The United States has been battling an opioid crisis for decades, marked by three distinct waves of rising overdose deaths. The first wave began in the 1990s with the widespread overprescription of opioid painkillers, leading to a sharp increase in opioid dependency. The second wave emerged around 2010, driven by a surge in heroin use as access to prescription opioids became more restricted. The third and most deadly wave began in 2013, fueled by the proliferation of illicitly manufactured fentanyl and other synthetic opioids, which are significantly more potent and lethal than their predecessors.
In response to the crisis, the U.S. Department of Health and Human Services (HHS) declared the opioid epidemic a public health emergency in 2017. But despite federal and state interventions, opioid-related deaths continued to rise, claiming more than half a million lives between 2014 and 2023. Fortunately, opioid-related fatalities declined in 2023 and continued to fall during the first half of 2024, marking a potential turning point in the crisis.
While some states have made significant progress in reducing opioid-related deaths, others continue to struggle, raising concerns about the epidemic’s long-term trajectory. To better understand these shifting patterns, researchers at Addiction-Rep, a marketing firm for rehab centers, analyzed the latest data from the Centers for Disease Control and Prevention (CDC) through June 2024. Their findings highlight key trends in the nation’s ongoing fight against opioid fatalities, including which states are experiencing the steepest declines—and where the crisis remains entrenched.
Here are some of the key takeaways from the analysis:
- Opioid Fatalities on the Decline: Opioid-related deaths peaked in mid-2023 at 85,387 deaths in the 12-month period ending in July 2023. Deaths have since declined to 71,484 by June 2024, marking a 16% drop.
- The Toll of Synthetic Opioids: Synthetic opioids, primarily fentanyl, remain the leading cause of opioid-related fatalities, though deaths from these drugs declined nearly 20% year-over-year from June 2023 to June 2024.
- Heroin’s Rapid Decline: Heroin-related deaths have fallen dramatically over the past five years, dropping from 14,743 in 2019 to 3,242 in 2024—a decline of nearly 80%.
- Men Disproportionately Affected: Men continue to account for the majority of opioid-related deaths, but fatality rates for both men and women declined by nearly 19% year-over-year.
- Eastern States Leading the Decline: Opioid-related deaths are declining fastest in several Eastern states, including North Carolina (-48%), Pennsylvania (-29%), Ohio (-29%), and Virginia (-28%).
- Western States See Worsening Trends: The crisis has worsened in some Western states. Alaska (+39%), Nevada (+20%), Oregon (+13%), and Washington (+5%) saw increases in opioid-related death rates between June 2023 and June 2024.
- West Virginia Remains the Deadliest State: West Virginia remains the deadliest state for opioid overdoses, with 57.5 deaths per 100,000 people in the 12 months ending in June 2024 (down from 70.5 the prior year).
Opioid-Related Deaths in the U.S. Over Time
After peaking in 2023, opioid-related deaths have declined sharply
Source: Addiction-Rep analysis of CDC Wonder data | Image Credit: Addiction-Rep
Over the past two decades, opioid-related deaths have risen from fewer than 10,000 annually to a peak of 85,387 in the trailing 12 months ending in July 2023. The most dramatic surges occurred during the early years of the fentanyl-driven third wave (2013–2017) and again between 2020 and 2022, when the COVID-19 pandemic exacerbated the crisis. Illicit fentanyl became the dominant driver of fatal overdoses during this period, infiltrating drug supplies nationwide and significantly increasing the lethality of substance use. As a result, opioids have remained the primary factor in the vast majority of overdose deaths.
For the first time since 2018, opioid-related deaths have begun to decline. After peaking in mid-2023, deaths fell to 71,484 for the 12-month period ending in June 2024, marking a 16% drop. Over the same period, the opioid-related death rate declined from 25.5 per 100,000 people to 21.0, a reduction of more than 17%.
Opioid-Related Deaths by Drug & Sex
Synthetic opioids remain the leading cause of death, with men disproportionately affected
Source: Addiction-Rep analysis of CDC Wonder data | Image Credit: Addiction-Rep
Synthetic opioids, primarily fentanyl, remain the leading cause of opioid-related deaths in the U.S., though fatalities have started to decline. In the 12-month period ending in June 2024, deaths from synthetic opioids fell nearly 20% compared to the 12-month period ending in June 2023, dropping from 77,669 to 62,364.
