The U.S. overdose death rate fell 24.4% from 2023 to 2024, marking the first decline across all four previously defined waves of the overdose crisis, including the fentanyl- and stimulant-driven “fourth wave,” according to a study published June 2 in Addiction.
Researchers from the University of California San Diego and NYU Grossman School of Medicine in New York City analyzed national overdose death records from the CDC’s Wide-ranging ONline Data for Epidemiologic Research (WONDER) database, examining all overdose deaths recorded between January 1999 and December 2024. Death rates were evaluated by race, ethnicity and substance involvement.
“We are seeing a historic shift in the overdose crisis,” said Joseph Friedman, MD, PhD, resident physician in the Department of Psychiatry at UC San Diego School of Medicine and the study’s first author, said in a June 2 news release. “But this is not the end. The substances involved are changing, some parts of the crisis are still growing, presenting new challenges. We need to avoid interpreting declining national numbers as a sign that the crisis has been resolved.”
Here are six things to know:
- Deaths involving fentanyl combined with stimulants — the hallmark of the fourth wave — decreased in 2024 after years of increases. Researchers said all four overdose crisis waves now appear to be in decline.
- The decline was largely tied to reductions in fentanyl-related overdose deaths, both with and without stimulant involvement. Fentanyl deaths without stimulants fell from 31,193 in 2023 to 19,673 in 2024, while fentanyl deaths with stimulants fell from 41,583 to 28,062.
- While fentanyl deaths fell, overdose deaths involving stimulants without fentanyl increased from 18,142 in 2023 to 18,907 in 2024. These deaths accounted for 23.8% of all overdose deaths in 2024, up from 17.3% in 2023.
- Non-Hispanic Black and African American individuals experienced the largest decline in overdose death rates, with rates falling 29.3% between 2023 and 2024. However, their overdose death rate remained 1.51 times higher than the national average.
- Non-Hispanic American Indian and Alaska Native individuals had the highest overdose death rate in 2024 at 50.8 deaths per 100,000 people, more than double the national average of 23.7 per 100,000.
- Although overall overdose deaths declined, xylazine remained a growing concern. The drug was involved in 8.3% of fentanyl-related overdose deaths in 2023 and 12.6% in 2024, according to the study.
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