There were 30,000 fewer U.S. drug overdose deaths in 2024 than the year before — the largest one-year decline ever recorded. 

However, Nevada was one of two states that experienced a small increase in overdose deaths, which experts attribute to factors such as poor mental health, the makeup of the drug supply and delays in trends.  

An estimated 80,000 people died from overdoses last year, according to provisional Centers for Disease Control and Prevention data released last month. That’s down 27 percent from the 110,000 in 2023. In Nevada, there were 1,528 people who died from overdoses last year, a rise of 0.5 percent from the previous year, according to the provisional data.

The upward tick isn’t new for Nevada. Between January 2023 and January 2024, overdose deaths in the state increased by about 31 percent — one of 14 states with an upward trend, according to CDC data. 

The CDC has been collecting comparable data for 45 years. The previous largest one-year drop was 4 percent in 2018, according to the agency’s National Center for Health Statistics. The provisional numbers are estimates of everyone who died of overdoses in the U.S., including noncitizens. That data is still being processed, and the final numbers can sometimes differ a bit. But it’s clear that there was a huge drop last year.

Some of the biggest drops were in Ohio, West Virginia and other states that have been hard-hit in the nation’s decades-long overdose epidemic. South Dakota was the only other state that did not see a decline in drug overdose deaths. 

Experts say more research needs to be done to understand what drove the reduction, but they mention several possible factors. Among the most cited:

— Increased availability of the overdose-reversing drug naloxone.

— Expanded addiction treatment.

— Shifts in how people use drugs.

— The growing impact of billions of dollars in opioid lawsuit settlement money.

— The number of at-risk Americans is shrinking, after waves of deaths in older adults and a shift in teens and younger adults away from the drugs that cause most deaths.

Still, annual overdose deaths are higher than they were before the COVID-19 pandemic. In a statement, the CDC noted that overdoses are still the leading cause of death for people 18-44 years old, “underscoring the need for ongoing efforts to maintain this progress.”

Karla Wagner, a foundation professor at the UNR School of Public Health, agrees. 

“When we look at national trends and we see promising short term trends that look like declines, it’s tempting to want to take our foot off the gas,” said Wagner, who has received funding for her research from the National Institutes of Health and CDC since 2008. “We are seeing decreases in a lot of places, but it is important to acknowledge that this is still a lot of deaths.”

According to Wagner, there’s a chance Nevada might just be late to the trend. 

“The drug market across the country is not uniform,” said Wagner, “There were places that saw fentanyl adulteration early on. They experienced a big rise in deaths. People who use drugs adapt to that risky, unsafe, unregulated, illicit market. Death started going down in places where people are adapting and have the resources to adapt to that. It might just be that we are a little behind the curve.”

However, it’s not the only explanation for Nevada’s increase in drug overdose deaths.

According to the latest data from the Nevada State Unintentional Drug Overdose Reporting System, only 34 percent of overdose deaths had a bystander present. A majority — 51.7 percent — of those cases had at least one opportunity for intervention. 

“People are dying inside, alone. We really need to focus our efforts on finding those people,” Wagner said. 

Some experts worry that the recent decline could be slowed or stopped by reductions in federal funding and the public health workforce, or a shift away from the strategies that seem to be working.

Dave Sheehan, a spokesperson for the Southern Nevada Health District (SNHD), said that the district has already been affected by the termination of federal funding and that officials are currently assessing how the loss of funding will affect the district’s core services. It’s unclear, he said, if those federal changes would affect the more than $2 million in Substance Abuse and Mental Health Services Administration grants for this year. 

SNHD had significantly expanded its opioid response efforts in the past year. In 2024, the Health district provided training to about 1,300 people and distributed 82,701 naloxone doses. It also launched a program to provide follow-up support to individuals after an overdose and also began conducting biweekly outreach efforts in areas with elevated overdose activity. 

Sheehan said that Nevada has some unique factors that have contributed to its stubborn overdose rates, including an increase in fentanyl in the drug supply. He also noted that in Clark County, excessive heat compounds the risk of an overdose, with 56 percent of heat-related deaths involving a combination of drugs or substances.

Experts note that there have been past moments when U.S. overdose deaths seemed to have plateaued or even started to go down, only to rise again. That happened in 2018.

Meanwhile, drug manufacturers, distributors, pharmacy chains and other businesses have settled lawsuits with state and local governments over the painkillers that were a main driver of overdose deaths in the past. The deals over the last decade or so have promised about $50 billion over time, with most of it required to be used to fight addiction.

Last week, all 50 states reached a historic settlement with the Sackler family that owns OxyContin maker Purdue Pharma. Nevada will receive about $58 million as part of that nationwide settlement.

The money from those settlements, along with federal taxpayer funding, is going to a variety of programs, including supportive housing and harm reduction efforts, such as providing materials to test drugs for fentanyl, the biggest driver of overdoses now.

But what each state will do with that money is currently at issue. 

“States can either say, ‘We won, we can walk away’” in the wake of the declines or they can use the lawsuit money on naloxone and other efforts, said Regina LaBelle, a former acting director of the Office of National Drug Control Policy. She now heads an addiction and public policy program at Georgetown University.

In 2023, state lawmakers crafted legislation to place guardrails around Nevada’s portion of opioid litigation recoveries, dedicating $870 million from these settlements to addressing opioid-related risks, harm and effects. Community leaders in Nevada have expressed doubt over a few proposals that they say would not have used the money directly enough on stopping overdoses.

President Donald Trump’s administration views opioids as largely a law enforcement issue and as a reason to step up border security. It also has been reorganizing and downsizing federal health agencies.

Health Secretary Robert F. Kennedy Jr. said overdose prevention efforts will continue, but some public health experts say cuts mean the work will not go on at the same level.

U.S. Rep. Madeleine Dean, a Pennsylvania Democrat, asked Kennedy at a recent hearing “why the hell” those changes are being made when the steep drop in deaths showed “we were getting somewhere.” Some advocates made a similar point in a call with reporters last month.

“We believe that taking a public health approach that seeks to support — not punish — people who use drugs is crucial to ending the overdose crisis,” said Dr. Tamara Olt, an Illinois woman whose 16-year-old son died of a heroin overdose in 2012. She is now executive director of Broken No Moore, an advocacy organization focused on substance use disorder.

Olt attributes recent declines to the growing availability of naloxone, work to make treatment available, and wider awareness of the problem.

Kimberly Douglas, an Illinois woman whose 17-year-old son died of an overdose in 2023, credited the growing chorus of grieving mothers.

“Eventually people are going to start listening,” she said. “Unfortunately, it’s taken 10-plus years.”

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.