By JT Santana
Every August 31, International Overdose Awareness Day asks us to do something that statistics alone cannot accomplish. It asks us to remember people.
Not cases. Not percentages. Not trend lines plotted across a government dashboard. People who had names, birthdays, irritating habits, favorite foods, private jokes, complicated families, unfinished plans, and people who expected them to come home.
Some were parents. Some were children. Some were siblings, friends, coworkers, neighbors, partners, veterans, students, professionals, laborers, artists, caregivers, or people living on the street. Some had struggled with substance use for years. Others had used a drug once, returned to it after a period of abstinence, took something they did not know contained fentanyl, mixed substances without recognizing the danger, or experienced an overdose involving medication.
An overdose death does not become less tragic after someone learns what substance was involved.
This year, however, International Overdose Awareness Day arrives with something the United States has desperately needed: genuine evidence of progress.
Final mortality data from the Centers for Disease Control and Prevention show that 79,384 people died from drug overdoses in the United States during 2024. That number is enormous, but it represents a major decline from the previous year. The age-adjusted overdose death rate fell from 31.3 deaths per 100,000 people in 2023 to 23.1 in 2024, a 26.2% decrease and the largest annual percentage decline recorded during the period examined by CDC (Garnett & Miniño, 2026). (CDC)
The newer numbers remain encouraging. CDC provisional estimates predict 68,641 overdose deaths during the 12 months ending in February 2026, a 12.1% decline from the preceding 12-month period. Provisional numbers can change as death certificates, toxicology findings, and other records are completed, so they should not be treated as final mortality totals. The direction of the trend, however, gives public-health officials legitimate reason for cautious optimism. (CDC)
We should celebrate that progress.
Then we should get back to work.
Seventy-nine thousand deaths are not a victory. Sixty-eight thousand predicted deaths are not a victory. A declining death toll tells us that intervention can save lives; it does not tell us that the problem has disappeared.
International Overdose Awareness Day should never become an annual ceremony during which we mourn the dead, post a purple graphic, express concern, and return to business as usual on September 1.
Awareness has value only when somebody does something with it.
Progress Is Real, and So Are the People Missing From the Table
The decline in overdose mortality deserves more attention than it sometimes receives. For years, Americans became accustomed to overdose statistics moving in one direction: up.
The modern overdose crisis developed through several overlapping phases involving prescription opioids, heroin, illegally manufactured fentanyl, methamphetamine, cocaine, counterfeit pills, and increasingly complicated patterns of polysubstance use. From 1999 through 2023, drug overdose deaths increased by roughly 520%, according to CDC. By 2023, synthetic opioids, primarily illegally manufactured fentanyl and related compounds, were involved in about 69% of all overdose deaths. (CDC)
Then the numbers began moving downward.
CDC’s final 2024 figures show declines across every age group it examined and across the racial and ethnic groups included in its analysis. Death rates involving synthetic opioids other than methadone fell sharply. Cocaine-involved and psychostimulant-involved death rates declined too (Garnett & Miniño, 2026). (CDC)
Researchers, policymakers, community organizations, treatment providers, harm-reduction workers, families, emergency responders, and people who use drugs will debate the precise contribution of each factor. Naloxone distribution has broadened. Access to medications used to treat opioid use disorder has changed. Community outreach has grown in many places. Drug-use patterns have shifted. The illicit supply itself changes continually, sometimes in ways that vary dramatically between communities.
No single explanation accounts for a nationwide decline of this scale.
That uncertainty should create scientific curiosity, not political opportunism.
A falling death rate must never become an excuse to cut prevention funding, dismantle outreach programs, restrict naloxone access, abandon treatment expansion, or announce that the overdose crisis has somehow solved itself. The logical response to evidence of improvement is to identify which interventions are contributing, study where the gains are occurring, find communities still being left behind, and keep people alive long enough for recovery to remain possible.
There is another danger hidden inside encouraging statistics. Percentages can make catastrophe sound smaller than it is.
Seventy-nine thousand three hundred eighty-four people died in 2024.
Think about that number without converting it into a graph.
Think about tens of thousands of empty chairs at dinner tables. Think about children growing up with photographs instead of parents. Think about parents keeping a bedroom exactly as their son or daughter left it. Think about partners learning how to answer forms asking for marital status. Think about siblings reaching for their phones before remembering there is nobody on the other end.
