Declines in US Overdose Deaths Compared to Exponential Predictions
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Introduction
After decades of growth described nearly perfectly with an exponential curve, US overdose mortality has begun to decrease. Here we aim to determine whether decreases in overdose mortality between 2023 and 2024 deviate from a previously defined exponential growth curve.
Methods
This observational study examined overdose deaths in the US between January 1980-December 2024. Mortality trends were compared to an exponential growth curve, fit on data from 1979 to 2016.
Results
After precipitously surpassing exponential growth predictions in 2020-2023, overdose deaths fell sharply from approximately 32 per 100,000 in 2021-2023 to 23.7 in 2024, below the lower bound of the exponential curve prediction (24.98) for the first time since 2001. Decreases reflected declining illicit fentanyl-involved deaths (with and without stimulants); however, deaths involving stimulants without fentanyl, and those involving xylazine, continued to increase in 2024.
Conclusions and Relevance
Recent decreases in overdose deaths are encouraging, unprecedented, and represent the first significant, large-magnitude deviation below exponential growth. However, policymakers, clinicians, and public health officials should be prepared for the possibility that a resurgence could occur, especially if novel synthetic drugs change the risk environment of illicit drug use. Stimulants and xylazine continue to represent increasingly important public health challenges.
