US overdose mortality saw first drop below the Jalal-Burke exponential growth curve in 2024

Between 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.

We 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.

After 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.

Rather 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.