All positive trends, hopefully to continue. Drug overdose data suffers from issues that would be familiar to people working with crime data. In surprisingly large sections of the country, cause of death may be determined by an elected coroner, who may not be a medical professional. Where death is ruled as caused by an overdose and lab work is performed, it is either incomplete as to all drugs present or so complete as to required informed judgement as to the primary cause of death. However, also like crime data, much work and investment since 2010 has improved the timeliness, accuracy and completeness of data to make trending reliable enough. Credit here to partnerships with CDC augmented by support from ONDCP.
The period of the charts from 2010 to 2025 roughly maps the transition of opioid overdoses and deaths from prescription opioids though heroin, and to fentanyl and its derivatives. It also marks a key transition in the response to overdoses from overwhelmingly criminal justice, to growing partnership with public health, and attention to harm reduction. The wide distribution from naloxone has gone from rejected as encouraging moral hazard to standard issue. Distribution of fentanyl testing strips, medicine for opioid use disorder (MOUD) beginning during incarceration and other practices are reducing fatalities. Folks are recovering.
Darkly, the acceleration of fatalities since fentanyl has dominated the marketplace may also play a role. You can see it in the chart. Waking up to the problem with the diversion/overprescribing of medical opioids has helped curtail what was estimated to be the production of 1,000,000 new dependent persons a year, but you can do the math of how many people have died since 2010, not as a rate but as a staggering total of users.
Things change and I am a couple of years out of this now, but I do wonder about a conclusion that fentanyl has been diluted by other substances and drugs to a less lethal level. What has been more prevalent in my experience is that other drugs have been mixed with fentanyl to yield all but heroin, methamphetamine or cocaine flavored fentanyl. Similarly, fentanyl has been pressed into counterfeit medication pills such as Xanax, perhaps as concealment, but also resulting in unwitting exposure and overdose. Still, like the other charts, we need not to so much take comfort as to find and encourage practices that are contributing.
Loved this article! I agree with Jeff's assessment that much of the progress could be attributed to increased govt investments of various types and levels. Additionally, I wonder if changes in alcohol use/abuse may be a common denominator for, obviously, alcohol-related deaths, motor vehicle fatalities, and homicides. MV fatalities and homicides account for a significant share of the alcohol-related deaths because alcohol abuse plays an important causal role in each phenomena. Per capita alcohol consumption is positively associated with homicide rates after controlling for other factors.
Additionally, I wonder if inflation and affordability may explain some of the drop in alcohol and drug use. If you look at the trends for homicides during the Great Recession, we had a downturn in homicide rates. Folks had less $ to spend on alcohol, drugs, and guns - all things connected to homicide trends.
I also think the keys to understanding each of these downward trends begins with looking at the demographic patterns. The larges declines from 2021 to 2024 in homicide victimization have occurred among individuals in their 20's ~37% and the largest declines in drug unintentional overdose deaths 2021 to 2024 has been among folks in their 20s ~ 50%. Perhaps there are shifts in social norms and behaviors of Gen Z that move in the direction of safety.
Great article—it's a fascinating look at several mysterious trends that seem to share some common threads.
Another important clue, in my view, is looking at where these increases in deaths occurred. The rise in traffic fatalities and homicides, for example, was concentrated in the largest cities. But alcohol-related deaths increased the most in rural areas, and drug overdoses rose fastest in both the biggest cities and the most rural regions, with smaller cities and suburbs seeing much smaller increases.
Dashboard on each of these causes of death by urbanization and % change here:
When the CDC finally releases data from 2025 onward, I’ll be very interested to see where the decreases are happening. Will things simply revert to the pre-pandemic trend, or will the already struggling areas fall even farther behind?
Also, it's worth remembering that it was the response to the pandemic that caused disruptions and increased injury and substance deaths, not the pandemic itself. I think our public health officials underweighted the damage they did by attempting to impose a not-very-complete lockdown.
Exceptional work. I would like to see age-portion population data. Certain age groups have been long been fairly strongly associated with crime rate regardless of race and several other factors.
