Drop in US Overdose Deaths Not Attributed to Increased Naloxone Use

Drug overdose deaths in the United States saw an unexpected decline a few years ago, but evidence suggests this isn't because more people are being revived than before.

Drug overdose fatalities peaked around 111,000 annually in mid-2023. By the close of 2025, this figure had fallen below 71,000 per year. Researchers are still working to understand the reasons behind this trend. One hypothesis pointed to the broader availability of naloxone, a medication that reverses opioid overdoses, enabling more individuals to be saved.

However, a study examining U.S. emergency medical services (EMS) agencies revealed that emergency responses for nonfatal overdoses also decreased alongside the deaths. Naloxone use also declined. This indicates that overall overdoses lessened, rather than naloxone becoming more effective at preventing fatalities, according to research published October 21 in the Journal of the American Medical Association.

“Naloxone continues to save lives daily,” stated Michael Barnett, a health services researcher at Brown University School of Public Health. “But it doesn't appear to be the cause of the abrupt change” in overdose death rates.

Expanded access to naloxone has been driven by state policies, community distribution initiatives, and the U.S. Food and Drug Administration's approval of a nasal spray version as an over-the-counter medication.

Barnett and his team analyzed close to 186 million EMS activations nationwide—ambulance or other EMS responses following a 911 call—from May 2020 to December 2025. Out of 2.5 million responses for nonfatal drug overdoses, 40.5 percent involved opioids.

From May 2023 onwards, EMS activations for nonfatal opioid overdoses dropped by an average of about 6,000, or approximately 33 percent, below expected levels. Total naloxone administrations also decreased, by around 4,700 on average, or 21 percent below expectations. The study suggests that naloxone wasn't used more frequently by bystanders before EMS arrived, though it lacked data on instances where a bystander administered naloxone without a 911 call.

Other potential explanations for the sharp decrease in overdose deaths—which followed three decades of increase—include shifts in the illicit opioid supply or changes within the population at risk for overdoses. Barnett suggested that a disruption in the fentanyl supply might best explain the sudden and widespread nature of this turnaround. He also noted that the population at risk has likely been decreasing for years.

However, Barnett cautioned that a decline driven by supply issues can reverse, pointing out that the drop in overdose deaths slowed in 2025. He indicated that traffickers could adapt by sourcing new chemicals or turning to more potent synthetic opioids.