crisis is over. Sustaining this progress will require continued investment in addiction treatment, harm reduction and overdose prevention, while ensuring that the communities most affected by the epidemic are not left behind.
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