All positive trends, hopefully to continue. Drug overdose data suffers from issues that would be familiar to people working with crime data. In surprisingly large sections of the country, cause of death may be determined by an elected coroner, who may not be a medical professional. Where death is ruled as caused by an overdose and lab work is performed, it is either incomplete as to all drugs present or so complete as to required informed judgement as to the primary cause of death. However, also like crime data, much work and investment since 2010 has improved the timeliness, accuracy and completeness of data to make trending reliable enough. Credit here to partnerships with CDC augmented by support from ONDCP.
The period of the charts from 2010 to 2025 roughly maps the transition of opioid overdoses and deaths from prescription opioids though heroin, and to fentanyl and its derivatives. It also marks a key transition in the response to overdoses from overwhelmingly criminal justice, to growing partnership with public health, and attention to harm reduction. The wide distribution from naloxone has gone from rejected as encouraging moral hazard to standard issue. Distribution of fentanyl testing strips, medicine for opioid use disorder (MOUD) beginning during incarceration and other practices are reducing fatalities. Folks are recovering.
Darkly, the acceleration of fatalities since fentanyl has dominated the marketplace may also play a role. You can see it in the chart. Waking up to the problem with the diversion/overprescribing of medical opioids has helped curtail what was estimated to be the production of 1,000,000 new dependent persons a year, but you can do the math of how many people have died since 2010, not as a rate but as a staggering total of users.
Things change and I am a couple of years out of this now, but I do wonder about a conclusion that fentanyl has been diluted by other substances and drugs to a less lethal level. What has been more prevalent in my experience is that other drugs have been mixed with fentanyl to yield all but heroin, methamphetamine or cocaine flavored fentanyl. Similarly, fentanyl has been pressed into counterfeit medication pills such as Xanax, perhaps as concealment, but also resulting in unwitting exposure and overdose. Still, like the other charts, we need not to so much take comfort as to find and encourage practices that are contributing.
https://www.crimeinamerica.net/is-a-record-low-in-alcohol-use-connected-to-violence-reductions/
Is A Record Low In Alcohol Use Connected To Violence Reductions?
Loved this article! I agree with Jeff's assessment that much of the progress could be attributed to increased govt investments of various types and levels. Additionally, I wonder if changes in alcohol use/abuse may be a common denominator for, obviously, alcohol-related deaths, motor vehicle fatalities, and homicides. MV fatalities and homicides account for a significant share of the alcohol-related deaths because alcohol abuse plays an important causal role in each phenomena. Per capita alcohol consumption is positively associated with homicide rates after controlling for other factors.
Additionally, I wonder if inflation and affordability may explain some of the drop in alcohol and drug use. If you look at the trends for homicides during the Great Recession, we had a downturn in homicide rates. Folks had less $ to spend on alcohol, drugs, and guns - all things connected to homicide trends.
I also think the keys to understanding each of these downward trends begins with looking at the demographic patterns. The larges declines from 2021 to 2024 in homicide victimization have occurred among individuals in their 20's ~37% and the largest declines in drug unintentional overdose deaths 2021 to 2024 has been among folks in their 20s ~ 50%. Perhaps there are shifts in social norms and behaviors of Gen Z that move in the direction of safety.
Great article—it's a fascinating look at several mysterious trends that seem to share some common threads.
Another important clue, in my view, is looking at where these increases in deaths occurred. The rise in traffic fatalities and homicides, for example, was concentrated in the largest cities. But alcohol-related deaths increased the most in rural areas, and drug overdoses rose fastest in both the biggest cities and the most rural regions, with smaller cities and suburbs seeing much smaller increases.
Dashboard on each of these causes of death by urbanization and % change here:
https://theusaindata.pythonanywhere.com/avoidable_deaths_after2020
When the CDC finally releases data from 2025 onward, I’ll be very interested to see where the decreases are happening. Will things simply revert to the pre-pandemic trend, or will the already struggling areas fall even farther behind?
Also, it's worth remembering that it was the response to the pandemic that caused disruptions and increased injury and substance deaths, not the pandemic itself. I think our public health officials underweighted the damage they did by attempting to impose a not-very-complete lockdown.
Exceptional work. I would like to see age-portion population data. Certain age groups have been long been fairly strongly associated with crime rate regardless of race and several other factors.
I am interested in the impact of GLP-1s on some of stats (other than homicide numbers). The timing seems to line up.
Are GLP-1s successfully allowing addicts to kick addiction?