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US Overdose Mortality Saw First Drop Below the Jalal-Burke Exponential Growth Curve in 2024.

Joseph R Friedman1, Joseph J Palamar2, Daniel Ciccarone3

  • 1Department of Psychiatry, University of California, San Diego, San Diego, CA.

Medrxiv : the Preprint Server for Health Sciences
|November 24, 2025
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Summary

US overdose deaths have decreased significantly, falling below the predicted exponential growth curve for the first time since 2001. This encouraging trend marks a major deviation, but vigilance is needed for emerging drug threats.

Keywords:
FentanylGrowth TrendsHeroinPrescription OpioidsStimulantsSynthetic DrugsXylazine

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Area of Science:

  • Public Health
  • Epidemiology
  • Drug Policy

Background:

  • US overdose mortality has followed an exponential growth curve for decades.
  • Recent years (2020-2023) saw overdose deaths surpass exponential growth predictions.
  • A significant decrease in overdose deaths occurred between 2023 and 2024.

Purpose of the Study:

  • To determine if the recent decrease in US overdose mortality deviates from the established exponential growth curve.
  • To analyze the trends in overdose deaths from 1980 to 2024 in the US.

Main Methods:

  • Observational study design.
  • Analysis of US overdose death data from January 1980 to December 2024.
  • Comparison of mortality trends against an exponential growth curve fitted to 1979-2016 data.

Main Results:

  • Overdose deaths decreased from approximately 32 per 100,000 (2021-2023) to 23.7 in 2024.
  • The 2024 mortality rate fell below the exponential curve's lower bound (24.98) for the first time since 2001.
  • Declines were linked to reduced fentanyl-involved deaths, but stimulant- and xylazine-involved deaths continued to rise.

Conclusions:

  • The recent decline in overdose deaths is unprecedented and a significant deviation from exponential growth.
  • Continued increases in stimulant and xylazine-related deaths pose ongoing public health challenges.
  • Preparedness for potential resurgence due to novel synthetic drugs is crucial for policymakers and clinicians.