ArticleThe International journal on drug policy2026
US overdose mortality saw first drop below the Jalal-Burke exponential growth curve in 2024.
Article in The International journal on drug policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Fentanyl purity and overdose decline: A reexamination of geographic trends.Science advances · 2026Article
- Variation in knowledge and attitudes among overdose prevention collaborations: Insights from fatality review teams.Drug and alcohol dependence · 2026Article
- Fentanyl Purity and Overdose Decline: A Reexamination of Geographic Trends.medRxiv : the preprint server for health sciences · 2026Article
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7 authors.
Funding
Abstract
backgroundBetween 1979 and 2016, US overdose death rates rose in a smooth fashion, described by Jalal and Burke using an exponential growth curve that fit observed data nearly perfectly. Fluctuations above this curve have subsequently been seen during shocks related to drug supply and the COVID-19 pandemic. However, large-magnitude dips below the curve have never been demonstrated. Given that overdose mortality began sharply falling during 2023-2024, we assess updated overdose trends against the Jalal-Burke curve.
methodsWe examined US overdose deaths from the National Vital Statistics System between 1979-2024. We recreated the Jalal-Burke curve, fitting an exponential growth curve to overdose rates from 1979 to 2016, projected through 2024, with 95% confidence intervals. We also examined trends by specific substance involvement.
resultsAfter precipitously surpassing exponential growth predictions in 2020-2023, overdose deaths decreased sharply from approximately 32 per 100,000 in 2021-2023 to 23.7 in 2024, falling below the lower bound of the Jalal-Burke curve (24.1 per 100,000) for the first time since 2001. These decreases reflected declining illicit fentanyl-involved deaths, which fell to 14.25 per 100,000 in 2024; however, deaths involving stimulants without fentanyl, and those involving xylazine, represent an increasing share of deaths, rising to 5.64 and 1.89 per 100,000, respectively, in 2024.
conclusionsRather than simply representing a return to the Jalal-Burke exponential growth curve, recent decreases in overdose deaths represent the first significant, large-magnitude deviation below exponential growth projections. This represents a very positive development; however, shifting challenges in the US drug crisis require a tailored response.
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