Drug Overdose Deaths Fall Even as New Threats Emerge

Drug Overdose Deaths Fall Even as New Threats Emerge

Opioid treatment and prevention measures show promise, but the use of potent synthetic nonopioid substances is growing.

Rhode Island banned the sale or advertisement of kratom products to individuals under 18. (Newsday LLC/Getty Images)

Over the past two decades, the United States has experienced persistently high rates of drug overdose deaths, increasing by about 520% from 1999 to 2023, according to the Centers for Disease Control and Prevention. Recent data, however, indicates a shift.

The number of overdose deaths fell by nearly 3% from 2022 to 2023, the first year-over-year decline the CDC has recorded since 2018. Preliminary estimates suggest that 76,516 Americans died from overdose between April 2024 and April 2025, representing a 24.5% decrease compared with the previous year.

Experts attribute the decline to increased access to the opioid antagonist naloxone, wider distribution of fentanyl test strips, shifts in the illicit drug supply and increased public awareness, among other factors. While this progress is encouraging, thousands of Americans still die from drug overdoses every year.

State Actions

States addressed overdose and substance use in 2025 by increasing access to naloxone and nonopioid pain treatments, and allocating opioid settlement funds to support prevention and treatment.

• Arkansas required the state Department of Human Services to ensure that FDA-approved nonopioid drugs receive coverage comparable to opioids for the treatment of pain.
• Colorado increased the availability of naloxone in schools and required the state to consult with the Colorado Youth Advisory Council on opioid use among young people.

States continued to use opioid settlement funds to reduce overdose deaths in their communities.

• Iowa allocated a portion of the state's opioid settlement funds to the Office of the Attorney General to fight the opioid crisis. The bill also provided the Department of Health and Human Services with funding to support a youth nonprofit, an opioid treatment program and grants to establish recovery community centers.
• Maryland established the Buprenorphine Training Grant Program to assist counties in training paramedics to administer buprenorphine, an opioid partial agonist that reduces physical dependency on opioids and increases safety in overdose cases. The bill also requires the state Office of Overdose Response to convene a work group to study barriers to buprenorphine in the state.

Some states increased or allowed access to equipment that allows individuals who intend to take a drug to test it for deadly fentanyl.

• Indiana removed fentanyl test strips from the state's list of drug paraphernalia, allowing legal possession and distribution of the strips.
• Illinois required curricula for grades six through 12 to include fentanyl education and test strip use.

New Threats

While fentanyl remains a major concern, other potent synthetic opioids continue to emerge as threats to the safety of American communities. These include nitazines, phenibut, nitrous oxide, tianeptine (known as "gas station heroin"), kratom and xylazine (a veterinary anesthesia linked to 11% of opioid-involved overdose deaths). These substances can be used alone or in combination with other drugs, such as opioids or stimulants. Using drugs in combination can increase the risk of an overdose and complicate overdose reversal efforts. For example, xylazine and other nonopioid drugs do not respond to naloxone in an overdose.

Many states acted in 2025 to get ahead of these emerging threats.

• Oregon prohibited retailers from selling nitrous oxide canisters to individuals under 18.
• Utah added tianeptine and phenibut to its list of Schedule I controlled substances to better control who makes, sells and uses the drugs.
• Nebraska added xylazine to its list of controlled substances.
• Rhode Island prohibited the preparation, distribution, sale, possession and advertisement of kratom products labeled as a conventional food or beverage. The state also banned the sale or advertisement of kratom products to individuals under 18.

Looking Ahead

States are preparing for new and evolving drug threats using information from the National Drug Early Warning System, updated by the National Institute on Drug Abuse, and the "Overdose Prevention" section of the CDC's Morbidity and Mortality Weekly Report.

While lawmakers have made progress in reducing overdose deaths, they can expect new and emerging drug threats to affect the health and safety of their communities. Ultimately, sustained collaboration among executive and legislative agencies and the communities they serve remains key to protecting Americans and ensuring safety nationwide.

Molly Widoff is a former policy analyst with NCSL's Health Program; she is no longer with the organization.