In 2024, overall overdose deaths fell 27% in the U.S., dropping from 105,007 deaths in 2023 to 79,384 deaths in 2024, according to a Sept. 3 report from The Commonwealth Fund. Provisional data show approximately 70,000 deaths in 2025.
The findings point to a broader lesson for states: Reducing overdose deaths requires multiple interventions that make prevention and treatment easier to access and target resources to individuals at greatest risk. But federal and state funding and policy changes could threaten access to some of the programs highlighted in the report.
The Commonwealth Fund analyzed overdose mortality data in U.S. states and reviewed state policies and initiatives addressing overdose deaths.
Here are six things to know:
1. Overdose deaths declined across nearly every state. West Virginia recorded a decrease of 556 deaths, or 42%; California recorded 2,350 fewer deaths; Florida recorded 2,052 fewer deaths; and New York recorded 1,881 fewer deaths. South Dakota was the exception, with an absolute increase of three deaths.
2. Expanding low-barrier naloxone access is a key state strategy. Maryland more than doubled distributions between 2021 and 2025 to over 460,000 doses, with growth concentrated in low-barrier settings including vending machines, EMS leave-behind programs and opioid-associated disease prevention and outreach programs. Missouri reached naloxone saturation in 2021 through a centralized purchasing and distribution model.
3. Statewide distribution models are being used to reach high-risk populations. Virginia launched REVIVE! in 2013 and, following its 2023 saturation plan, naloxone is largely free to high-risk populations statewide. Ohio has offered no-cost naloxone as of August 2022 and has naloxone vending machines in prisons and at highway rest stops.
4. States are combining harm-reduction tools, expanded coverage and targeted interventions. The report highlights drug testing strips and other harm-reduction services. Ohio’s RecoveryOhio Early Warning system predicts ZIP codes at heightened overdose risk 30 days in advance. The approach gives the state an early-warning mechanism for identifying communities facing heightened overdose risk and targeting overdose-prevention efforts.
5. Integrating treatment into correctional settings is another focus. New York provides services in all 58 jail systems and 41 prisons, reaching nearly 20,000 people, and medications for opioid use disorder increased sevenfold between 2022 and 2025. Ohio provides naloxone release kits upon reentry and initiated a long-acting injectable buprenorphine pilot in 2024. Maryland’s 2024 Medicaid 1115 waiver extended coverage to incarcerated people 90 days before release, with a pilot in two facilities in 2026 before statewide expansion.
6. Funding and policy changes could threaten access to harm-reduction tools. In April 2026, SAMHSA said agency funding could no longer be used for drug use supplies including drug testing strips. The report also warned that Medicaid cuts could adversely affect access to medications for opioid use disorder and naloxone. At the state level, Colorado’s Naloxone Bulk Purchase Fund reaches all 64 counties at no cost, but its funding is not permanent. The report recommended sustained funding for existing programs and financing models such as value-based payment.
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