Those stories do not disappear when the national curve bends downward.
Overdose Is Not Restricted to Some Imaginary Category of Person
One of the most persistent mistakes surrounding overdose is our habit of treating it as something that happens to “other people.”
That assumption has killed people.
There is no single face of overdose. There is no reliable visual test for determining who is vulnerable. A person does not have to identify as addicted, dependent, or as someone living with a substance use disorder to experience a life-threatening overdose.
Someone may take an opioid prescribed for pain and experience trouble after taking too much. Another person may return to opioid use after weeks or months without using, unaware that their tolerance has fallen. A teenager may swallow what appears to be a prescription pill obtained from a friend or social-media contact without knowing the pill was counterfeit. Someone using cocaine or methamphetamine may encounter fentanyl unintentionally. Another person may knowingly combine substances without anticipating how their effects will interact.
The body does not ask whether someone meets a diagnostic criterion before it stops breathing.
Stigma creates its own form of risk here. When society divides people into those supposedly worthy of rescue and those deemed responsible for their circumstances, hesitation enters situations where seconds matter.
We still hear some version of the same tired argument: They chose to use drugs.
People choose to drive cars. We still pull them from wreckage.
People make poor decisions about food, alcohol, medication, sex, exercise, sleep, and countless other parts of human life. We do not ordinarily stand beside them during a medical emergency and conduct a character evaluation before deciding whether they deserve oxygen.
Emergency response is not a referendum on someone’s virtue.
You help the person stay alive.
Everything else can be discussed later.
Six Things Everyone Should Know About Overdose
The following points are worth learning before anyone ever encounters an overdose. Reading them after someone becomes unresponsive is a terrible time to begin your education.
- An overdose happens when the body cannot safely handle the amount or combination of substances present. Drugs can interfere with breathing, heart function, consciousness, temperature regulation, and other functions required to keep someone alive. Opioids can suppress respiration. Stimulants can create severe cardiovascular and neurological emergencies. Alcohol, benzodiazepines, opioids, stimulants, and other drugs may produce different symptoms, and combinations can make an already dangerous situation much harder to predict.
- An overdose can happen to someone who does not regularly use drugs. First-time use does not confer protection. Neither does occasional use. Risk may increase after a period without opioid use when tolerance has declined, after taking medication in a manner different from its prescription, after consuming an unexpectedly potent substance, or after encountering a counterfeit pill. The illicit drug supply has made assumptions about contents particularly dangerous.
- Know the warning signs of an opioid overdose. CDC identifies inability to awaken, extremely slow or shallow breathing, choking, gurgling or unusual snoring sounds in someone who cannot be awakened, discolored lips or fingernails, and very small pupils among possible indicators. A person who cannot be awakened and is not breathing normally should never simply be left to “sleep it off.” If you cannot tell whether someone is experiencing an opioid overdose, CDC recommends treating the situation as one and acting. (CDC)
- Naloxone can temporarily reverse an opioid overdose. Naloxone blocks opioid effects and can restore breathing. CDC states that it can be safely administered when an opioid overdose is suspected and will not harm someone merely from being given naloxone when opioids are absent. If normal breathing does not return within two to three minutes after an initial dose, another dose may be needed. Potent opioids can sometimes require repeated dosing. (CDC)
- Naloxone does not replace emergency medical care. Give naloxone when opioid involvement is possible, call 911, support breathing, place the person on their side when appropriate to reduce choking risk, follow dispatcher instructions, and remain with them until emergency personnel arrive. Naloxone’s effect is temporary. Opioids may remain active after naloxone begins wearing off, leaving the person vulnerable to renewed respiratory depression. (CDC)
- Surviving an overdose does not mean nothing serious happened. A period of severely reduced oxygen can injure the brain and other organs. Aspiration, cardiac complications, kidney injury, neurological damage, and other medical consequences can occur. Every suspected overdose deserves medical attention, and every survival creates another opportunity for treatment, harm-reduction support, naloxone access, peer assistance, medical care, and simple human connection.
None of those six lessons requires a medical degree.
That is part of their significance.
The person standing between somebody else and death may be a roommate, parent, hotel employee, bartender, teacher, librarian, neighbor, Uber driver, friend, security guard, coworker, cashier, or stranger.
That possibility is far less hypothetical than many people think.
