After three decades of ever-escalating drug overdose deaths, the tide of fatalities may have finally started to turn. Total drug overdose deaths in America declined by around 5 percent last year, the first drop since 1990, according to preliminary government data made public on Wednesday.
The reversal was slight enough that experts could not be sure whether it was the start of a trend or simply a blip.
Drug overdose deaths, 1980 to 2018
Data through 2017 is based on final reported mortality totals. Data for 2018 is provisional and adjusted to account for delays in drug-death reporting.
Source: National Center for Health Statistics, Centers for Disease Control and Prevention
Even with the shift, the number of deaths in 2018, more than 68,000, still exceeded the nation’s peak of yearly deaths from car crashes, AIDS or guns.
“It looks like there’s light at the end of the tunnel,” said Dr. Andrew Kolodny, the co-director of opioid policy research at Brandeis University. But, he added, “there’s nothing to celebrate, because the death toll is still very high.”
A decline in prescriptions for opioid painkillers was the major factor for the overall drop in overdoses. Fatal overdoses involving other drugs, particularly the deadly synthetic opioid fentanyl as well as methamphetamine, which has come roaring back over the last few years, continued to rise.
Many in the addiction and law enforcement fields say the overall drop may be a result of more drug users having access to treatment, and to naloxone, the overdose-reversing drug that has brought back thousands from the brink of death. There has also been growing awareness about the immense danger of fentanyl.
More cautious prescribing of opioid painkillers, the result of numerous limits instituted in many states in recent years, might have also had a role. Prescription painkillers were the main cause of overdose deaths until heroin, and then fentanyl, surpassed them over the last decade. The fading presence in some regions of carfentanil — an analogue of fentanyl that the Centers for Disease Control and Prevention describes as 10,000 times more powerful than morphine — could also be a factor.
Fentanyl’s contribution to the overdose death rate in selected states, 2010 to 2018
Provisional data on fentanyl deaths in 2018 is not available for Pennsylvania.
“We are all cautiously optimistic and grateful to see this drop,” said Patrick Trainor, a spokesman for the Drug Enforcement Administration in Philadelphia, which has been particularly hard hit by fentanyl deaths. “But no one can point to any one thing.”
After President Trump made the opioid crisis one of his health care priorities in his 2016 campaign message, some in the addiction field now fear his focus will shift as he heads into the 2020 campaign. Already, he is talking much more frequently about other health care issues, such as high medical bills and prescription drug prices.
Alex M. Azar II, Mr. Trump’s Health and Human Services secretary, said in a statement that the new data showed “that America’s united efforts to curb opioid use disorder and addiction are working.”
“Lives are being saved, and we’re beginning to win the fight against this crisis,” he said. “While the declining trend of overdose deaths is an encouraging sign, by no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades and it will not be solved overnight. We also face other emerging threats, like concerning trends in cocaine and methamphetamine overdoses. President Trump and H.H.S. will continue to provide the resources and support communities, families and individuals in our collective efforts to prevent and treat addiction.”
Mr. Trump and Congress have provided $3.3 billion in grants to states since 2017 for treatment, prevention and recovery services, but the money will run out next year. And Mr. Trump and other Republicans are fighting in court to overturn the Affordable Care Act, which has allowed 36 states to expand Medicaid and provide free addiction treatment to low-income adults.
Senator Rob Portman, an Ohio Republican, said that in his state, “probably half our Medicaid expansion dollars are now used for mental health or substance-use disorder treatment.”
The other 14 states have so far opted not to expand the program, largely because of their Republican leaders’ opposition to the health law, and instead are relying heavily on the grants.
The new numbers are based on completed death investigations and estimates from federal public health officials about how many open death investigations are likely to be ruled overdose deaths. Final numbers will not be released for several months.