For the third consecutive year, U.S. drug overdose deaths have fallen, marking the longest sustained drop in decades. But addiction leaders warn the gains remain fragile.
Itai Danovitch, MD, chair of the department of psychiatry and behavioral neurosciences at Los Angeles-based Cedars-Sinai Medical Center, told Becker’s what is driving the decline, where gaps persist and how health systems should approach the next phase of addiction care.
Question: The U.S. has now seen three consecutive years of declines in overdose deaths after pandemic-era peaks. From your perspective, what are the biggest drivers behind this trend, and which interventions appear to be making the most meaningful impact?
Dr. Itai Danovitch: The decline is promising, though I also have concerns. The positive drivers include sustained efforts to increase access to effective treatments, harm reduction infrastructure including overdose reversal kits, syringe services, and fentanyl test strips (though many of these programs are now imperiled), and improvement in how health systems identify and engage people with opioid use disorder. However, a less reassuring reason for the decline is survivor bias. So many people have died from overdoses over the last two decades that the pool of susceptible people has decreased. This, together with the fact that we still have around 70,000 overdose deaths per year, remains very concerning.
Q: While overdose deaths are falling nationally, some states continue to see increases tied to fentanyl and methamphetamine use. What does this uneven recovery tell health systems about where addiction care and prevention efforts still fall short?
ID: The differences in death rates across states and regions reflects disparities in illicit drug markets and access to healthcare. States with the highest overdose rates tend to have less treatment infrastructure, less access to services, limited harm reduction, and geographies where care is harder to reach. It is important to recognize that improvements in national trends can obscure serious local crises. There are still many regions and communities where risks are very high. The increase of dangerous adulterants is a significant concern, and it varies considerably by geography. The bottom line is that just because numbers are coming down at the national level does not mean we can take our eye off the ball.
Q: As overdose mortality trends improve, how should health systems think about the next phase of addiction strategy — particularly around integrating behavioral health, primary care and long-term recovery support into mainstream healthcare delivery?
ID: We have to keep our eye on the ball. Our work is not done. The drug supply remains unstable, adulterants continue to emerge, and many people at risk remain disconnected from care. We need to continue expanding access to low-barrier treatment, normalize addiction care in primary care and behavioral health, invest in harm reduction, and sustain public health surveillance. In addition, while the opioid epidemic has garnered a lot of attention, appropriately, alcohol continues to kill approximately 180,000 people per year. Health systems must continue to work to integrate addiction treatment, handling it as a chronic condition with the same effort we expect for diabetes or hypertension, including systematic screening, delivery of evidence based intervention, longitudinal monitoring, and coordination across a continuum of care. We also need reportable quality measures that both incentivize systems to make investments and recognize and highlight successes. Addiction will continue to be a major health challenge, however we have robust interventions and models of care that are highly effective and impactful.
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