Drug overdose dilemmas: Fewer fatalities — but more total overdoses and racial disparities 


June 10, 2024

Editor’s note: Don Mathis is a certified peer recovery specialist and certified community health worker at Voices of Hope Maryland. He is a former CHN board member.   

Update: Last week, the Department of Health and Human Services announced 10 new states will join the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program: Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont. This program provides states with sustainable funding that helps them expand access to mental health and substance use treatment, supporting President Biden’s efforts to tackle the country’s mental health and addiction crises. 

By Don Mathis
In May, the Centers for Disease Control and Prevention reported that the number of fatal drug overdoses in 2023 showed a 3 percent decrease from 2022, from 111,029 to 107,543. That 3,486 fewer people died from overdoses is good news. 

But how good? Is this single statistic a sign of widespread success in our national efforts to reverse and reduce our drug epidemic? A recent New York Times article asked “Has fentanyl peaked?” Has it? Are there fewer fatal overdoses because people with substance use disorder are using less? 

At Voices of Hope Maryland, we’re encouraged that fatal ODs are decreasing,” Jennifer Tuerke, executive director at that recovery community organization, told me. “We know that in our communities, much of this is due to our pro-active use and distribution of Naloxone (brand name Narcan), the medicine that quickly reverses an opioid overdose. It’s important to remember that after a successful overdose reversal, the person needs a variety of treatment, harm reduction, recovery, and peer support services.” 

Alice Bell, Overdose Prevention Project Director for Prevention Point Pittsburgh, notes that the small decrease in drug deaths was only seen among the White population. 

“Here is Pennsylvania, the rate of overdose deaths for Black people is more than twice the rate for White people and continues to increase,” Bell said in an email statement. “Increased access to Naloxone undoubtedly plays a role in the decrease in opioid overdose deaths, but a recent study shows that a Black person who overdoses in Pennsylvania is 40 percent to 50 percent less likely to receive life-saving naloxone than a White person.” 

“Before we cite the modest reduction in fatal overdoses as a victory in the ‘War on Drugs,'” added Jess Golembrosky, a certified peer recovery specialist with the Delaware Division of Substance Abuse and Mental Health, “It’s crucial that we expand harm reduction strategies considering the overdose rates in minority communities, the rise in poly-substance use and the increased rates of sexually-transmitted infections and hepatitis C. And yes, the need and demand for naloxone is state-wide in Delaware, from inner-city Wilmington to the rural farm areas and beach communities in Kent and Sussex counties.” 

What have we learned? We’ve learned that a focus on reducing fatal drug overdoses is necessary, but not sufficient as a sole benchmark for reducing substance use disorder. We’ve learned that a new initiative from the Biden-Harris administration, “White House Challenge to Save Lives from Overdose,” will increase training on and access to Naloxone and will save more lives. 

Yet, 20-years plus of research and program evaluation shows that a comprehensive plan for addressing substance use disorder and misuse has produced evidence as to which strategies work and which don’t. These analyses show that significant federal investments in the Department of Health and Human Services’ agencies like the Substance Abuse and Mental Health Services Administration and its initiatives like State Opioid Response Grants are essential. [Editor’s note: these programs are threatened because the amount of funding proposed by the House Appropriations Committee for the Departments of Labor, Health and Human Services and Education, which includes substance use treatment programs, would be cut by at least about 10 percent.] 

The scourge of drug addiction and the influx of new, more dangerous drugs is occurring in every state, in every Congressional district. Now is not the time to cut federal funding for drug programs. 

opioid crisis
Substance use disorder