Three US states have seen surges in drug overdoses, despite historic decreases throughout the rest of the country.

Nationwide, drug overdose deaths fell 26.3 percent in the 12 months leading up to April 2025 compared to 2024, newly released CDC data shows. 

The figures show national deaths dropped from 100,049 to 73,690, a major decline after several years of increases following the Covid pandemic.

By April 2025, overdose deaths ranked second only to the 72,000 reported in 2019. In 2020, these numbers jumped to 94,000 and climbed each year until 2024.

Virginia, Massachusetts, and West Virginia led with decreases in overdose deaths by 44, 42, and 41 percent, respectively. State lawmakers credit these improvements to stringent seizures of powerful opioids like fentanyl and the broader availability of naloxone (Narcan), which reverses overdoses.

Nevertheless, some experts argue that the fentanyl crisis has been so devastating in the US that it may be exhausting its pool of victims, inadvertently leading to a reduction in overdose fatalities.

But despite national trends, overdose deaths increased in Arizona, Hawaii and South Dakota by 7.5, 5.2 and 1.2 percent, respectively. 

Arizona reported the largest increase in deaths, nearly three-quarters of which are largely driven by opioids like fentanyl, which is 100 times more potent than morphine. 

After several years of consistent surges, drug overdoses are finally down in most US states, CDC data shows. However, three states still are on the rise. Pictured above is a group of people using drugs in Philadelphia

Experts have suggested deaths in the Grand Canyon State could be due to the state’s proximity to Mexico, where almost all of the illicit fentanyl that makes its way into the US is produced. 

Hawaii, which saw the second-largest increase with 345 deaths, has also been designated by federal authorities as a ‘high-intensity drug trafficking area’ due to high tourist traffic, which has made it a target for Mexican cartel activity. 

And South Dakota has a large Native American population, a group historically significantly more prone to drug use and overdose than other ethnicities or groups in the US. 

Experts compiling the data, part of the CDC’s National Vital Statistics System, however, cautioned that the figures are provisional and data is likely incomplete due to underreporting of overdoses. 

Of the 73,690 overdose deaths reported in the 12 months leading up to April 2025 in the US, 48,442 (66 percent) were due to natural and synthetic opioids. 

Natural opioids are made from the opium poppy plant (Papaver somniferum) and include morphine, heroin, codeine, thebaine and opium. 

Synthetic opioids, meanwhile, are made in a lab. Fentanyl is the deadliest and most infamous, though the category also includes tranquilizers and pain relievers like carfentanil, and tramadol. 

Psychostimulants were the second-most common cause of fatal overdose in the US, accounting for 27,835 deaths. 

These drugs help stimulate the central nervous system and improve attention and alertness. They include illegal substances like cocaine and methamphetamine, as well as nicotine, caffeine and the ADHD drug Adderall. 

The only US overdose figure that remained steady compared to last year was deaths from methadone, which took 3,257 lives in the year leading up to April 2025.  It’s used to treat opioid use disorder (OUD), or addiction to opioids, though it is possible to take a larger than intended dose and overdose. 

The above CDC graph shows the increase in drug overdose deaths in Arizona. Rates have risen 7.5 percent over the last year

Overdose deaths are up in Arizona, Hawaii and South Dakota. 

In Arizona, fatal overdoses increased from 2,596 to 2,790, a 7.5 percent jump. This could be due to the state’s close proximity to the US-Mexico border broadening access to fentanyl and other illicit drugs. 

According to US Customs and Border Protection, 99 percent of all fentanyl seized by the authority came from the southern border. The state also has six designated ports of entry from Mexico, giving dealers several openings to smuggle fentanyl into the US.

Authorities have also warned because transport is so easy, fentanyl costs for customers are often low, making overdoses more likely. 

In Hawaii, overdose deaths saw a 5.2 percent jump from 328 to 345. The state has been designated a ‘high-intensity drug trafficking area’ due to its location in the Pacific, which helps the transport of drugs like fentanyl increase westward.

Hawaii is also a leading tourist destination, increasing the amount of potentially vulnerable populations who could become addicted to and overdose on drugs.

Native Hawaiian and Pacific Islander populations are also particularly prone to drug use due to decades of historical trauma from colonization and marginalization.  

And in South Dakota, overdose deaths increased from 83 to 84, a 1.2 percent increase, which experts have suggested is largely due to socioeconomic and demographic issues. 

About eight percent of the state’s population is made up of Native Americans spread across nine reservations. 

Similar to Native Hawaiians, this group has been shown to have an increased risk of drug use and overdose due to decades of cultural trauma, which could make them more likely to turn to substance use. 

Mountains of research also show the Indian Health Service, a federal agency within the Department of Health and Human Services meant to provide care for Native Americans, is consistently underfunded and understaffed, limiting healthcare and harm reduction. 

The above CDC graph shows the increase in drug overdose deaths in Hawaii

The above data shows a surge in drug overdose deaths in South Dakota

Virginia, meanwhile, saw the largest decrease in overdose deaths from 2,171 in the 12 months leading up to April 2024 to 1,211 in the year leading up to April 2025. This is a 44.2 percent dip. 

Virginia Governor Glenn Youngkin credited the decrease to the state’s Operation FREE (Fentanyl Awareness, Reduction, Enforcement and Eradication) initiative, which is focused on reducing the prevalence of fentanyl and providing overdose prevention resources like Narcan. 

He said in an April press release: ‘We’ve interrupted the drug trade by launching Operation FREE, an aggressive law enforcement partnership between federal, state, and local agencies to crack down on the drug trade, which has so far seized enough fentanyl to kill every Virginian ten-times over.’

The state also passed legislation banning pill presses, which are used to add fentanyl to other drugs, and established felonies for drug dealers whose victims die of an overdose.   

Virginia also has distributed 400,000 doses of Narcan since 2022. 

In Massachusetts, overdose deaths fell 42 percent from 2,197 to 1,272. In 2024, the state’s largest city, Boston, introduced four public health vending machines for quick access to Narcan, drug testing strips and sterile syringes.   

West Virginia’s overdose deaths also decreased 41 percent from 1,232 to 729. State press releases published earlier this year attributed the decrease to a 54.5 percent decline in children being removed from their homes due to parental substance abuse from 2020 to 2024. 

The number of children taken out of the home with substance use as a contributing factor also fell 39 percent from 2017 to 2024.  

Alex Mayer, Secretary of the West Virginia Department of Human Services (DHS), said: ‘These trends reflect the real-life impact of West Virginia’s shift toward recovery-focused, family-centered care. 

‘When we support parents in their recovery, we’re also protecting children and strengthening families, and that’s a win for everyone.’ 

Overdose deaths are up in Arizona, Hawaii and South Dakota.