Published: 08/10/2026 | Author: Courtney Myers

Fentanyl overdose deaths were cut in half since mid-2023, and two researchers who went looking for the reason came back with an uncomfortable answer. The interventions most often credited don’t appear to explain a drop that size.

Greg Midgette and Peter Reuter of the University of Maryland published their analysis on August 6. The findings matter for anyone using opioids or supporting loved ones impacted because it says something specific about factors that haven’t changed.

The Opioid Crisis Continues

Fentanyl is a synthetic opioid many times deadlier than morphine, active at doses too small to see. Fentanyl turns up in counterfeit pills and in stimulants sold as cocaine or methamphetamine, often without the buyer knowing.

Between late 2021 and June 2023, the country averaged nearly 10,000 overdose deaths a month, six times the figure for 2000 and the peak of a 40 year climb. Then it reversed. The total fell from about 110,000 deaths in June 2023 to 72,000 by August 2025 nationwide rather than regional.

One number shows how specific this is. Fatal overdoses not involving fentanyl have held steady at 21,000-22,000 a year since 2018. Any changes took place in the fentanyl market.

Analysis Limitations

Naloxone, sold as Narcan, reverses opioid overdose, needs no prescription, and doesn’t harm folks if given to someone who hasn’t taken opioids.

Naloxone became available over the counter in March 2023, right as the decline began, but an early study found only about 9% of pharmacies stocked it. Emergency calls involving naloxone dropped 25% to 30% between 2022 and 2025. The authors read that as fewer overdoses taking place rather than more being caught in time. Canada, which expanded naloxone seven years earlier, saw its decline at roughly the same time.

The buprenorphine picture is similar. Prescribers jumped from about 42,000 to nearly 54,000 a month, but the number of patients receiving it changed little. CDC reports the national dispensing rate stayed stable from 2019 through 2024, and there was no increase in people admitted to treatment with opioids as their main problem.

The authors are careful here. Naloxone and buprenorphine almost certainly saved lives. But neither is large enough to explain the overall decline.

Xylazine and Naloxone

The supply-side explanations find more traction, and one carries direct safety information. Xylazine, a veterinary sedative, showed up in about 20% of fentanyl powder in early 2022 and close to 40% two years later. 

Drug usage has also shifted due to new synthetics like xylazine. Interviews with 52 people who had recently survived an overdose reversal in two Midwestern cities found 46 reported “using less, changing route of administration, or abstaining entirely.” People described avoiding dealers known to carry xylazine and switching from injecting to smoking, driven by fear of skin wounds and by the drug not producing the expected effect.

If that pattern holds broadly, xylazine may have pushed people toward safer practices without anyone intending it. The authors call the evidence largely qualitative and the causal link far from proven.

The practical point is not in doubt. Xylazine isn’t an opioid, so naloxone doesn’t reverse its sedation. That’s no reason to skip naloxone. Fentanyl is almost always present alongside it, and breathing is what naloxone protects. Give it, call 911, stay with the person.

Consistency Matters More Than Strength

The other supply-side factor is variation. The Street Drug Analysis Lab at the University of North Carolina at Chapel Hill tested more than 23,000 samples from 42 states as of early August 2026 and found that fluctuation in fentanyl content drives overdose risk more than average potency does. Someone whose tolerance stems from taking weaker drugs is in acute danger when they hit a strong batch.

Greater consistency alone could reduce deaths without the drugs weakening. The researchers treat this as a partial contributor at most, since the decline began before pill consistency was widely reported and most illicit fentanyl remains in powder form.

Harm Reduction and Treatment

Harm reduction and treatment are parallel paths, not a sequence where one earns the other. Fentanyl test strips identify contamination, and not using alone means someone’s there to respond.

Medication for opioid use disorder works. Buprenorphine and methadone reduce cravings and withdrawal and lower overdose risk, and naltrexone is an option after withdrawal. Since access hasn’t widened much in practice, it’s worth pressing a prescriber rather than assuming a referral moves quickly.

Narcotics Anonymous meetings run alongside medical treatment rather than against it. Attending doesn’t require having already stopped, nor does it require giving up medication. 

Help for Fentanyl and Opioid Use

That’s where we come in. Our browsable directory indexes NA meetings nationwide by city, with filters for open, closed, virtual, and Spanish language meetings.

You can also dial 800-934-1582(Sponsored) for free, confidential information 24 hours a day. If you or someone else is in crisis, call or text 988.