Illicit drug overdoses and the deaths they cause are trending down this year, despite spikes in a handful of states, according to a Stateline analysis of data from the federal Centers for Disease Control and Prevention.
A handful of places with rising overdoses are responding to the problem with cooperation, they say, by sharing information about overdose surges and distributing emergency medication.
“The national conversation is just about warships in the Caribbean and drones and borders,” said Nabarun Dasgupta, who studies overdose trends at the University of North Carolina. “It discounts this huge groundswell of Americans taking care of Americans. There’s a huge amount of caregiving and tending to the needs of local communities that is being done in a non-flashy way because this is hard, slow work.”
Overdose deaths have been dropping steadily since 2023. As of April, the latest date available, deaths were at 76,500 for the previous 12 months — their lowest level since March 2020. A pandemic spike in overdose deaths drove the number as high as almost 113,000 in the summer of 2023, according to federal statistics.
President Donald Trump has ordered more than a dozen military strikes against boats in the open waters of the Caribbean and the Pacific Ocean since Sept. 2, claiming without publicized evidence that their occupants were drug runners bringing narcotics to the United States. Nearly 60 people have been killed.
The bulk of deadly fentanyl is smuggled over the border with Mexico in passenger cars, according to a September report by the federal Government Accountability Office. Chemicals and equipment, mostly from China, are smuggled in via cargo trucks, commercial ships, airplanes and the mail, according to the report.
A more timely indicator of overdoses — nonfatal suspected overdose patients in hospital emergency departments — was down 7% this year through August compared with 2024, according to Stateline’s analysis of CDC statistics.
The nonfatal overdoses were up for the year in only a few states and the District of Columbia. The largest spikes were 17% in the district, 16% in Rhode Island, 15% in Delaware, 11% in Connecticut and 10% in New Mexico, with smaller increases in Colorado, Pennsylvania, Wyoming, South Dakota, Utah, New Jersey and Minnesota.
Other states saw drops in nonfatal overdoses: Maryland had the largest decrease through August, about 17%.
But Baltimore had an attention-grabbing cluster of 42 overdoses between July and October, all within the same neighborhood. No fatalities were reported. The cluster led the city to set aside $2 million in October for more mobile services, harm reduction and social supports to fight overdoses.
New Mexico is seeing more overdoses and more deaths than the previous year in three counties on the Colorado border. In response, New Mexico is distributing both warnings and naloxone, an opioid-overdose antidote.
Officials are giving naloxone to storekeepers near overdose sites and alerting those seeking services about the deadly threat in the local supply.
“We started planning naloxone saturation and different types of outreaches so we can hopefully stem this from getting even worse,” said David Daniels, harm reduction section manager in the New Mexico health department.
“Putting messaging directly into clients’ hands is extremely valuable. That might be, ‘If you’re choosing to use, don’t use the regular amount. Maybe you should use a quarter of it. Test it out first,’” Daniels said.
The three counties in New Mexico — which include the capital city Santa Fe, ski resort Taos and Española, the setting of the 2023 TV black comedy series “The Curse” — saw about 438 more deaths from July through September than they did during the third quarter of 2024, according to Stateline calculations. That’s more than double the 383 overdose deaths for the area during the same time period last year.
Roger Montoya, a former Democratic state representative who runs an arts nonprofit in Rio Arriba County, said most of the deaths there have been among homeless substance users.
A local hospital has responded with programs to get treatment for more people, and his own Moving Arts Española group concentrates on helping children and young people break a cycle of economic despair that often leads to addiction and homelessness, he said.
“We try to redirect and strengthen the resiliency of young people who largely are being raised by grandparents and kin because mom and dad are either dead, on the street or incarcerated,” Montoya said.
But most states with overdose increases are still showing fewer deaths, mostly because the drug supply in the eastern United States is more likely to be cut with sedatives that don’t have the same deadly effect as fentanyl, though they can cause overdose.
The drugs linked to Baltimore’s mass overdoses were cut with an unusual, powerful sedative, according to federal testing. The sedative can cause people to lose consciousness but can’t itself be treated with reversal medication such as naloxone.
By contrast New Mexico’s tests on this year’s clusters generally found more deadly fentanyl than usual in the local supply, said Phillip Fiuty, a technical adviser on adulterant testing in the state health department.
“We’re not seeing the type of adulteration they’re experiencing on the East Coast. Once something is in New Mexico, there’s little to no adulteration,” Fiuty said.
Some East Coast states are seeing more overdoses but fewer deaths. Rhode Island warned of spikes in nonfatal overdose in August and September, but deaths through September were still lower than during the same period last year, according to state figures.
That’s not always the case. Connecticut reported a surge of both fatal and nonfatal overdoses near interstate highways in May and June.
“One of the factors is change in the illicit drug supply or bad batches. I think that’s what’s playing out now. The drug supply is increasingly unpredictable,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
The association has a suggested framework for community response to spikes, but cities and counties may be hampered by a new aggressiveness on enforcement and more hostility to local efforts to stop deaths, she said.
The current Trump administration has shown some reluctance to support community harm reduction techniques, she said. That includes the temporary suspension of $140 million in funds for a program called Overdose Data to Action, known as OD2A, that the first Trump administration started to sound the alarm when spikes happen.
“Given recent cuts to health care and substance use and overdose prevention services that we’re seeing, that is impacting some of the work on the ground,” Freeman said. “It’s pushing people away from being able to make the changes they need to make to change their lives. It has the potential to create more of an overdose problem.”
Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Washington State Standard, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Washington State Standard is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Washington State Standard maintains editorial independence. Contact Editor Bill Lucia for questions: info@washingtonstatestandard.com.