American Fentanyl Deaths Are Dropping — But China Holds the Cards

For the first time in decades, American streets are witnessing something public health officials once thought impossible: overdose deaths are plummeting. Provisional data from the Centers for Disease Control and Prevention shows drug overdose deaths fell to approximately 72,836 in the 12 months ending August 2025, the most recent data available, down more than 20 percent from the previous year and marking the most prolonged sustained decline in decades.The dramatic reversal follows a 26.9 percent drop in 2024, when deaths fell from 110,037 to approximately 80,391 — the lowest level since 2019.Yet the celebration is cautious. Experts warn the decline may be temporary, driven mainly by disruptions in the Chinese chemical supply chain rather than by lasting public health victories. While deaths are dropping nationwide, the epidemic’s toll remains staggering: more than 72,000 Americans still died from overdoses in the most recent 12-month period, with the crisis continuing to devastate black and Native American communities even as white communities see improvements.Yet as communities cautiously celebrate, addiction researchers and public health experts are issuing an urgent warning. The decline may not signal victory over fentanyl. Instead, it reveals a darker reality about how the synthetic opioid has reshaped America’s drug-using population.A Grim Calculus: The Depletion EffectAmong the most disturbing theories explaining the drop is what researchers call the depletion effect. Over the past five years, nearly 500,000 Americans died from drug overdoses, with fentanyl driving the majority of deaths. Yet many addiction experts believe that the most recent decline reflects, in part, the tragic reality that the most vulnerable users have already died.“The experience of Estonia, which has had a fentanyl dominated market for decades, is that when the drug first appears the death rate is high and then after 5 or 10 years everyone who could not handle such a potent drug has died and the rest have become tolerant to its effects,” a professor at Stanford University’s Department of Psychiatry and Behavioral Sciences, Keith Humphreys, tells The New York Sun.He emphasizes a critical point about market adaptation. “Also, no one is surprised anymore that they are taking fentanyl — it is expected both by users and dealers,” Mr. Humphreys says. This awareness marks a stark shift from the early years of the fentanyl crisis, when users believed they were purchasing heroin or prescription pills, only to consume a more lethal substance unknowingly.The theory aligns with data showing fewer young people initiating drug use. Research from the University of Michigan found that teen abstinence from substances reached its highest level in 2024. New users with low tolerance for powerful opioids like fentanyl face the highest overdose risk.“We have lost over 1.2 million people to drug overdose since this crisis began over 25 years ago,” managing director of the Department of Research and Academic Engagement at the Drug Policy Alliance, Sheila Vakharia, tells the Sun. “While one potential factor is the fact that we have already lost so many, another compelling factor is the fact that we are seeing a generational or cohort shift so that younger generations of people are not growing up to use street opioids at the same rate as older generations did.”Ms. Vakharia pointed to recent research suggesting that fewer young people initiating prescription opioid use in the late 2000s meant fewer escalated to heroin use, and then fewer were likely to be exposed to fentanyl by now.Yet a professor of the University of Maryland’s School of Public Policy, Peter Reuter, cautions against oversimplifying the numbers. “The precision of estimates on the number of regular fentanyl users is low,” Mr. Reuter tells the Sun. “It is impossible to be sure whether the 2023 number was larger or smaller than the 2022 number.”He notes that many deaths involving fentanyl also involve stimulants, with methamphetamine more common in fentanyl deaths than cocaine. “Many of them did not know that fentanyl was mixed with the meth or cocaine,” Mr. Reuter continues. “It is unclear, then, what the relevant population of users is.”Despite the difficulty of precisely measuring the depletion effect, the theory carries weight among frontline researchers who have watched the crisis unfold over the years.Survivors Learn to Navigate a Toxic LandscapeAnother factor behind declining deaths is adaptation by surviving drug users. People who use fentanyl have developed harm reduction practices: smoking rather than injecting, carrying naloxone to reverse overdoses, using test strips to identify contaminants, and deliberately using drugs with others nearby who can provide emergency aid.“It is very challenging to measure population tolerance levels, but it is likely playing a role too,” Ms. Vakharia explains. “With recent fluctuations in the fentanyl potency on the street, it is possible that people with a higher tolerance may have been less likely to accidentally overdose.”She emphasizes that harm reduction advice, such as “never use alone” and “go slow,” has helped people reduce the risk of fatal overdose.“The wider availability of naloxone means that people are more equipped to respond to overdose in communities,” Ms. Vakharia continues. “We also know that the more widespread use of fentanyl test strips and advanced drug checking technologies could also be helping people to know what is in their drugs and then decide how to reduce overdose risk.”Improved access to medications for opioid use disorder, such as methadone and buprenorphine, has also helped people recover long-term. These medications reduce opioid cravings and withdrawal symptoms.