Since the opioid epidemic was declared a public health emergency in 2017, it has claimed more than half a million lives. While the epidemic was initially driven by prescription opioids and heroin, it has evolved in recent years, to be dominated by illicit synthetic fentanyl—a substance significantly more potent than morphine. By 2023, most counterfeit opioid pills contained a deadly dose. As of 2022, nearly 1 in 3 adults reported in a KFF survey that they or a family member have been addicted to opioids (29%).

Leading up to and during the pandemic, opioid overdose deaths increased sharply. Deaths began to fall in mid-2023 and have continued to decline, though they remain above pre-pandemic levels. While it is not possible to identify a single driver of the decline, multiple policy actions may have contributed. These policies included efforts to expand access to treatment and overdose-reversal drugs and public awareness efforts about counterfeit opioid pills. They also included supply-side actions aimed at improving fentanyl detection at the ports and borders and limiting the flow of precursor chemicals used to manufacture illicit fentanyl abroad. These efforts coincided with indicators of shifting fentanyl supply, including DEA testing that suggested lower fentanyl potency in counterfeit pills.

Despite progress, a range of more recent federal policy actions may affect future trends, including federal budget cuts, federal staffing reductions, and cuts to federal grants that support state and local programs; reduced Medicaid and Marketplace coverage; and a shift toward a more enforcement-focused approach, including the designation of illicit fentanyl as a “Weapon of Mass Destruction.” This analysis examines opioid overdose deaths over time – including 2024 (the latest finalized data available through CDC WONDER data) – and trends across demographic groups and states. Additional data can be found on KFF’s State Health Facts.