Overdose Deaths
No one should die from overdose. These deaths are preventable. Provisional 2023 data shows a slight decrease in overdose deaths, and new reports show a decrease from April 2023-April 2024. While this is encouraging, overdose deaths still remain too high. This page focuses on official 2022 data (most reliable data). The CDC reports that there were 107,941 deaths in 2022. These are not just numbers; they are our loved ones: our families, our friends, our neighbors. Criminalization is driving the overdose crisis. Yet, many elected officials continue to fail our communities by calling for ineffective punitive policies as a response to the crisis. Elected officials must prioritize a health-based approach instead.
Criminalization drives the overdose crisis. What you need to know.
- There were 107,941 overdose deaths in 2022.
- Overdose deaths increased slightly from 2021 to 2022.
- In 2022, overdose deaths have risen in most states and Washington D.C.
- The unregulated, unpredictable drug supply is due to drug crackdowns and enforcement.
- Fentanyl has driven major increases in overdose deaths nationally since 2013.
- Fentanyl entered the market after the crackdowns on prescription opioids and heroin, and the overdose crisis intensified. This phenomenon, where harsh enforcement leads to more potent drugs, is known as the “iron law of prohibition”.
- Criminalization is increasing overdose deaths and making the crisis worse.
- Incarceration kills. Drug and alcohol overdose deaths have more than doubled in jails and prisons.
- People are 27 times more likely to die from overdose within two weeks of release from incarceration compared to the general population.
- Fear of arrest can deter people from asking for help during an overdose emergency.
- Despite harsh penalties for all fentanyl-related substances since 2018, overdose rates have increased across the U.S.
- In 2022, all states except one (Oregon) criminalized low-level drug possession, and all states criminalized drug sales. Despite this fact, overdose rates have increased.
- Black, Native, and Latinx overdose death rates increased between 2021 and 2022 while white overdose death rates decreased that year. Between 1999 and 2022:
- The Black overdose death rate increased more than six-fold, driven largely by fentanyl.
- The Native American overdose death rate increased over 10-fold.
- The Latinx overdose death rate more than quadrupled, especially in recent years due to fentanyl.
- Despite an urgent need for a health-based approach to the overdose crisis, there are barriers to proven interventions.
- Fear of federal interference is a barrier for many jurisdictions that want to establish overdose prevention centers.
- Harm reduction programs are under attack across the nation, and state and federal funding available to community-based harm reduction providers is scarce.
- Medications for opioid use disorder reduce opioid cravings and withdrawal symptoms, while cutting overdose risk in half. But they are difficult to access due to strict regulations and stigma.
- Methadone is very difficult or impossible to access in most parts of the country. It is the only medication in the nation that can only be dispensed at specialty clinics that require near-daily attendance and have strict rules for compliance.
- Buprenorphine can be challenging to access because only a small minority of healthcare providers choose to prescribe it to patients. In addition, many people face barriers including cost, insurance coverage, and pharmacy access.
Frequently Asked Questions
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Oregon decriminalized drugs in 2020—how has this impacted their overdose rates?
Oregon’s overdose death rate after drug decriminalization remains below the national average and is comparable to other western states. A recent JAMA study found no evidence that Oregon’s drug decriminalization law led to an increase in fatal overdose rates in the state. For comparison, in Washington, drug possession was decriminalized for five months in 2021. However, after recriminalizing, their overdose rates still increased. Read our fact sheet to learn more.
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Why did fentanyl deaths increase first east of the Mississippi River vs. the West Coast?
Overdose deaths involving prescription opioids were highest in Appalachia and in parts of the East Coast at the beginning of the overdose crisis. When access to prescriptions was restricted, demand for opioids remained and the heroin supply grew to meet increasing demand. Heroin overdose deaths then rose quickly in these states as people transitioned away from prescription opioids to heroin. Soon law enforcement began to seize large quantities of heroin to get it off the street. Since white powder heroin was commonly sold in these markets, it was easier for heroin suppliers to adulterate it with fentanyl to increase its potency. (Meanwhile, Mexican black tar heroin on the West Coast remained unadulterated, because it is not easy to mix with.) It eventually became cheaper for suppliers to source and use this fully synthetic opioid, since heroin is costly and time-consuming to make. Fentanyl was easier and more discreet to transport to meet the demand for heroin in these regions. In recent years, fentanyl moved westward, but it was often mixed into counterfeit opioid pills or sold alone as a white powder as an alternative to heroin.
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How does the overdose crisis intersect with the public suffering and homelessness seen in cities like San Francisco, Portland, and Philadelphia?
What we are seeing some cities in the United States is the direct result of decades of overlapping systemic failures, the fallout of COVID-19, and the failure of local and national governments to do their jobs. Underfunding housing, social and health services including access to drug treatment is a recipe for disaster no matter where it exists. What is happening on the streets is a homelessness issue that must be met with increased access to housing and social support. In fact, unsheltered homelessness across the country has risen by 30% in the past five years. People experiencing homelessness are some of our neighbors most vulnerable to overdose, which is why we need services that can immediately connect them to care or respond in the event of an overdose emergency. This includes street outreach teams, community-based crisis response teams, and overdose prevention centers.
“I lost my son, my only child, Jeff, to an overdose. Criminalization didn’t save him. Punitive drug laws have resulted in nothing but more imprisonment, more deaths, and more devastated families. We need health-based solutions to save our loved ones.”
Denise Cullen, LCSW, Co-Founder, Broken No More
Health-based Solutions to the Overdose Crisis
Overdose deaths are preventable. Any overdose death is a policy failure. Given the magnitude of the crisis, our elected officials must prioritize health-based policies that can prevent overdose deaths and save lives.
The Drug Policy Alliance is working to pass federal and state legislation that would remove barriers to effective interventions, monitor overdose trends, support research, and allocate much-needed funding to support life-saving overdose prevention programs.
Learn more about the solutions:
- Overdose prevention centers. These facilities are designed to reduce the potential risks of drug use, including overdose and unwanted public use. They also connect people with addiction services and social supports, including treatment.
- Evidence-based treatment. There are a variety of treatment options, including psychosocial treatment, medications for opioid use disorder such as methadone and buprenorphine, and contingency management.
- Harm reduction. Interventions include drug checking (like fentanyl and xylazine test strips), naloxone (a medication that can reverse an opioid overdose), drug education, and syringe exchange services that keep people from contracting infectious diseases.
- Safer supply. Drug prohibition has created an unregulated drug supply that is unpredictable. The opposite of this would be to offer a safe supply where people know exactly what’s in their drugs and its potency.
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