“More jails and prisons are providing these medications, more emergency rooms initiate patients onto them, more providers are prescribing, and looser federal policies mean it’s easier to stay on them,” Ms. Vakharia says.Yet many experts believe the most significant driver of the decline lies not in treatment advances, but in disruptions to the drug supply itself.Supply Shock: A Temporary Reprieve“As our attached study shows, the overriding factor in the overdose death decline is clearly the decreasing supply of fentanyl, which likely resulted from China interdicting the precursor chemicals that are used to make it,” Mr. Humphreys observes.Recent research published in the journal “Science” by Mr. Reuter and his colleagues argues that regulatory changes in China beginning in 2023 disrupted the supply of precursor chemicals used to manufacture fentanyl, reducing both availability and potency on American streets.Drug Enforcement Administration data shows fentanyl purity declined in early 2024. While seven out of ten pills contained a potentially deadly dose in 2023, that number dropped to five out of ten in 2024.“Precursor controls may have played an important role in the decline, but that does not mean the federal government should be investing in other supply-side programs,” Mr. Reuter underscores. “I am fully supportive of treatment and harm reduction programs. However, it is hard to tell a story in which these account for such a rapid and substantial decline in overdose deaths.”The effectiveness of China’s crackdown has emerged as a critical question, with experts noting Beijing’s enforcement appears selective and strategically timed for diplomatic advantage. For years, illicit Chinese outfits have provided the critical precursor chemicals routinely used by Mexican cartels to manufacture the deadly drug.The co-founder and CEO of China Beige Book and member of the U.S.-China Economic and Security Review Commission, Leland Miller, confirmed China’s role. “China can restrict precursors and sometimes does, but they haven’t flipped the switch completely,” Mr. Miller tells the Sun. “They use it as leverage. They absolutely have the capacity.”Other experts characterize China’s control over the precursor supply chain as even more deliberate and strategically weaponized. “China is the single source of industrial-scale precursor,” Mike Kuiken, vice chair of the United States-China Economic and Security Review Commission, tells the Sun. “They know exactly where the factories are. This is a quiet lever they use to induce pain.”The geopolitical dimension adds another layer of complexity to understanding the overdose decline. China’s willingness to restrict precursor chemicals appears tied to broader diplomatic negotiations with the United States, suggesting that American overdose rates may fluctuate based on factors entirely unrelated to domestic public health policy.The Evolving Drug SupplyWhile fentanyl deaths decline, public health officials face a terrifying reality: the drug supply is evolving toward even more dangerous substances. Two drug classes have addiction experts deeply concerned: xylazine and nitazenes.Xylazine, known on the street as “tranq,” is a veterinary tranquilizer being mixed with fentanyl in 48 of 50 states. The DEA reported that approximately 23 percent of fentanyl powder and seven percent of fentanyl pills seized in 2022 contained xylazine. The substance is hazardous because it’s resistant to naloxone. It also leads to severe and often necrotic skin sores and ulcers, often far from the injection site. “When we see xylazine detected in overdose deaths, it is usually because the xylazine was added to fentanyl — it is never found on its own — and it’s likely the fentanyl still was the primary driver of the death,” Ms. Vakharia says. She notes that those who use fentanyl with xylazine in it actually tend to use it fewer times per day because the effects last longer. “For some people, xylazine may reduce the frequency of their use and reduce their overdose risk.”“The interactions are complex,” Mr. Reuter asserts. “Many users may be deterred by knowing that xylazine might be in the fentanyl they are sold, so it may lead to less fentanyl consumption but higher death rates amongst those who continue to use.”Even more alarming are nitazenes, synthetic opioids that can be up to 100 times more potent than fentanyl. The drugs were developed in the 1950s as potential painkillers, but were never government approved because they were so toxic.“Nitazines are more potent than fentanyls, and if they spread more broadly than they have so far we should expect an increase in deaths,” Mr. Humphreys says.“Sure, it is possible that more potent opioids like nitazenes can increase overdose risk, and this is something we should track, since nitazenes are still not widespread,” Ms. Vakharia says.The decline represents genuine progress; however, researchers emphasize its fragility. “I think it’s a ‘both and’ discussion rather than an ‘either or’ discussion when it comes to the impact of various factors,” Ms. Vakharia points out. “No one factor started this crisis, and no one factor will reduce all deaths.”

American Fentanyl Deaths Are Dropping — But China Holds the Cards

American Fentanyl Deaths Are Dropping — But China Holds the Cards

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