U.S. progress against fentanyl deaths continues amid Trump’s strikes, dealmaking, addiction programs

Drug overdose deaths have fallen in President Trump’s second term alongside his get-tough approach to fentanyl that includes sealing the border, killing foreign drug traffickers and rescheduling synthetic opioids to deliver harsher criminal sentences.

Roughly 68,000 people died of drug overdoses in the U.S. in the 12 months ended in October, the most recent point for which federal data is available. It was a 20% drop compared with the same measure in October 2024.

The decline is a continuation of the dramatic drop in overdose morbidity that began in mid-2023 and continued through the second half of President Joseph R. Biden’s term.

Overdose deaths peaked at a one-year rate of 111,466 in June 2023 before plummeting.

Deaths from synthetic opioids, specifically, which includes fentanyl, halved from an annual rate of about 80,000 in late 2023 to 40,000 in the year leading to last October, according to federal data.

“It’s very substantial, and it’s really hard to find any historic example in the last 50 years of drug fatalities declining anything like as steeply as this,” said Peter Reuter, a distinguished professor in the Department of Criminology at the University of Maryland.

Drug experts see myriad drivers of progress, ranging from better treatment options and access to overdose-reversing naloxone. The return to post-pandemic normalcy likely helped after a sharp increase in overdoses during the height of the COVID-19 crisis.

The Trump administration points to its efforts to secure the border, re-list illicit fentanyl and its analogs as dangerous Schedule I drugs and dismantle cartels with military strikes and joint operations with Mexico, including the one that killed drug lord El Mencho in February.

It also highlights demand-side efforts, such as grants for local groups that promote drug-free communities and support for Angel Parents who lost children to drug overdoses and want to raise awareness about fentanyl, which is often pressed into fake pills and taken by unsuspecting users.

Yet an overseas factor is perhaps the biggest catalyst for the marked drop in fentanyl deaths.

There appeared to be a major disruption in the illicit fentanyl trade, beginning in 2023, that was tied to Chinese government actions against fentanyl precursor chemicals and resulted in a sharp reduction in overdose mortality in the U.S. and Canada, according to a recent article in the peer-reviewed Science journal.

The fact that both countries saw a reduction is notable, given their disparate approaches to drug policy, and the researchers concluded there was a drop in the purity of fentanyl powder.

Researchers also saw increasing references to a “fentanyl drought” on Reddit, the popular internet platform.

“It has been said that ’success has many fathers,’ and supporters of various types of interventions — including treatment, harm reduction and domestic law enforcement — have wished to be associated with the sizable and welcome reductions in [overdose deaths],” the authors wrote.

“Yet multiple indicators are consistent with a major disruption in the illicit fentanyl trade that translated into sharp reductions in overdose mortality beginning in mid- or late-2023 and continued into 2024 across both the U.S. and Canada,” they said.

Mr. Biden negotiated a deal with Chinese President Xi Jinping in November 2023 that called on Beijing to target any company that manufactured fentanyl precursor chemicals.

Often, Chinese chemicals make their way to Mexico to be made into fentanyl by cartels and trafficked into U.S. communities.

The Biden deal piled on top of the first Trump administration’s efforts in 2019 to get China to schedule fentanyl as a restricted class of drugs.

Last year, the second Trump administration got new commitments from China to crack down on fentanyl in exchange for a lower tariff rate from Mr. Trump.

Mr. Xi is scheduled to host Mr. Trump in the coming weeks, though the U.S. side has postponed the trip due to the war in Iran.

Efforts to combat fentanyl could come up alongside issues such as trade and the status of Taiwan.

“I think the key thing for Trump is, ’Can you keep China onside?’” said Keith Humphreys, a Stanford University professor who tracks the overdose issue and co-authored the Science journal paper with Mr. Reuter and others.

Mr. Trump “is applying heavy, public pressure,” Mr. Humphreys said. “Sometimes that works, and countries comply. At other times, countries feel they have to save face, and they resist.”

Researchers say China is hardly transparent about its moves on fentanyl or its motives. However, an asymmetry between U.S. and Chinese goals compels Beijing to act at times.

“The United States is very concerned about fatal overdoses associated with the drug,” the Science article said. “For China, domestic opioid abuse is a negligible issue, as are the financial stakes in selling fentanyl or its precursors to North America. It can choose to increase control efforts at little cost in return for substantial U.S. concessions on other issues.”

Mohamed Kabbaj, a professor of biomedical sciences at Florida State University, said maintaining cooperation with China and Mexico will be critical to regulate precursor chemicals and “disrupt trafficking networks at their source, before fentanyl reaches the country.”

He added, “Equally important is the public health response, such as expanding access to addiction treatment, increasing the availability of overdose-reversal medications like naloxone, and continuing education and prevention efforts. I believe that a strategy that combines enforcement, international collaboration, and treatment is the most effective way to reduce the impact of fentanyl.”

Policymakers are trying to keep the overdose trendline moving in the right direction and helping states — particularly in the West — that have seen increases in fentanyl morbidity despite nationwide progress.

Colorado, for instance, said its provisional data show it likely had more overdose deaths in 2025 than in 2024.

“Sustained, multi-sector efforts across public health, public safety, and community partners are critical to effectively combat the complex and evolving nature of the fentanyl crisis,” the Colorado Department of Public Health and the Environment said in a written statement.

Fentanyl began fueling drug-overdose deaths during the second Obama administration, when synthetic opioids started showing up in the heroin supply.

The situation was particularly devastating because many Americans had become hooked on opioids during a period of overprescribing of painkillers in the 1990s and 2000s.

Centers for Disease Control and Prevention data show 3,105 people died from a synthetic opioid overdose in 2013, a number that shot to 72,776 deaths by 2023.

U.S. overdose deaths, most of which are caused by fentanyl, plateaued during the first Trump administration but rose sharply during the pandemic year of 2020 and into the first half of the Biden administration before hitting a peak and falling.

The Biden administration, by and large, focused on expanding treatment and access to naloxone, an overdose-reversing drug, in its addiction strategy.

Mr. Trump has taken a more confrontational stance toward drug cartels, labeling them terrorist groups, and he signed a bill that would reschedule illicit fentanyl and its analogs as Schedule I drugs. The move put illicit fentanyl on the most restrictive list of drugs and paved the way for stiffer criminal penalties for fentanyl crimes.

In January, Mr. Trump launched the Great American Recovery Initiative, a program aimed at bolstering the federal government’s response to substance abuse.

“President Trump is using every tool at his disposal to save lives from the scourge of illicit narcotics,” White House spokeswoman Anna Kelly said.

Jeffrey A. Singer, a senior fellow at the libertarian Cato Institute, cautioned against being too heavy-handed in the fight.

He said the decline in overdose deaths “appears to be multifactorial — driven by expanded naloxone access, harm reduction efforts and changes in user behavior — and it began before any recent shift toward more aggressive enforcement.”

Democrats fear progress will stall due to Mr. Trump’s federal funding and personnel cuts at key agencies, including at the Substance Abuse and Mental Health Services Administration.

“We’ve made real progress over the last several years combating the overdose crisis and saving lives,” said Rep. Frank Pallone, New Jersey Democrat and ranking member on the House Energy and Commerce Committee. “However, I’m very concerned all that progress is being undone by the Trump administration slashing substance abuse and recovery funding.”

If cuts continue, he said, “I fear we are going right back to the days of historic overdose deaths.”