The United States is witnessing a significant decline in fentanyl-related overdose deaths, with a 25% decrease in 2024 saving nearly 30,000 lives, driven by harm reduction strategies and personal recovery stories like that of Kayla from North Carolina.
Kayla, an 18-year-old from North Carolina, became instantly addicted to fentanyl after trying it, describing how the drug silenced her inner voices but exposed her to constant overdose risks from unpredictably potent pills smuggled from Mexico. She reflects on the fear that she could have died at any moment, highlighting the deadly nature of the synthetic opioid, which is 50 times more potent than heroin. Her experience mirrors that of many Americans caught in the grip of addiction, where drug cartels’ unregulated production means users never know the dosage they are consuming.
In 2023, over 110,000 drug-related deaths occurred in the U.S., but 2024 brought a staggering turnaround with a 25% drop in fatal overdoses, equating to approximately 30,000 fewer deaths. North Carolina is at the forefront of this trend, experiencing a 35% reduction in overdose fatalities, thanks in part to innovative approaches that prioritize health over criminalization. Harm reduction strategies, such as the Law Enforcement Assisted Diversion (LEAD) program in Fayetteville, partner police with the North Carolina Harm Reduction Coalition to divert substance users from crime toward recovery.
Kayla, who once used prostitution to fund her fentanyl habit, has benefited from LEAD, resulting in her criminal record being expunged and her graduation as a certified nurse assistant. She attributes her longest period of cleanliness—nearly a year—to methadone treatment, which stems cravings and prevents painful withdrawal symptoms. Medication-assisted treatment (MAT) with methadone or buprenorphine has been a game-changer in North Carolina, with over 30,000 people enrolled in programs in 2024, and numbers rising in 2025.
At clinics like those run by Dr. Eric Morse in Raleigh, patients receive their prescriptions efficiently, with many holding jobs once sober. Dr. Morse emphasizes that even reduced drug use improves survival odds, as harm reduction means supporting patients through positive drug tests rather than expelling them. However, not everyone supports this approach; critics like Republican state representative Mark Pless argue that MAT replaces one addiction with another and favor abstinence-based programs. Health professionals push back, citing a Yale University study showing abstinence treatment carries similar or higher overdose risks compared to no treatment.
Naloxone, a nasal spray that reverses opioid overdoses, has been administered over 16,000 times in North Carolina in 2024, potentially saving thousands of lives. Additionally, drug-testing services help users identify dangerous substances, though test strips cannot detect all harmful additives. Dr. Nabarun Dasgupta, who runs a national drug-testing lab, notes a generational shift where Generation Z is avoiding opioids more than previous generations, likely due to widespread awareness of overdose risks.
Legal actions have also played a role, with North Carolina’s former attorney general, now Governor Josh Stein, coordinating a $60 billion opioid settlement from manufacturers and distributors. This funding must be spent on prevention, treatment, recovery, or harm reduction, but uncertainties around Medicaid cuts in federal legislation could threaten progress. Disparities persist, as black, indigenous, and non-white populations in North Carolina have not seen the same rate of decrease, and states like Nevada and Arizona lag in reducing overdoses.
Kayla aims to taper off methadone and find a job in a hospital, embodying the hope that recovery is possible. She credits her harm reduction mentor and feels more alive than during her addiction, underscoring the human impact behind the statistics. While the decline in deaths is encouraging, ongoing efforts are needed to address inequalities and sustain progress in the fight against fentanyl.