US Overdose Deaths Outpace Other Countries, Report Finds

Drug overdoses in the US claimed over 100,000 lives for the third consecutive year in 2023, marking a staggering 50% increase since 2019.¹ With an overdose death rate of 324 per million people in 2022, the US significantly outpaces other nations, including Scotland and Canada, which rank second and third globally but have seen declines in recent years.

Trend tracking and harm reduction policies may help alleviate the high rate of overdose deaths in the US. | Image credit: Geza Farkas - stock.adobe.com

This analysis by The Commonwealth Fund underscores the urgent need for the US to address its overdose crisis by leveraging global insights, tracking emerging trends, and adopting harm-reduction policies to prioritize prevention and treatment.

“In the US, harm-reduction policies and practices are fragmented — meaning they differ state to state — making it challenging to prevent overdose deaths from a national angle,” noted the researchers of the study. “Harm reduction remains a critical means to reducing the number of fatalities due to drug overdose, as well as slowing the transmission of infectious diseases. As of 2023, 109 countries had national harm-reduction policies, but similar policies remain limited in the US.”

Drug overdoses have remained the leading cause of injury death in adults in the US for the past several decades, including overdoses related to synthetic opioids and stimulants.²

Emerging Trends

The researchers observed trends in polysubstance abuse—the combination of multiple drugs, often without the user’s knowledge—and the rise of new, potent substances are driving significant challenges in overdose prevention.¹ In a study spanning 20 states and Washington D.C., xylazine involvement in fentanyl-related deaths increased nearly 4-fold between 2019 and 2022, with the highest impact observed in southern US states.

Counterfeit pills further complicate the landscape. Often containing multiple substances without the user’s knowledge, these pills were implicated in a doubling of overdose deaths between 2019 and 2021. Globally, synthetic opioid deaths are on the rise, though fentanyl does not dominate as it does in the US.

Treatment, Prevention, and Care

Comprehensive prevention strategies are essential to address the overdose crisis. In the US, access to medication-assisted treatment remains inadequate; only 11% of Americans with opioid use disorder received opioid substitution therapy in 2020, compared with 87% in France and 86% in Norway. Harm-reduction practices, which are critical in preventing overdose deaths and infectious disease transmission, are fragmented across states and limited in scope. For instance, naloxone access and fentanyl test strips are restricted or criminalized in some states, despite their proven efficacy in reversing overdoses and identifying contaminated drug supplies.

Syringe services programs, though proven to reduce overdose deaths and disease transmission, remain illegal in several states, highlighting the need for policy reform to ensure equitable access to care and prevention resources nationwide.

Effective Health Promotion

To address the overdose crisis effectively, US health promotion efforts should prioritize nonstigmatizing messaging that avoids further marginalizing drug users. While preliminary data suggests a potential decline in overdose deaths from 2022 to 2023, it remains critical to focus on harm reduction and maintain momentum in prevention efforts. Tailoring communication and interventions to reflect the unique needs of different populations is essential for maximizing their impact.

The US can draw valuable lessons from countries like Portugal, which emphasize public health approaches and integrated health care solutions to reduce drug-related harms. Adopting similar strategies could help address the crisis across diverse communities in the US and ensure that interventions are compassionate, equitable, and effective.

References

1. Gumas ED. US overdose deaths remain higher than in other countries; Trend-tracking and harm-reduction policies could help. The Commonwealth Fund. January 9, 2025. Accessed January 8, 2025.

2. Garnett MF, Minino AM. Drug overdose deaths in the United States, 2003–2023. CDC. December 2024. Accessed January 8, 2025. https://www.cdc.gov/nchs/products/databriefs/db522.htm#ref1