The CDC runs a surveillance system that reconstructs the circumstances surrounding fatal drug overdoses. In 2024, among the deaths where investigators could establish those circumstances, a potential bystander who had an opportunity to intervene was nearby in 44.1 percent of cases. Not in the next county, and not an hour away. Nearby. I have worked in addiction medicine for more than three decades, and that figure changes the shape of the prevention question more than most of the numbers I read.
What the CDC Model Projects Between Now and 2028
Nisha Nataraj and colleagues at the Centers for Disease Control and Prevention published a simulation study in Lancet Regional Health – Americas that models the American population living with opioid use disorder through 2028. The model is called MODIPHI, and for this analysis the researchers recalibrated it using 2021 through 2024 data from the State Unintentional Drug Overdose Reporting System and the National Survey on Drug Use and Health.
If conditions hold at the 2024 status quo, the model projects 96,799 fatal and approximately 3.4 million nonfatal opioid-involved overdoses among people with opioid use disorder between 2025 and 2028, along with an estimated economic burden of $3.94 trillion in 2025 dollars covering healthcare, lost productivity, and criminal justice costs.
Those projections sit against real progress. Fatal opioid-involved overdoses in the United States fell from a peak of 81,806 in 2022 to an estimated 55,616 in 2024, and nearly every state recorded fewer deaths than the year before. Provisional data have also shown the rate of that decline slowing, however, and the researchers wanted to know what a reversal would cost. A sustained 5 percent annual increase in fatal overdose rates would add 15,997 deaths over the four years and $233 billion in burden. A sustained 5 percent annual decrease would prevent 13,678 deaths and $199 billion.
Why Bystander Naloxone Outperformed Every Other Single Strategy
The researchers then tested four prevention strategies to learn which ones could offset a rebound on their own: initiating people into medication for opioid use disorder, linking people to that medication within 24 hours of a nonfatal overdose, retaining people in treatment for at least six months, and bystander administration of naloxone during potentially fatal drug use.
Two of the four could not do it alone. Retaining every single person in medication treatment for six months reduced the excess deaths by 6.5 percent, which comes to 1,042 lives. Linking every person to medication within a day of surviving an overdose did considerably better at 31.9 percent, or 5,110 lives, and still fell short of closing the gap.
Two of the four succeeded. Raising annual initiation into medication treatment to 62.6 percent of the people with opioid use disorder who are not currently receiving it offset the entire rebound. So did successful bystander naloxone administration during 14.2 percent of potentially fatal drug use events.
The naloxone number is the one I would ask readers to sit with. Fourteen percent. Roughly one in seven. That is not a national mobilization, and it does not require a new medication, a new clinic, or a change in federal law. It requires that the person who happens to be nearby recognizes what is happening and has naloxone within reach. The economics are equally notable, because an earlier analysis the authors cite found that every dollar spent on community-based naloxone education and distribution returned an estimated $2,742 in benefit from fatal overdoses averted. I am not aware of another intervention in medicine with a ratio like that.
Applied in the more optimistic scenario, where overdose rates continue to fall, the same level of naloxone coverage was estimated to prevent an additional 11,768 deaths over four years, and the same level of treatment initiation an additional 13,038.
The Treatment Gap That Nobody Has Closed
Getting annual treatment initiation to 62.6 percent would be an enormous change from where we stand. Roughly one in four people who need medication for opioid use disorder report receiving it. Buprenorphine dispensing has actually slowed in recent years, even after the federal government eliminated the waiver requirement to prescribe it in 2022. The authors are direct about what stands in the way, and they list stigma around seeking medication first, followed by clinician barriers, systems-level problems, and payment policies that do not reward prescribing.
