In 2022, the Biden-Harris administration released its first full National Drug Control Strategy (NDCS) with an accompanying Performance Review System (PRS) report that detailed national substance use-related goals. Central among these goals was that, by the end of 2025, there would be 81,000 or fewer drug fatalities in the nation. Data released on May 14, 2025, provisionally estimates that, for the year ending in December 2024, the number of fatal drug overdoses in the Unites States was 80,391.
Therefore, the goal set by the Biden-Harris administration for 2025 was met a full year early.
While we must acknowledge that overdose death rates are still far too high and that we should be striving for an overdose-free generation, meeting this goal remains a significant accomplishment.
Some saw the 2025 goal as highly ambitious when it was set in 2022. At that time, drug fatalities were on a rapid rise in the U.S., fueled largely by fentanyl. The 2022 PRS provides year-by-year interim goals on the way to 2025; these interim goals reflect that the rapid increase in fatal overdoses underway at that time would have to be slowed, flattened, and finally brought down to at 81,000 or lower in less than four calendar years’ time (not unlike reversing the path of an ocean liner) — a major undertaking for a national goal reflecting the urgency of the crisis.
Further, some researchers had shown that over the long term, drug fatalities in the U.S. have tended to follow an exponentially increasing curve and that, absent some groundbreaking intervention, would likely continue to do so. The 2025 fatal drug overdose goal set in 2022 aspired to break away from this exponentially increasing curve, which, again, is a major undertaking.
Additionally, as reported by Reuters, the administration’s analysis in 2022 anticipated that if then-trending increases in drug fatalities continued apace, the number of fatal drug overdoses in the U.S. could reach 165,000 in 2025 (based on trends seen in the years before 2022). These types of trends added to the urgent need for action. Lives were at stake, and there was no time to lose to intervene to prevent these potential fatalities.
Achieving the 2025 goal one entire year early seems remarkable for these historical reasons and is welcome, as it reflects tens of thousands of lives saved. Even so, this achievement — as remarkable as it may be — should be viewed not as a terminus but as one important milestone on a rapid pathway to achieve no more drug fatalities in the nation. Elsewhere, we have called for an overdose-free generation in America by 2035 and a 50% reduction in fatal drug overdoses by 2030 (accompanied by a goal to ensure that all communities reach these reductions in a similar time frame). Therefore, May 14, 2025, is not a victory lap but rather a reflection on the current state of affairs in substance use policy.
While a drug fatality goal has centrality in the field must first be able to keep alive persons who are challenged by substance use, the 2022 PRS noted that other metrics are also important. These include the following: (a) prevalence of persons living with substance use disorder; (b) coverage of prevention, harm reduction, treatment, recovery, and criminal justice-related services; and (c) disruption of illicit and deadly drug supply. While some of these metrics can be addressed with current data, we note that some rely on measures one to two years old; for instance, the most recent national data on substance use prevalence is from 2023.
We understand and note that gathering, analyzing, and reporting rigorous data takes time. However, for national programs and policies, this raises a challenge of being able to judge progress on metrics as quickly as possible. We must further endeavor to find ways to ensure that rigor and timeliness go hand in hand rather than be at odds with each other.
The issue of timeliness of metrics is further exacerbated by an ever-changing drug supply with new drugs, adulterants, patterns of use (especially polysubstance use), and drug supply systems (including the online selling of counterfeit pills) continually evolving.
Beyond (but related to) timeliness, there is also the question of whether even the robust set of 2022 metrics and goals set by the White House Office of National Drug Control Policy is entirely comprehensive. Potential additions of metrics and goals could include the following: (a) number and pattern of nonfatal drug overdoses (perhaps as derived in part from the NEMSIS nonfatal overdose tracking dashboard and poison control centers); (b) physical and mental wellbeing of persons living with substance use challenges (including persons in recovery); (c) stigma confronted by persons living with substance use disorder; (d) comprehensiveness of services (such as housing) to address the social determinants of substance use; and (e) trends in emerging drug threats.
On top of such metrics and goals, we need the ability to assess health equity factors and patterns of knowing or unknowing substance and polysubstance use. But, of course, any consideration of additional goals and metrics must be accompanied by determining whether those metrics can be collected, analyzed, and reported in a sufficiently timely manner to inform programs and policies, and even if timely, whether they convey content that is sufficiently informative to sway programmatic and policy directions when necessary.
In conclusion, as we reflect on the one-year-early achievement of the 2025 fatal drug overdose goal, we cannot forget that much work remains to be done to save the lives of the remaining 80,391 persons who experience a drug-related death. At the same time, we also must remember that concerted efforts helped to achieve this important interim milestone and that tens of thousands of persons are alive today who might otherwise have been taken from us by drugs. We cherish every one of these lives and wish to honor their presence by doubling down on programs and policies that can save even more lives and improve the quality of life for all. Now is not the time for complacency nor backsliding on the investment in evidence-based services.
