Quick hits: US continues to be global leader in drug fatalities

"Quick hits" are brief rundowns of the latest drug related reports, studies and alerts

A report from The Commonwealth Fund, released today, explores why drug related fatalities fell globally through 2024, in 46 countries and territories with available data. Here are five key takeaways.

•The regions that have seen the highest overdose rates have also seen the biggest declines

°In 2024, West Virginia still had the highest overdose rate of any U.S. state— 45 per 100,000—despite also seeing the biggest annual decline in overdoses of 42%.

°The United States, Puerto Rico, Scotland and Canada saw significant declines in edeaths between 2023 and 2024—27%, 21%, 13% and 9% respectively. These countries have also consistently had the top four drug death rates globally since 2021, with the United States in the lead since 2020. Notably, these countries all have potent synthetic opioids in the street drug supply, including fentanyl and nitazenes.

°Northern Ireland saw the biggest increase in overdose fatalities, up 53% between 2023 and 2024. It now has the fifth highest rate globally, at 135 per million.

•Naloxone needs to be easy to get, and it needs to be free

°In 2022, SAMHSA required funding recipients to create plans for "naloxone saturation" which basically means that whenever there is an opioid overdose, someone with naloxone is nearby to reverse it.

°The regions that got closest to this goal, like Virginia, Missouri and Scotland, made naloxone free to high-risk populations. New York and Ohio also saw significant declines in overdose after providing free naloxone online or through vending machines.

•Paying attention to incarcerated people after they're released is key

°People who have just been released from prison are at a significantly elevated risk of overdose.

°West Virginia, which saw the highest decrease in overdose fatalities, actively connects people to treatment upon release.

°Canada and Scotland provide naloxone within their prison system and upon release.

•This progress is fragile

°Preliminary 2025 data suggests that overdoses are increasing in some US states as well as Scotland.

°U.S. cuts to Medicaid could mean people lose treatment to opioid use disorder treatment and naloxone, putting them at greater risk of fatal overdose.

°Bans on federal funding for harm reduction tools like fentanyl test strips could also increase risk.

•Global comparisons like this need to be taken with a grain of salt

°This report relies on government and World Health Organization reports of drug fatalities. They don't all use the same definition.

°In their appendix, authors note that "rates for some countries should be interpreted with caution as mortality numbers may be underreported due to incomplete mortality data or lack of appropriate coding."

°In the report's ranking, Mexico has the third lowest drug death rate globally in 2024, despite being one of the largest global suppliers of illicit fentanyl. Researchers have estimated that the Mexican government significantly undercounts overdose fatalities.

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