Nearly 43% of Overdose Deaths Had a Potential Bystander Present
One CDC statistic deserves to be printed on naloxone boxes, workplace bulletin boards, college orientation packets, bar bathroom posters, apartment-lobby signs, and public-health campaigns everywhere.
A potential bystander was present in nearly 43% of overdose deaths examined by CDC in 2023. (CDC)
Consider what that means.
In a large share of fatal overdoses, another human being was somewhere in the picture.
That does not mean every death could automatically have been prevented. Some people may have been discovered after rescue was no longer possible. Others may have experienced complicated medical emergencies. A bystander may not have known what was happening, may have lacked naloxone, may have been frightened, intoxicated, or unsure how to respond.
Yet 43% tells us something enormous about overdose prevention.
The public is part of the emergency-response system whether we formally recognize it or not.
Training ordinary people to identify an overdose is public health.
Making naloxone common is public health.
Teaching people not to abandon an unresponsive friend is public health.
Putting overdose-response education into colleges, workplaces, shelters, libraries, bars, nightlife venues, treatment programs, correctional reentry services, and community organizations is public health.
Removing the shame associated with carrying naloxone is public health.
A naloxone kit sitting in somebody’s backpack does not imply that person uses opioids. It means the person carries a medication capable of reversing an opioid overdose long enough for emergency care to arrive.
We normalized fire extinguishers without assuming everyone carrying one planned to start a fire.
Naloxone deserves the same common-sense treatment.
The Drug Supply Has Become a Polysubstance Problem
Talking about America’s overdose crisis solely as an “opioid epidemic” no longer captures the entire picture.
Opioids remain central, particularly illegally manufactured fentanyl. Yet stimulant involvement is substantial, and many deaths involve several substances at once.
A CDC analysis covering January 2021 through June 2024 examined 309,274 overdose deaths reported through the State Unintentional Drug Overdose Reporting System across 49 states and the District of Columbia. Researchers found that 59.0% involved stimulants and 43.1% involved both stimulants and opioids. Among stimulant-involved deaths, nearly three-quarters involved opioids too (Tanz et al., 2025). (CDC)
That overlap changes how people need to think about overdose.
Someone may believe they are using cocaine yet encounter fentanyl. Someone may intentionally use methamphetamine and an opioid. Someone may combine an opioid with a benzodiazepine or alcohol. Another person may swallow a counterfeit tablet manufactured to resemble a legitimate medication.
Risk exists both through deliberate polysubstance use and through exposure a person never intended.
Naloxone cannot reverse toxicity caused exclusively by alcohol, cocaine, methamphetamine, benzodiazepines, or other non-opioid substances. CDC and federal overdose-response guidance still recommend administering naloxone when opioid involvement is possible, since it can reverse the opioid component and is not expected to harm someone merely from being administered when opioids are absent. (CDC)
That distinction matters.
“Naloxone did not work” does not necessarily mean an overdose was never occurring. Another substance may be contributing. The person may need airway support, CPR, additional naloxone, cardiac treatment, or other emergency intervention.
Call 911.
Do not use the absence of an immediate response to naloxone as a reason to walk away.
Fatal Overdoses Are Only Part of the Story
Deaths understandably dominate headlines. They are countable, documented through death certificates, and impossible to dismiss.
Nonfatal overdoses are harder to measure.
A 2024 study examining fatal overdose records and emergency-department data from 2010 through 2020 estimated roughly 15 nonfatal overdoses for every fatal overdose across that 11-year period. The ratio changed across time and varied according to the substances involved. The researchers stressed that national surveillance of nonfatal overdoses remains incomplete, making the exact scale difficult to capture (Krawczyk et al., 2024). (PubMed Central (PMC))
That research should change how we talk about overdose.
For every funeral reported in mortality statistics, there are many more emergencies involving people who survived.
Some survived after receiving naloxone.
Some survived after EMS intervention.
Some reached an emergency department.
Some were revived by friends and never entered a hospital.
Some awakened without anyone fully recognizing how close they had come to dying.
A nonfatal overdose is not a moral failure requiring punishment. It is a major medical warning and an opening for intervention.
That person may need naloxone to take home. They may want medications for opioid use disorder. They may need wound care, housing help, psychiatric treatment, transportation, peer support, counseling, safer-use supplies, recovery services, or simply someone willing to speak to them without contempt.
People rarely build healthier lives from humiliation.
They sometimes do build them after someone treats their continued existence as worth protecting.
