Drug overdose deaths are on a sustained decline in the U.S., a celebrated development for behavioral health advocates.

“This is the first good news we’ve heard in a while on this front,” National Council for Mental Wellbeing CEO and President Chuck Ingoglia said in a statement. “Let’s hope this decline in fatalities is an indication that we’re turning the corner on overdose deaths.”

However, data show the improvements are uneven across various demographics.

A new analysis of the CDC’s overdose death data by the Kaiser Family Foundation (KFF) states that white people and young people have disproportionately benefited from the myriad efforts to reduce overdose deaths. Reductions in death were muted for all other groups and worsened for one.

In May 2024, the Centers for Disease Control and Prevention announced the first year-over-year reduction in overdose deaths in provisional data since 2018. That decline has sustained through April, the latest figures suggest. Year over year, drug overdose deaths were down 10% in April compared to the same period in 2023.

This is largely driven by a decrease in opioid overdose deaths, particularly from synthetic opioids such as fentanyl. Synthetic opioid overdose deaths accelerated with the onset of the pandemic, according to CDC data.

Now, experts are assessing what is forcing this downward trend.

“While it is too early to determine if the decline in opioid overdose deaths will continue, several federal policies aimed at reducing deaths may have played a role,” the KFF report states.

Some potentially influential policy moves highlighted by KFF include expanding harm reduction practices, reducing the flow of illicit drugs, increasing access to opioid overdose medication and relaxing policies around using other controlled substances to treat addiction.

However, the uneven impact of the death rate reversal may imply that interventions are similarly uneven.

“Until we can improve health equity and eliminate barriers to access for all Americans — no matter where they live — our efforts to reduce overdose deaths will likely remain uneven,” Ingoglia said.

Non-opioid overdose deaths down only a little 

KFF’s analysis of drug overdose death data shows that non-opioid overdose deaths were only down about 3% in the last six months of 2023 compared to 2022. All opioid-related deaths were down about 10%.

Overdose deaths from cocaine and psychostimulants increased with the onset of the pandemic but at a much lesser rate and have since shown less of a decrease. Generally, this class of drugs accounts for about a third of deaths. 

One potential explanation for the enduringly high numbers could be tied to differences in how opioid and stimulant use disorders are treated. There are no FDA-cleared medications to treat stimulant use disorders. There are several medications that, when paired with therapy, make up the oft-touted gold-standard treatment for opioid use disorder: medication-assisted treatment (MAT). Last year, the FDA announced it would draft new guidance to better enable research on stimulant use disorder. 

Contingency management, which uses incentives like cash to reward recovery behaviors, is a major option in place of the lack of pharmaceuticals. This intervention is promising but underutilized, according to a report by the U.S. Department of Health & Human Services.

In April, the digital B2B behavioral health company Pelago announced it started a contingency management program. In July 2023, Affect Therapeutics, a digital addiction treatment startup, raised $18 million for its contingency management-centered offering.

Uneven reductions in age, racial demographics

Two groups have benefited the most from the several attempts to reduce overdose deaths: white people (14% reduction) and those aged 18 to 25 (23% reduction).

During the last six months of last year, overdose deaths increased for two groups. They increased 2% for American Indian/Alaska Native (AIAN) people. Those aged 65 and older saw overdose deaths increase by 9%. There was little difference based on gender. Male deaths dropped 10% while female deaths dropped 11%.

“Earlier in the opioid epidemic, overdose rates were highest among white people, but this trend shifted with opioid death rates for Black people surging over 700%, compared to a 140% rise for White people in the past decade,” the KFF report states. “The high rates of opioid deaths among American Indian and Alaska Native (AIAN) people mirror broader worsening trends in behavioral health, including the highest and fastest-growing suicide and overall drug overdose rates.”

The report also states that the difference in impact reflects racial disparities in access to OUD treatment. Other federal data show that white people are more likely to access medication for opioid use disorder than those who are Black or Hispanic.

Improvements were also uneven based on location: 35 of the 47 states examined by KFF found a reduction in overdose deaths in the second half of 2023. However, most of the remaining 12 states saw dramatic increases.

Alaska saw a 58% increase, while Oregon and Nevada nearly tied at second with 36% and 3% increases, respectively. Washington and Iowa rounded out the five highest rates of increase, with 22% and 17%, respectively.