Drug overdoses spiked in these states. But they have dropped elsewhere in the country.

Fewer Americans died of drug overdoses nationwide last year, marking the first annual drop since 2018, according to Centers for Disease Control and Prevention estimates released Wednesday.

The CDC estimated 107,543 U.S. drug overdose deaths in 2023, a 3% decline from the 111,029 deaths in 2022. CDC National Center for Health Statistics officials said the estimates are based on provisional data and are not comparable to finalized 2023 figures, which will be released later this year or early next year.

The estimates hint at good news after a worrisome surge of fatal overdoses during the COVID-19 pandemic, but the number of deaths remains "catastrophically high," said Kevin Roy, chief public policy officer at Shatterproof, a nonprofit that addresses addiction treatment.

Despite the nationwide drop in overdose deaths, states including Alaska, Washington and Oregon had double-digit increases in fatal overdoses.

Synthetic opioids such as fentanyl are a factor in 2 in 3 overdose deaths. These deaths have accelerated in recent years with the widespread availability of cheap, illicit fentanyl, which is often manufactured overseas and smuggled into the U.S.

A National Institutes of Health study this week said law enforcement seized more than 115 million pills containing illicit fentanyl in 2023, a dramatic increase since 2017, when fewer than 50,000 pills were confiscated.

Cocaine and methamphetamine overdoses rise

Fentanyl is often combined with other street drugs, and people who overdose might have multiple drugs in their system. The CDC estimated more than 36,000 overdose deaths last year involved psychostimulants such as methamphetamine. Nearly 30,000 overdose victims had cocaine in their system, the estimates said.

CDC Director Mandy Cohen said the preliminary figures show there are "far too many" overdose deaths, a trend that reflects the "potency of what's in our communities."

"We're working hard, so I'm glad to see it's a small reduction," Cohen told USA TODAY this week during a tour of the Fountain House, a mental health nonprofit in New York City. "It's a start, but we have more work to do there and I want to see that continue."

Overdoses spike in Oregon, Washington and Alaska

The NIH study showed law enforcement increasingly detected and seized illicit fentanyl shipments in the Western U.S. Most seized shipments involved illicit fentanyl pills, but powder methamphetamine was found at an increasing rate, the study said.

The CDC estimates said overdose deaths generally increased at a faster rate last year in Western states. Alaska, Washington, and Oregon had increases of 27% or more from the year before.

Overdose rates in the Midwest and most Northeastern states decreased last year. Nebraska, Kansas, Indiana and Maine had the largest decreases of 15% or more.

Dr. Joshua Sharfstein, vice dean of public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, said the worst effects of the pandemic appear to be over.

"There was a big increase during the pandemic, because people were scared and traumatized and out of work," Sharfstein said. "That is resolving, so that that is helping overdoses go down."

Sharfstein also credited public health interventions such as distributing the overdose reversal drug naloxone and increasing access to the opioid substitute medication buprenorphine. Naloxone, also sold as a nasal spray under the brand name Narcan, is distributed by harm reduction groups, community health departments, schools and police and fire departments. 

He said the higher overdose rates in the Pacific Northwest are likely a reflection of the dangerously potent and plentiful supply of drugs circulating in those communities.

"As fentanyl sweeps into states like what has been happening on the West Coast recently, you see this enormous surge in death," Sharfstein said.

CDC director urges public to 'stay vigilant'

Among new approaches to prevention, Cohen cited federal initiatives to lower the risk of overdose deaths, including expanded use of fentanyl test strips. With fentanyl increasingly surfacing in the nation's drug supply, drug users can use these inexpensive test strips to check whether a substance contains fentanyl. Studies have shown drug users who use fentanyl test strips might discard drugs, take lower doses or take a "tester" shot, all of which can help reduce overdoses from mistakenly taking a drug that contains fentanyl.

In 2021, the CDC and the Substance Abuse and Mental Health Services Administration announced federal money could be used to purchase test strips as part of overdose response programs. More than half of states have changed laws to allow the use of fentanyl test strips.

Still, Cohen said, it's important for federal, state and local public health departments to monitor drug use and overdose trends. She cited the animal tranquilizer xylazine, which is sometimes mixed with illicit fentanyl. This combination, used in the street drug "tranq" or "zombie heroin," is dangerous because it depresses breathing, lengthens overdoses and causes skin ulcers and sores that last for months.  

"We have to look out for what's next over the horizon, because we tackle fentanyl, and then xylazine comes," Cohen said. "So it's always (what's) next, and we have to stay ahead and stay vigilant."

Contributed: Eduardo Cuevas

Ken Alltucker is on X at @kalltucker, contact him by email at alltuck@usatoday.com.