Naloxone Should Be Boring
I would love to see naloxone become boring.
Not controversial. Not political. Not something hidden behind a counter like evidence of scandal.
Boring.
As ordinary as a first-aid kit.
As unsurprising as an automated external defibrillator hanging on a wall.
As normal as keeping aspirin in a medicine cabinet.
Naloxone is available over the counter in the United States, and nasal-spray formulations make administration straightforward for people without medical training. CDC reports that naloxone can restore normal breathing within two to three minutes when respiratory depression results from an opioid overdose. (CDC)
Iowa residents have access to state-supported naloxone resources too. Iowa Health and Human Services maintains naloxone distribution initiatives and provides information for community access, pharmacies, organizations, and emergency responders. The state’s public-health materials explicitly frame naloxone as part of preventing deaths among Iowans exposed to opioids. (Iowa Health & Human Services)
Iowa law contains protections related to seeking medical assistance during a drug-related overdose under Iowa Code §124.418. Those protections have conditions and limits; they are not a blanket immunity from every possible criminal matter. The statute protects certain information arising from qualifying good-faith efforts to obtain medical assistance and addresses specified possession-related offenses, among other provisions. (Iowa General Assembly)
Nobody experiencing an overdose should have their survival depend upon whether a frightened person nearby has memorized the Iowa Code.
Call for help.
Give naloxone when opioid involvement is possible.
Support breathing.
Stay.
Let emergency professionals deal with everything that comes next.
A dead person cannot enter treatment tomorrow.
A dead person cannot repair a relationship.
A dead person cannot decide to stop using.
A dead person cannot meet a peer-support worker, start buprenorphine or methadone treatment, go back to school, reconcile with a parent, find housing, finish a sentence, see their kid graduate, relapse, try again, recover, struggle, succeed, or simply change their mind.
Survival preserves possibility.
That is reason enough.
Harm Reduction Is What We Do When We Accept That People Are Worth Saving Today
Harm reduction attracts strange opposition for an idea rooted in an extraordinarily simple principle: keep people alive and reduce preventable injury.
Some critics treat naloxone, fentanyl test strips, syringe-service programs, overdose education, or safer-use information as forms of permission.
That argument misunderstands how human beings behave.
A seat belt does not endorse reckless driving.
Condoms do not manufacture sexual activity.
A sterile syringe does not create drug dependence.
Naloxone does not create opioid use.
These interventions acknowledge that risk already exists and attempt to keep the consequences from becoming irreversible.
Harm reduction does not require giving up on treatment or recovery. It can serve as the bridge that gets someone there.
A person cannot recover from a fatal overdose.
That sentence should end a surprisingly large number of ideological arguments.
Evidence-based treatment deserves the same seriousness. For opioid use disorder, medications such as buprenorphine and methadone have substantial research support. Recovery can take several forms, and treatment decisions belong in the relationship between patients and qualified health professionals rather than political slogans about character or willpower.
Abstinence may be the goal for some people.
Reduced use may be progress for somebody else.
Stabilizing medication may transform another person’s life.
Simply staying alive through tonight may be the immediate goal for someone else.
Public health has room for all of them.
Stigma Still Kills
Overdose education frequently focuses on pharmacology, emergency response, treatment access, and the illicit drug supply.
We need to talk about stigma too.
Stigma changes behavior.
It convinces people to use drugs alone so nobody sees them.
It convinces families to hide substance-use problems instead of discussing them.
It causes people to hesitate before carrying naloxone for fear that somebody will make assumptions.
It contributes to people avoiding treatment.
It turns addiction into a character judgment.
It leaves grieving parents wondering whether they are allowed to say how their child died.
It makes society respond differently to death according to what substance appears on the toxicology report.
That hierarchy of grief is cruel.
A mother whose child died from fentanyl does not love her child less than a mother whose child died from cancer.
A spouse does not grieve less intensely when addiction was involved.
Children do not miss a parent less deeply after learning that parent overdosed.
There should be no asterisk attached to compassion.
International Overdose Awareness Day is partly about refusing that asterisk.
We remember the dead without demanding that their lives become cautionary tales. We can discuss risk, prevention, addiction, treatment, policy, and personal responsibility without reducing human beings to the worst day of their lives.
People are more complicated than their toxicology reports.
Every one of the 79,384 people counted in America’s 2024 overdose statistics had a biography before they became a statistic.
