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August 31 is International Overdose Awareness Day, a moment to commemorate those we've lost and to take action to prevent further overdoses, fatal and non-fatal. Some might wonder if this is still really a major public health issue when the CDC reported a 25% decline in overdose deaths in the 12-month period ending in March 2025. The short answer is yes. We've made strides in reducing deaths but we are far from solving this public health problem.
So, why do we still need to discuss overdose as a serious problem? First, overdose deaths are one extreme measure of a much bigger issue. It is the tip of the iceberg: for every 1 person who dies from opioids, there are nearly 3000 who used a prescription opioid in the past year. Second, 77,678 lives lost this past year might translate to a 25% decrease in OD-related deaths, but it's far too many for the family that lost their daughter or the classroom that lost their teacher or the rural clinic that lost their only doctor. International Overdose Awareness Day is also an opportunity to educate everyone about polysubstance use as many people are consuming alcohol, smoking pot, vaping or using other substances along with opioids.
"Fentanyl is finding its way into stimulants, so people who have never used heroin may die of an opioid overdose when using cocaine or methamphetamines," explains addiction medicine physician, Michael Weaver, MD. "People can also OD on stimulants (without fentanyl), known as "overamping", and this can be fatal."
Another key point is that overdose is disproportionately impacting vulnerable groups including women, people of color, rural populations and individuals with co-occurring mental illness. Racial disparities are quite stark -- Black and Native American populations are experiencing overdose deaths rates that are 1.4 to 1.8 times higher than those among white communities. Why? Several factors are involved including increased fentanyl mixed with stimulants, income inequality, less access to treatment and harm reduction services, and structural racism.
As an addiction medicine physician, I was initially surprised to see a drop in OD deaths after years of concerning steady rise. But I am relieved, if not thrilled, by the positive trend. Why are we seeing this decline? It's due in large part to aggressive, persistent public health measures, rooted in expanded harm reduction efforts such as widespread naloxone (i.e. Narcan) distribution. Access to lifesaving medications for opioid use disorder (MOUD) such as methadone and buprenorphine has also increased. In addition, people who use are adjusting their use patterns: they're using test strips to detect xylazine and fentanyl, and they're not using alone.
We're fortunate to have effective treatment for OUD. First-line management is medications, but they're grossly underutilized.
"OUD is a chronic medical condition, and offering care that combines medications with counseling can lower the risk of fatal overdose by roughly 60 to 80%," describes addiction psychiatrist, Adam Bisaga, MD. "Patients engaged in treatment consistently experience much lower mortality than those not receiving these medications."