The opioid crisis began in the mid-1990s with the approval and promotion of Purdue Pharma's OxyContin. Since then, drug overdose deaths in the United States have increased significantly. The COVID-19 pandemic exacerbated the crisis, and drug overdose deaths passed 110,000 in 2022.
For the first time since 2018, overdose deaths finally decreased in 2023. Overdose deaths involving opioids, specifically, also decreased. These decreases are good news for everyone involved in fighting the opioid crisis. However, the question is whether the drop in fatal opioid overdoses is a sign that we’ve turned a corner in that fight.
Decrease in opioid deaths in 2023
Provisional data from the Centers for Disease Control and Prevention (CDC) estimates that 107,543 people died from drug overdoses in 2023. That's down 3% from the 111,029 deaths in 2022.
In terms of overdose deaths involving opioids, 81,083 died in 2023 compared to 84,181 in 2022—a decrease of 3.7%. Both of these decreases are positive signs, but they don't tell the whole story of the current state of the opioid crisis.
While deaths involving synthetic opioids like fentanyl decreased from 2022 to 2023, deaths involving psychostimulants like methamphetamine increased over that period. Deaths involving cocaine also increased between 2022 and 2023. Even with these shifts, fentanyl and other synthetic opioids remain the biggest drivers of opioid deaths in 2023.
CDC Chief Medical Officer Deb Houry, MD, said of the new data that it "demonstrates we are making progress to prevent deaths from drug overdoses. However, this does not mean we have accomplished our mission. There are still families and friends losing their loved ones to drug overdoses at staggering numbers."
Statewide trends
Overdose deaths declined significantly in:
- Arkansas
- Indiana
- Kansas
- Maine
- Nebraska
- North Carolina
Others, like Alabama, Hawaii, and Utah, saw overdose deaths increase by 8% from 2022 to 2023.
In Alaska, overdose deaths increased by 44% in 2023—the steepest increase nationwide. Nevada, Washington, and Oregon also saw significant increases in overdose deaths between 28 and 30%.
Like overdose deaths, prescription opioid dispense rates vary significantly across the U.S. Washington and Oregon have some counties with high opioid dispense rates. Still, the counties with the highest dispense rates are largely concentrated around the Southeast.
The role of fentanyl
Although fentanyl deaths in 2023 were lower than in 2022, they remain high. How many fentanyl deaths were there in 2023? Over 74,000 people died from overdose deaths involving synthetic opioids like fentanyl in 2023. That means synthetic opioids played a role in nearly 70% of all overdose deaths from that year.
Fentanyl played a major role in the surge in fatal drug overdoses over the last ten years, fueling a fentanyl crisis. According to Anne Milgram, the head of the Drug Enforcement Administration (DEA), "The shift from plant-based drugs, like heroin and cocaine, to synthetic, chemical-based drugs, like fentanyl and methamphetamine, has resulted in the most dangerous and deadly drug crisis the United States has ever faced."
As little as two milligrams of fentanyl can be deadly. A common myth about fentanyl is that it's only found in a few street drugs, but that's not the case. Part of what makes fentanyl so risky is that it has no taste or smell and is found in a variety of other drugs, including cocaine, methamphetamine, and heroin. People can ingest fentanyl without even realizing it when using illicit drugs laced with fentanyl. Certain groups, like people who are disabled or unemployed, are disproportionately at risk for fatal overdoses involving fentanyl or other opioids.
Possible reasons behind the decrease
The CDC did not provide any data showing the reasons for the overall decrease in overdose deaths in 2023. One possible explanation is that naloxone, a drug that rapidly reverses opioid overdoses, is now more widely accessible. In July 2023, the FDA approved a second naloxone spray product for over-the-counter use. There are also Narcan (naloxone) distribution programs to help opioid users and their loved ones access naloxone for free, like Project DAWN in Ohio.
More widespread access to medications for addiction treatment (MAT) may also have contributed to the decrease. When people dealing with opioid use disorder (OUD) can access treatment, they are less likely to die of opioid-related overdoses.
Trends in non-fatal drug use
Even when drug use does not result in fatal overdoses, it can still be concerning from a public health standpoint. As of 2022, non-fatal opioid-involved overdoses were still increasing. Emergency medical services also saw 4% more non-fatal opioid-involved overdoses each quarter, on average, between 2018 and 2022.
There has also been a recent trend toward lacing illicit drugs with xylazine, also known as tranq. Xylazine is not an opioid but is often mixed with opioids. When paired with opioids, it makes people more likely to lose consciousness or experience an opioid overdose.
During the pandemic, illicit drug use rose among adults but fell among teenagers. Now, post-pandemic, teen drug use has largely stayed below the pre-pandemic levels.
Substance use disorders affect many different groups in many different ways. Opioid addiction affects active service members and veterans, the elderly, and houseless people, each with their own vulnerabilities and unique risk factors. When attempting to address fatal overdoses and non-fatal drug use, policymakers and professionals must consider all these factors to meet the needs of each group.
Challenges to sustained progress
The decrease in overdose deaths, and opioid-related deaths specifically, is encouraging. However, there is still much more work to be done to address the opioid crisis. To achieve sustained progress, it will be necessary to overcome challenges such as:
Insufficient OUD treatment capacity
Being able to provide effective, comprehensive treatment to anyone dealing with OUD who wants it would go a long way toward addressing overdose deaths and the opioid crisis. Currently, there is insufficient treatment capacity to reach all of those patients. Many healthcare providers do not have training in addiction treatment, and there are not enough providers offering MAT to treat all those who need it.
As of 2022, only around a quarter of U.S. adults who needed OUD treatment had received any medication to treat OUD. To maintain long-term progress in fighting the opioid crisis, patients will need more healthcare providers trained in MAT and accessible ways to receive that care.
Social and economic concerns
There are also several social and economic factors still impeding progress against opioid overdoses. Stigma, both from the general public and professionals, can prevent people with OUD from seeking treatment. Mental health concerns increase a person's risk of OUD, but these patients are not significantly more likely to receive treatment.
Poverty, unemployment, and homelessness are associated with higher rates of OUD. Fully tackling the opioid crisis will require addressing these structural factors.
The fight against the opioid crisis continues. Despite the dip in overdose deaths in 2023, more research, resources, education, and treatment options for OUD are essential. Policymakers, addiction professionals, and activists need to do everything possible to break down structural barriers to OUD treatment so more people can get the help they need.
Ophelia makes OUD treatment accessible
Ophelia is proud to play even a small role in making OUD treatment more accessible. We’re committed to providing evidence-based OUD treatment that fits seamlessly into patients’ lives. Our team of clinicians get to know each client on a deep level to create a customized treatment plan. To see if your insurance covers treatment, visit us online today.
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