They deserve to be remembered that way.
What We Do With Progress Will Tell Us Whether We Learned Anything
The historic decline in overdose mortality gives the United States a choice.
We can interpret improvement as permission to move on.
Or we can treat it as evidence that deaths once portrayed as inevitable were never inevitable at all.
That second interpretation demands more from us.
It means maintaining naloxone access.
It means improving overdose education.
It means investing in evidence-based treatment.
It means supporting recovery services.
It means taking polysubstance use seriously rather than framing every overdose through opioids alone.
It means studying geographic and demographic disparities hidden inside national averages.
It means responding to nonfatal overdoses as openings for care rather than opportunities for punishment.
It means continuing public-health surveillance so that emerging substances and changing patterns are recognized before another mortality curve rises.
It means accepting harm reduction as one legitimate part of a larger response.
It means refusing stigma.
And it means ordinary people learning what to do when someone stops breathing.
The nearly 43% bystander statistic should haunt us a little.
It should motivate us too.
You may someday be that bystander.
Not at a treatment center.
Not in some distant neighborhood you have mentally associated with drugs.
At a family gathering.
In an apartment.
In a restroom.
At work.
At a party.
In a parking lot.
At a hotel.
In your own home.
You may hear unusual snoring from someone who cannot be awakened. You may see lips becoming discolored. You may notice that breathing has slowed or stopped. You may discover that the person will not respond when you call their name.
At that moment, stigma is useless.
Political arguments are useless.
A lecture is useless.
Judgment is useless.
Action can save a life.
Administer naloxone if opioid involvement is possible. Call 911. Support breathing according to your training or the dispatcher’s instructions. Stay with the person. Give another naloxone dose after two to three minutes if normal breathing has not returned and another dose is available.
Do not assume they will be fine.
Do not leave them alone.
Do not decide they deserve what is happening.
Help them live.
Awareness Must Become Action
International Overdose Awareness Day is a day of remembrance, but remembrance alone is too passive for a crisis that remains preventable.
We should say the names of people we have lost.
We should make room for families whose grief has been complicated by shame.
We should acknowledge the remarkable decline in national overdose mortality and the people whose work helped make that decline possible.
Then we should ask what comes next.
The answer cannot be complacency.
In 2024, 79,384 people still died.
The current provisional numbers suggest that fewer families may receive that devastating phone call this year. That is extraordinary news. Every death prevented represents an entire human future that did not disappear.
Let us protect that progress.
Learn how to recognize an overdose.
Carry naloxone.
Teach somebody else how to use it.
Keep naloxone where people can reach it.
Talk honestly with teenagers about counterfeit pills and fentanyl.
Support treatment that is grounded in evidence.
Support practical harm-reduction services.
Stop treating people who use drugs as disposable.
Stop forcing grieving families to defend the humanity of the people they buried.
And when somebody may be overdosing in front of you, act.
The goal is not to determine whether that person deserves another chance.
The goal is to make certain they are alive long enough to have one.
References
Centers for Disease Control and Prevention. (2026). About overdose prevention. National Center for Injury Prevention and Control. (CDC)
Centers for Disease Control and Prevention. (2026). Data resources: Overdose prevention. National Center for Injury Prevention and Control. (CDC)
Centers for Disease Control and Prevention. (n.d.). 5 things to know about naloxone. National Center for Injury Prevention and Control. (CDC)
Centers for Disease Control and Prevention. (n.d.). Lifesaving naloxone. National Center for Injury Prevention and Control. (CDC)
Garnett, M. F., & Miniño, A. M. (2026). Drug overdose deaths in the United States, 2023–2024. NCHS Data Brief No. 549. National Center for Health Statistics. (CDC)
Iowa Department of Health and Human Services. (n.d.). Save a life with naloxone. (Iowa Health & Human Services)
Iowa Legislature. (2026). Iowa Code § 124.418: Persons seeking medical assistance for drug-related overdose. (Iowa General Assembly)
Krawczyk, N., et al. (2024). Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010–2020. Injury Prevention. (PubMed Central (PMC))
Tanz, L. J., Miller, K. D., Dinwiddie, A. T., Gladden, R. M., Asher, A., Baldwin, G., Nesbit, B., & O’Donnell, J. (2025). Drug overdose deaths involving stimulants—United States, January 2018–June 2024. Morbidity and Mortality Weekly Report, 74, 491–499. (CDC)