Stigma belongs at the top of that list. I still meet families who believe that methadone or buprenorphine means their son has traded one addiction for another, and I still meet physicians who will manage a patient's diabetes for twenty years without comment and then decline to write for buprenorphine because they do not want that kind of practice. Opioid use disorder is not a failure of character being managed with a crutch. It is a chronic neurological condition being treated with a medication that reduces mortality, which is a point I have made before in writing about why addiction is still treated as a character flaw.
There is something else worth noticing in the model's own output. Over the four years, the population in treatment or in sustained remission grows to nearly 60 percent of the modeled group, and the researchers point out that this is exactly why naloxone education has to extend to people in remission and to their families. A return to use after a period of abstinence carries a particular danger, because tolerance falls away while the supply does not become any less potent. The same caution applies to medications prescribed alongside treatment, which I have written about in the context of benzodiazepines during opioid treatment.
What This Means for You
If you love someone with opioid use disorder, or someone in recovery from it, obtain naloxone and learn how to use it. It is available without a prescription at pharmacies across the country, the training takes a few minutes, and it should be kept somewhere more than one person in the household can reach it quickly. The 44.1 percent figure I opened with describes people who were physically close enough to help, and the distance between being close enough and actually helping is preparation.
If you are the person with opioid use disorder, medication has the strongest mortality evidence behind it of anything we have, and the period right after a nonfatal overdose is one of the better moments to begin. Ask specifically about buprenorphine or methadone rather than waiting to be offered them, and if the first clinician declines, ask another one.
Recovery also has a biological substrate that deserves attention alongside medication. Chronic opioid exposure tends to leave people nutritionally depleted in ways that affect how the brain rebuilds dopaminergic signaling, and correcting those deficits is part of why some people feel functional within weeks and others feel flat for months. That is one reason we pay close attention to brain nutrition in recovery, drawing on formulations developed at Action Potential Supplements. At Rescue From Rehab, we treat opioid use disorder as a measurable biological condition with a recovery timeline, which means medication, nutritional and inflammatory markers, and naloxone in the home are all part of the same plan rather than competing philosophies.
The decline in overdose deaths over the past three years is real, and it was produced by ordinary, unglamorous work. Naloxone reached more hands, medication reached more pharmacies, and more people knew what to do when someone in front of them stopped breathing. This model says that the work is not finished and that the gains will not sustain themselves. Nearly 138 people still die of an opioid-involved overdose every day in this country, and in close to half of those deaths, someone is near enough to help. Giving that person the training and the medication to act is the most attainable thing any of us can do, and it is worth doing this week.
Illustration created with AI image tools.
This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Drew W. Edwards, Ed.D., who holds full editorial responsibility for its content.
References
- Nataraj, N., Chen, Y., Stewart, A., Rikard, S. M., Zhang, K., Rice, K., Jiang, X., Mattson, C. L., Ko, J., Guy, G. P. Jr., & Losby, J. L. (2026). Burden of overdoses among persons with opioid use disorder in the United States, 2025-2028: a simulation modeling study. Lancet Regional Health – Americas, 56, 101435. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(26)00065-7/fulltext
- Nataraj, N., Rikard, S. M., Zhang, K., et al. (2024). Public health interventions and overdose-related outcomes among persons with opioid use disorder. JAMA Network Open, 7(4), e244617. https://doi.org/10.1001/jamanetworkopen.2024.4617
- Naumann, R. B., Durrance, C. P., Ranapurwala, S. I., et al. (2019). Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug and Alcohol Dependence, 204, 107536. https://doi.org/10.1016/j.drugalcdep.2019.06.023
- Dowell, D., Brown, S., Gyawali, S., et al. (2024). Treatment for opioid use disorder: population estimates - United States, 2022. MMWR Morbidity and Mortality Weekly Report, 73, 567-574. https://doi.org/10.15585/mmwr.mm7325a1
- Centers for Disease Control and Prevention. State Unintentional Drug Overdose Reporting System (SUDORS). https://www.cdc.gov/overdose-prevention/data-research/facts-stats/sudors-dashboard-fatal-overdose-data.html