Drug deaths are falling for the first time in recent memory, representing a rare glimmer of hope after years of record overdose mortality. On Wednesday, to the surprise of some experts, Biden administration officials sought to take credit for the decrease.
The officials said the White House’s efforts to distribute naloxone have helped to reverse 500,000 overdoses and attributed the overall improvement to increased availability of addiction treatment medications and harm-reduction services like test strips used to detect fentanyl or xylazine.
“I’m happy to report that our efforts are working and that our policies are saving lives,” Neera Tanden, the director of the Domestic Policy Council, said during a press briefing. The new data, she added, represents “the largest recorded reduction in overdose deaths, ever, and this is no coincidence. Efforts taken, investments made, and policies put in place by this administration are having a positive and real impact.”
But over 90,000 Americans still die of drug overdoses every 12 months, according to data released this month by the Centers for Disease Control and Prevention. Were it not for 2021, 2022, and 2023, this year’s likely death toll would still represent an all-time high.
While experts celebrate the sudden decrease in deaths, they have done so cautiously. It remains unclear not only which factors have contributed to the decline, but also whether they’re the result of government interventions or forces outside the Biden administration’s control.
It is possible that the federal government’s efforts to disrupt global drug trafficking and provide improved prevention, treatment, and harm-reduction services are beginning to achieve their desired effect.
But other potential reasons for the drop in drug deaths include a change in the drug supply and a shift toward more cautious drug user behavior based on years of experience with fentanyl. Another hypothesis centers on a statistical concept known as the depletion of susceptibles — essentially, the idea that deaths have fallen because so many people have already died from overdose, meaning the remaining at-risk population is far smaller.
Even as they acknowledged there is work left to be done, key White House figures appeared confident in attributing the most recent reduction to their efforts.
“This is historic, and the largest drop in overdose deaths in American history,” said Rahul Gupta, the director of the Office of National Drug Control Policy. “Think about it: This is a unique feat. It’s never happened before, and it is because of the commitment of President Biden and the actions of his administration.”
When told by STAT of the Biden administration’s comments, however, outside experts were more skeptical and wondered whether the apparent celebration was appropriate given the continued scope of the crisis.
“I want to say this for our federal partners: They’re being really brave, and they’re continuing on their initiatives as long as they are still in office,” said Caty Simon, a leadership team member at the National Survivors Union, a nonprofit that advocates on behalf of people who use drugs. “But this is a victory lap. This is optics. And it’s premature.”
Biden’s White House has been historically supportive of harm reduction measures like syringe exchange and drug checking. Arguably, the administration has also been the most progressive in history on the controversial practice of supervised consumption, looking the other way as OnPoint NYC, a New York City nonprofit, opened two sites in Manhattan and another organization moved to open a third facility in Rhode Island.
Simon, however, expressed fear that harm reduction measures have become associated with left-leaning politicians and progressive politics — a trend already reflected in the rhetoric of Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead the Department of Health and Human Services.
Beyond harm reduction, however, White House officials cited improved access to naloxone and a relaxation of regulations governing the use of addiction treatment medications, including via telehealth, as key factors in the reduced death rate.
In 2024, the Substance Abuse and Mental Health Services Administration finalized a sweeping overhaul of the regulations governing methadone treatment, which many patients have historically found so restrictive that the medication is commonly referred to as “liquid handcuffs.” And in 2022, Congress passed legislation formally repealed the “X-waiver,” a requirement that medical providers wishing to prescribe buprenorphine, another medication used to treat opioid use disorder, first receive at least a full day of extra training.
“The colossal drop in overdose deaths is undoubtedly cause for optimism, but not necessarily for celebration,” said Andrew Kessler, the founder of Slingshot Solutions, a Washington-based consulting firm that specializes in addiction and mental health issues. “The Biden administration has certainly been aggressive in its approach to this issue, yet still even more needs to be done. … Our government investment in treatment, recovery, prevention, the workforce, anti-overdose measures, and more still needs to grow at exponential levels if we are to truly see progress that is even close to satisfactory.”
Some of the administration officials’ claims were shaky, however. In reality, it was the Trump administration that effectively eliminated the X-waiver in the waning days of his administration in early 2021. Upon taking office, the Biden administration reversed that action, only to implement it again, and only later did Congress formally repeal the requirement.
Gupta at one point cast the recent progress as a “48% turnaround,” arguing that drug overdoses were increasing at 31% year-over-year as of early 2021 and are currently decreasing by 17%.
It is true that Biden, upon taking office, inherited a drug crisis that had escalated rapidly during Trump’s first term and grew worse during the Covid-19 pandemic. Still, Gupta did not acknowledge that the CDC’s current 12-month projected death toll of roughly 94,112 is virtually identical to the same figure from January 2021, the month Biden took office, when the agency counted 94,788 overdose deaths nationwide. He also claimed that the Biden administration’s actions have “saved over 500,000 American lives”; an ONDCP spokesperson later said Gupta’s remarks were a reference to the White House helping to fund the distribution of roughly 10 million overdose-reversal kits, which have in turn been used to reverse a half-million overdoses.
Gupta also claimed to have made “significant strides” in telehealth access to buprenorphine, though emergency measures that allowed for more liberal telehealth prescription were first implemented in early 2020 during the Trump administration’s initial response to the Covid-19 pandemic.
Under Biden, HHS and the Drug Enforcement Administration have failed to reach an agreement on whether to extend those emergency measures. Instead, the DEA has repeatedly delayed its final decision. It is unclear how the agency intends to proceed under a new administrator in 2025 — and whether it will face similar resistance from HHS, or be given the autonomy to add back certain pre-Covid restrictions.
Notably, the White House briefing also made no mention of racial or geographic disparities in drug overdose deaths. While recent CDC data shows significant decreases across the South, East Coast, and Midwest, certain states saw dramatic increases: Overdose deaths were up 25.3% year-over-year in Nevada and 40.6% in Alaska.
American Indians and Alaska Natives die of overdose at a higher rate than any other racial or ethnic group, according to the CDC. Little specific data is available regarding the racial breakdown of the latest batch of overdose death data, but in recent years, deaths among Black people have also skyrocketed: As of 2020, older Black men were nearly seven times more likely to die from drug overdose than older white men, according to the CDC.
“We’re even still seeing overdose rates go up in Black, brown, and indigenous communities,” Simon said. “Now they go down elsewhere, in white communities. That is also a huge issue, and we cannot allow those communities to languish and rest on our laurels and say that this is the end of the overdose crisis, or even the beginning of the end of the overdose crisis.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
