ArticleAddiction (Abingdon, England)2026
Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement.
Article in Addiction (Abingdon, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Multilevel drivers and constraints of shifts from injecting to smoking opioids and stimulants: A qualitative study from the San Diego-Tijuana border region.Drug and alcohol dependence · 2026Article
- Fentanyl purity and overdose decline: A reexamination of geographic trends.Science advances · 2026Article
- Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement.Addiction (Abingdon, England) · 2026Article
- Commentary on Friedman et al.: Inequitable improvements and data gaps-A call for better drug surveillance data.Addiction (Abingdon, England) · 2026Article
- A pilot trial of contingency management for stimulant use in a low-barrier syringe service program.Preventive medicine · 2026Article
- Fentanyl Purity and Overdose Decline: A Reexamination of Geographic Trends.medRxiv : the preprint server for health sciences · 2026Article
- US Overdose Mortality Saw First Drop Below the Jalal-Burke Exponential Growth Curve in 2024.medRxiv : the preprint server for health sciences · 2026Article
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7 authors.
Funding
Abstract
aimsTo characterize decreases in overdose death rates in the United States (US) between 2023 and 2024 by race/ethnicity, and substance involvement.
designPopulation-based study of national death records accessed via the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) platform using an underlying cause of death approach.
settingUS. PARTICIPANTS/CASES: All individuals who died from drug overdose between January 1999 and December 2024. MEASUREMENTS: Annual overdose deaths per 100 000 population. Year of occurrence of overdose death, substance involvement, race/ethnicity of decedents.
findingsAfter many years of increases, the US overdose death rate dropped 24.4% between 2023 and 2024. Decreases reflected declining illicit fentanyl-involved deaths (with and without stimulant involvement). The fourth wave of the US overdose crisis-defined by deaths involving fentanyl together with stimulants-declined for the first time in 2024. Despite overall decreases, deaths involving stimulants without fentanyl and deaths involving xylazine continued to represent a growing fraction of overdose fatalities. Non-Hispanic Black and African Americans had the largest decrease in death rates in 2023-2024, falling by 29.3% but remaining elevated at 36.0 per 100 000, 1.51 times higher than the national average of 23.7 per 100 000. Non-Hispanic American Indian and Alaska Native individuals had the highest overdose death rates rate in 2024, at 50.8 per 100 000, 2.15 times the national average rate, and experienced a below-average relative decrease of 20.1%.
conclusionsAll four previously defined waves of the US overdose crisis appear to be in decline, as deaths involving illicit fentanyl, with and without stimulants, dropped sharply between 2023 and 2024. Concurrently, the fraction of overdose deaths involving stimulants without fentanyl and those involving xylazine continued to increase. While racial disparities in drug overdose death rates narrowed slightly during this period, large gaps remain, with the highest overdose death rates among American Indian, Alaska Native, and Black individuals.
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