The U.S. has been experiencing a prolonged crisis with opioid overdoses which has affected innumerable lives, families, and communities. Americans are more likely to die from drug overdoses than gun violence or car accidents. The number of people who died of an opioid-related overdose each year rose exponentially from at least 1999 until 2023, but recently the trend has shifted. Provisional data shows drug overdose deaths (of which opioid-involved deaths make up a large majority) saw about a 25 percent nationwide drop from October 2023 to October 2024, and more than a 28 percent drop in New York State over the same period.
Experts are puzzled about the nationwide drop, but some speculate that improved access to medication for opioid-use disorders and to harm reduction services (such as syringe exchange programs, overdose prevention education, safe consumption spaces, and peer support programs) may have contributed to the decline. My recent research has also identified potential best practices that could further help sustain this downward trend in opioid-related deaths.
I was one of the principal investigators of a five-year study to reduce overdose deaths. The HEALing Communities Study, launched in 2019 by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration, was the largest community-based addiction research study ever conducted. It spanned 67 communities in Kentucky, Massachusetts, New York, and Ohio — four states that had seen large increases in overdose deaths.
Our study was built upon the principle of community-engaged research, in which researchers and community members form partnerships at all stages. These partnerships included diverse community coalitions that identified strategies, developed plans for implementation, and recruited members to take the lead in addressing challenges. The coalitions included people with lived experience and were intentionally formed to have diversity in race, ethnicity, gender, socioeconomic status, and professional expertise. Because of the power of these collective voices, local governments began to pay more attention to the urgency of the overdose crisis and attended coalition meetings.
Our study was built upon the principle of community-engaged research, in which researchers and community members form partnerships at all stages.
As the principal investigator for the New York site, I oversaw the implementation of the study in 16 New York counties, both urban and rural. Several counties saw meaningful decreases in overdose deaths, but three counties — Cayuga, Ulster, and Chautauqua — saw more dramatic reductions. Cayuga County, for instance, reported to me that they witnessed a nearly 57 percent reduction in overdose deaths over the past three years. In Ulster County, overdose fatalities decreased by more than 45 percent in 2024 compared to 2023. Meanwhile, Chautauqua County reported a 55 percent reduction in overdose fatalities during an 11-month period in 2024 compared with the same period in 2023.
These dramatic reductions confirmed what we learned from the study — that addressing the longstanding problem of overdose deaths requires an integrated approach, community engagement, and data-driven strategies.
As a long-time addiction researcher, I understand the importance of an integrated approach that simultaneously addresses substance-use disorders, co-occurring mental health issues, and related challenges like housing and food insecurity. Unfortunately, access to drug use services in the U.S. often requires people to navigate multiple separate systems that provide addiction treatment, harm reduction services, mental health treatment, housing assistance, and more.
In Ulster County, for example, a parent of three children who had experienced multiple overdoses due to past abuse and trauma reported benefitting from study resources. After one overdose, the individual found themselves alone, with no shelter, an untreated addiction, and children to support. The study helped secure funding for a mobile outreach service called ORACLE — Opioid Response as County Law Enforcement — led by the local sheriff’s office. ORACLE provided a voucher for the person to stay in a specialized motel with a care package that included food, toothbrushes, soap, and socks. ORACLE then connected them with a service provider through which they received substance-use treatment and permanent housing — effectively “closing the loop” for this individual’s recovery process.
We also saw first-hand the importance of seeing community members as experts in addressing their own challenges. Over the past two decades, I have witnessed a shift away from “parachute science” whereby researchers enter a community without prior engagement, collect data with little input, and depart. In contrast, the community coalitions began by identifying where critical resources were most needed, for instance by pinpointing high-risk areas for overdoses called “overdose hotspots.” In these locations, they strategically placed “NaloxBoxes” which contain the overdose reversal medication naloxone and fentanyl test strips. This initiative ensured that life-saving tools were available when and where they were most needed. As a result, we found that naloxone distribution was 79 percent higher in communities that had the boxes compared with study communities that did not yet have them.
In New York state, rapid access to data remains a significant challenge due to delays in government reporting. For instance, overdose deaths disproportionately impact Black communities, but data by race and ethnicity is often lacking or lagging in U.S. health systems. The lack of timely data limits a coalition’s ability to implement data-driven solutions, which is why in the study, we also worked to democratize the data process. The ability for communities to access timely data on overdose deaths and the people most in need of treatment helps them to allocate resources when and where they are needed.
For example, data showing numerous overdose calls from certain hotels or apartment buildings could identify those places as hotspots for a NaloxBox or naloxone vending machine. Online, password-protected data dashboards helped community coalitions integrate and visualize data so that they could monitor trends and make data-informed decisions closer to real-time. As one example, Chautauqua County discovered that stimulants (such as cocaine and methamphetamines) were involved in almost 80 percent of overdose deaths in 2023. This insight allowed the coalition to pivot their messaging to a new population — people using stimulants.
The ability for communities to access timely data on overdose deaths and the people most in need of treatment helps them to allocate resources when and where they are needed.
Data also can inform distribution and training strategies. Cayuga County told me they discovered more bystanders administered naloxone than first responders such as police or EMTs. This insight led them to launch a public information campaign to encourage bystanders to use naloxone to save lives. Also, data showing a rise in deaths from fentanyl in the stimulant drug supply prompted our study’s communication campaigns to warn of the danger and promote harm reduction strategies.
Results from the study published in the New England Journal of Medicine suggested more time was needed to measure its long-term impact. Implementing best practices like prescribing medication for opioid-use disorder and distributing naloxone takes time to establish and reach large numbers of people at highest risk of an overdose death. To address a societal challenge as widespread as the opioid crisis, we need to sustain efforts beyond the intervention period, including a strong commitment from the state and local government.
Policymakers and community leaders can adopt these approaches nationally. At the local level, researchers must ensure that communities lead the efforts to reduce overdose deaths, like the coalitions in Cayuga, Ulster, and Chautauqua. Local solutions, backed by scientific evidence, can turn the tide on this national crisis.
Dr. Nabila El-Bassel is a University Professor at the Columbia University School of Social Work. She is director of the Columbia Center for Healing of Opioid and Other Substance Use Disorders and director and cofounder of Columbia’s Social Intervention Group and the Global Health Research Center of Central Asia.