Meanwhile, deaths from heroin have been steadily declining for years. In the 12-month period ending in June 2019, heroin was responsible for 14,743 deaths, but by June 2023, that number had dropped to 4,973, a 66% decline over four years. The trend continued into June 2024, with heroin-related deaths falling another 35% to 3,242. Other opioids, including prescription painkillers, accounted for 9,317 deaths in the 12 months ending in June 2024, a 21% decline from June 2023, while methadone-related deaths remained relatively low at 3,388, with only a 5% decrease year-over-year.
Men continue to account for the majority of opioid-related deaths, though declines have been consistent across sexes. In the 12-month period ending in June 2023, men accounted for 61,111 fatalities, while women accounted for 24,276. By June 2024, deaths declined by a similar percentage in both groups, with male deaths dropping 19% to 49,404, and female deaths falling 19% to 19,723. Despite these improvements, men remain disproportionately affected by the opioid crisis, with opioid-related deaths among males continuing to outnumber those among females by more than 2-to-1.
Changes in Opioid-Related Fatality Rates by State
Opioid-related deaths are declining fastest in the eastern half of the U.S.
Source: Addiction-Rep analysis of CDC Wonder data | Image Credit: Addiction-Rep
While the opioid epidemic initially hit the hardest in several Eastern states, these same states are now seeing some of the fastest declines in opioid-related deaths. In the 12-month period ending in June 2024, states like North Carolina (-47.7%), Pennsylvania (-28.9%), Ohio (-28.8%), and Virginia (-27.5%) experienced some of the largest year-over-year drops in opioid-related fatality rates. Other states in the eastern half of the country, including South Carolina, Wisconsin, and Arkansas, also saw significant declines.
Conversely, the crisis has worsened in parts of the Western U.S. Four states—Alaska, Nevada, Oregon, and Washington—reported year-over-year increases in opioid-related death rates. Alaska saw the sharpest rise, with its fatality rate climbing nearly 39% from 34.4 to 47.7 per 100,000 people, according to preliminary data, making it one of the deadliest states for opioid overdoses. Nevada (+19.8%), Oregon (+13.4%), and Washington (+4.9%) also experienced increases in death rates, defying the broader national trend.
The rise in opioid-related deaths in several Western states can be attributed to multiple factors. One significant contributor is the increasing prevalence of synthetic opioids, particularly fentanyl, in these regions. Historically, the Western U.S. had lower rates of opioid misuse compared to Eastern states, but recent data indicates a shift. Between 2019 and 2023, synthetic opioid-related deaths in the West Census Region increased by 4.6 times, compared to a 2.4-fold increase nationally.
Additionally, the combination of fentanyl with other substances, such as methamphetamine, has become more common in Western states. This co-use increases the risk of overdose, as users may be unaware of the presence of fentanyl in the drugs they consume. This, combined with rising rates of homelessness, increased fentanyl trafficking through the Southwest border, and differing public health responses, has exacerbated the issue. This geographic shift westward suggests that while opioid-related deaths may be stabilizing in historically hard-hit states, the crisis is evolving and continuing to affect new regions.
Below is a breakdown of the states with the highest and lowest opioid-related death rates as of June 2024, as well as those experiencing the most significant year-over-year changes. For a deeper look into the methodology and the full dataset covering 44 states and the District of Columbia, see the original version on Addiction-Rep.
States With the Highest Rates of Opioid-Related Deaths
States Where Opioid Fatalities Are Declining Fastest
Methodology
Photo Credit: Victor Moussa / Shutterstock
Opioid-related deaths and death rates were obtained from the CDC WONDER online database. Deaths were identified using multiple cause-of-death codes, including opium (T40.0), heroin (T40.1), natural opioid analgesics (T40.2), methadone (T40.3), synthetic opioid analgesics excluding methadone (T40.4), and other or unspecified narcotics (T40.6). The latter category includes cases where an opioid was reported but not specifically identified.
For the first half of 2024, the analysis used the CDC’s provisional data file, which is subject to updates, while final data files were used for all other periods. To identify the states where opioid-related deaths are declining the fastest, researchers at Addiction-Rep calculated the percentage change in the opioid-related death rate between the 12-month period ending in June 2024 and the 12-month period ending in June 2023. They also examined the total number of opioid-related deaths in each period and the change in total deaths.
This analysis covers all opioid-related deaths, though overdoses account for approximately 98% of such cases nationwide. Monthly population estimates were derived from the Census Bureau’s annual July estimates, assuming a consistent rate of change between months. Only states with complete data for the entire study period were included.
For complete results, see America’s Opioid Crisis: States Where Drug Fatalities Are Declining Fastest on Addiction-Rep.
