Avoiding a new US “war on drugs”

The US overdose crisis contributed to over 100 000 deaths in 2023.1 The 22% decrease in overdose deaths between August 2023 and August 2024 relative to the preceding 12 months1—the most substantial decrease of this epidemic—might signal that investments in overdose prevention and treatment for substance use disorder are taking effect. Other potential contributors include fewer susceptible people after consecutive years of record overdose mortality; a reversion to the mean after the overdose mortality spike in the covid-19 pandemic; the emergence of non-opioid sedatives (such as xylazine) in the illicit drug supply, which pose unique risks but might also reduce how often people consume fentanyl; and positive side effects of the scale-up of glucose dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists (such as Mounjaro and Ozempic), which are associated with reduced risk of opioid overdose.234

Overdoses in several western US states, however, are rising as fentanyl penetrates the illicit drug supply.1 Increasing availability of ever more potent synthetic opioids and analogues (such as nitazenes), which can be up to 40 times stronger than fentanyl,5 is an ongoing threat …