A drop in drug overdose deaths drove most of the 2025 decline in unintentional injury deaths, the largest single contributor to the falling U.S. death rate, according to an Oct. 27 analysis from HHS’ Office of the Assistant Secretary for Planning and Evaluation.
Unintentional injuries accounted for 30% of the decline in the age-adjusted death rate between 2024 and 2025, ahead of COVID-19, cancer and heart disease. Overdoses made up about 73% of the injury decline.
Nearly all of the overdose decline, about 96%, came from deaths involving fentanyl and other synthetic opioids. Those deaths fell 20.7%, from 45,917 in 2024 to 36,406 in 2025. Deaths involving other opioids but no synthetic opioids rose slightly. Non-opioid overdose deaths declined modestly.
ASPE measured both years using the same census population estimates. That adjustment shrinks the overall death rate decline to about 2%, down from the 4.6% the CDC reported in July. The overdose findings hold up under either method because those deaths are concentrated among younger and middle-aged adults, where population revisions were smaller.
The analysts said the data do not show what caused the decline. They noted that the pattern fits a change in the illicit drug supply. They cited DEA data showing that the purity of seized fentanyl powder fell from 19.5% in fiscal year 2023 to 10.3% in fiscal year 2025. Over the same period, the share of tested pills containing a potentially lethal dose fell from 76% to 29%.
The report also listed federal efforts against the opioid epidemic, including:
- the FDA’s 2023 approval of over-the-counter naloxone
- the 2023 removal of the federal waiver requirement for prescribing buprenorphine
- the 2025 reauthorization of the SUPPORT for Patients and Communities Act
ASPE said further progress may depend on reducing avoidable opioid exposure, expanding treatment and overdose reversal, and targeting the illicit synthetic opioid supply.
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