CDC data show national overdose deaths fall while three states rise

The latest CDC estimates show a sharp nationwide decline in drug overdose deaths, even as three states report upticks. In the 12 months ending in April 2025, the United States recorded 73,690 overdose deaths, down 26.3 percent from 100,049 in the prior year. The figures, drawn from the CDC’s National Vital Statistics System, come amid a long arc of changes driven by shifts in the drug supply, public health efforts, and the evolving fentanyl crisis that has swept across communities since the Covid-19 pandemic. Health officials caution that the data are provisional and could be revised as more information becomes available.

The national trend places overdose deaths just behind the 72,000 tallied in 2019, a marker many public health officials say underscores the persistent toll of opioids, stimulants and other substances. Over the past two years, deaths rose to a peak in 2020 and have fluctuated since, with recent declines attributed in part to tighter controls on illicit fentanyl, expanded naloxone (Narcan) distribution and targeted state enforcement efforts. Of the 73,690 deaths reported through April 2025, 48,442 (66 percent) were attributed to natural and synthetic opioids, a category dominated by fentanyl and its analogs. The remainder included a large share of deaths caused by psychostimulants such as cocaine and methamphetamine, plus other opioids and various drug combinations. Methadone, used to treat opioid use disorder, remained steady at 3,257 deaths, the only major category with little change year over year.

The national picture, while improving overall, hides local pockets where deaths rose. In Arizona, Hawaii and South Dakota, overdose fatalities climbed 7.5 percent, 5.2 percent and 1.2 percent respectively in the latest 12 months. Arizona saw deaths rise from 2,596 to 2,790, a surge experts attribute to persistent access to illicit opioids, including fentanyl, and to broader cross-border dynamics that keep the drug market highly responsive to changes in enforcement and supply. Hawaii recorded 345 deaths, up from 328 a year earlier, while South Dakota’s tally rose from 83 to 84. In all three states, authorities emphasize that fentanyl plays a central role in deaths, with the drug’s extreme potency driving rapid fatal overdoses even amid broader declines elsewhere.

The divergent national trend aligns with several structural factors. In Arizona, authorities note the state’s proximity to Mexico and the extensive U.S.-Mexico border network that has long facilitated the movement of illicit fentanyl into the United States. U.S. Customs and Border Protection data show that the vast majority of fentanyl seizures originate south of the border, and Arizona’s multiple ports of entry can provide dealers with space to route shipments. While law enforcement actions and border controls are intensifying, public health experts caution that the supply chain for fentanyl remains robust and highly adaptive, contributing to ongoing risk of overdose even as other regions see fewer deaths.

Hawaii’s uptick is linked in part to its status as a high-intensity drug trafficking area due to heavy tourist traffic and logistical ease that can complicate drug interdiction efforts. The state’s geographic position in the Pacific also makes it a transit point for illicit fentanyl as traffickers push supply westward. Native Hawaiian and Pacific Islander communities, historically affected by higher substance-use burdens and trauma, are among the groups researchers monitor for disproportionate harm, though the data remain too limited to draw firm conclusions about the specific risk patterns in these communities.

South Dakota’s rise coincides with broader demographic and socioeconomic factors. About eight percent of the state’s population is Native American across nine reservations, a group that research has shown faces elevated risks for substance use and overdose. Experts note ongoing underinvestment in the Indian Health Service, a federal agency charged with providing healthcare to Native Americans, which has historically struggled with staffing and resources that can hinder harm-reduction and treatment efforts.

In Virginia, Massachusetts and West Virginia, by contrast, the national decline is even more pronounced. Virginia’s overdose deaths dropped from 2,171 in the year ending April 2024 to 1,211 in the year ending April 2025, a 44.2 percent decrease. Governor Glenn Youngkin credited the state’s Operation FREE initiative—Fentanyl Awareness, Reduction, Enforcement and Eradication—for interrupting the drug trade and expanding overdose-prevention resources like Narcan. Virginia has thus far distributed roughly 400,000 doses of Narcan since 2022 and has enacted measures including a ban on pill presses that could be used to add fentanyl to counterfeit pills, along with felony charges for drug dealers whose victims die of an overdose.

Massachusetts likewise posted a substantial gain, with deaths falling 42 percent, from 2,197 to 1,272. In 2024, Boston opened four public-health vending machines offering Narcan, drug-testing strips and sterile syringes as part of a broader harm-reduction approach designed to reduce fatalities and connect people to treatment services.

West Virginia also saw a meaningful drop, from 1,232 deaths in the year ending April 2024 to 729 in the year ending April 2025, a 41 percent decline. State officials credited a shift toward recovery-first, family-centered care, noting that reductions in child removals related to parental substance use contributed to the favorable trend. West Virginia’s secretary of the Department of Health and Human Resources emphasized that helping families stay together and supporting parents in recovery can lessen the upstream drivers of overdose risk.

Taken together, the nationwide decline and the state-level changes underscore a complex landscape in which gains in some regions coexist with persistent, localized challenges. Public health experts caution that the numbers can be affected by reporting lags and the ongoing evolution of the illicit drug market, particularly around fentanyl, which remains the deadliest driver of overdose deaths in the United States.

The CDC researchers note that data quality varies by jurisdiction and that provisional figures can be revised as death certificates are finalized. While the overall trend signals progress, officials say continued commitment to prevention, treatment, harm reduction and enforcement is essential to sustain and deepen declines, especially in communities bearing a disproportionate share of the burden of addiction and overdose.