OverdosesWhat Do the Numbers Say?

The first of the three waves described by the CDC bears a brand name. In the 1990s, Purdue Pharma launched OxyContin, an opioid analgesic promoted as carrying less risk of dependence thanks to its extended-release formulation. It quickly became, according to the US Supreme Court, the most prescribed brand-name narcotic medication in the nation. Between 1999 and 2019, the Court noted, about 247,000 Americans died from an overdose of prescription opioids.

In 2007, an affiliate of Purdue pleaded guilty to a federal crime: misleadingly presenting OxyContin as "less addictive" and "less subject to abuse" than other pain relievers. Thousands of civil lawsuits followed, brought by individuals, families, and governments. Between 2008 and 2016, the Sackler family, owners of the company, withdrew about 11 billion dollars, three-quarters of its assets.

In 2020, Purdue pleaded guilty once more. No member of the Sackler family was criminally prosecuted, by either the federal government or the states, the Supreme Court noted.

The company had filed for bankruptcy in 2019. Its first plan shielded the Sacklers from any civil lawsuit without the victims' consent; each victim, along with their family, would have received between 3,500 and 48,000 dollars, according to Justice Kavanaugh, who defended it. The Supreme Court rejected it on June 27, 2024, by five votes to four. On November 18, 2025, a New York bankruptcy judge approved a new 7.4-billion-dollar plan: the family leaves the company, which is to become a company owned by a nonprofit foundation.

The second wave began in 2010 with heroin, the third in 2013 with synthetic opioids, predominantly illicitly manufactured fentanyl. According to the CDC, about 806,000 people died from an opioid overdose between 1999 and 2023.

The third wave is the deadliest: in nine years, synthetic opioid deaths surged more than twentyfold, reaching 73,838 in 2022. Used in hospitals as an analgesic and anesthetic, fentanyl is fifty to one hundred times more potent than morphine, according to the WHO: traffickers add it to heroin or sell it as counterfeit pills mimicking prescription medication, without buyers knowing what they are consuming. It acts fast and quickly causes respiratory depression, CDC researchers write.

Where does this fentanyl come from? Since around 2019, no longer from China, where it came from until then, but from Mexico. It is produced clandestinely there by cartels, chief among them the Sinaloa and Jalisco New Generation cartels, from chemicals bought in China, according to the Congressional Research Service.

The product is still changing. Xylazine, a veterinary sedative not approved for human use and with no known antidote, is detected in a growing share of illicit fentanyl deaths: 2.9% in January 2019, 10.9% in June 2022, across 21 jurisdictions monitored by the CDC. Naloxone, for its part, cannot reverse the sedation it causes.

The sharpest jump occurred in 2020, the first year of the Covid-19 pandemic: from 70,630 deaths in 2019 to 91,799 in 2020.

This death does not strike at random. In 2024, according to the NCHS, it mostly struck men, whose rate was more than double that of women, and adults aged 35 to 44. American Indian and Alaska Native populations are the most affected. In February 2025, the CDC reiterated that drug overdose remained the leading cause of death among Americans aged 18 to 44.

The setting, most often, is a home. Out of nearly 192,000 accidental or undetermined-intent overdose deaths reviewed by the CDC from 2022 to 2024 across 46 states and DC, more than 144,000 occurred without a witness. More than half the time, the individual was alone at home: when people use alone, help arrives too late, or not at all.

The moment, too, is known. The WHO lists among the risk factors the resumption of opioid use after a long period of abstinence, on coming out of detoxification, treatment, or incarceration. *Following release from prison, a meta-analysis published in 2010 in Addiction found a drug-related mortality risk at least three times higher during the first two weeks than during the subsequent ten.*

This is where the antidote encounters its limits. The WHO recommends giving naloxone to potential witnesses. In the United States, the FDA approved an over-the-counter nasal spray on March 29, 2023; in France, kits are dispensed in pharmacies, some without a prescription, and nearly 30,000 were ordered in 2023 according to the OFDT, cited by Le Quotidien du pharmacien.

After twenty years of increases, the curve has turned. In 2024, 79,384 Americans died from an overdose, and the rate fell by 26.2%: for both men and women, the largest annual decline in a decade. It spanned all age cohorts, led by the youngest. The CDC cites among the causes widespread naloxone distribution, better access to treatment, and changes in the illicit drug market.

Substitution treatment cuts mortality. A meta-analysis published in the BMJ in 2017 found that among opioid-dependent individuals, all-cause mortality was approximately three times lower during methadone treatment than during periods out of treatment. Retention in treatment substantially reduces the risk of death, including from overdose, the authors concluded. In France, approximately 171,000 individuals received opioid agonist therapy in 2024, according to the OFDT.

There are also supervised drug consumption facilities (haltes soins addictions), opened in Paris and Strasbourg in 2016 for supervised consumption. According to an Inserm evaluation in May 2021, participants experienced fewer overdoses, abscesses, and emergency room visits. Inserm recorded no deterioration in public order, and discarded syringes around the Paris site fell to a third.

Across the European Union, the European Drug Report 2026 from the EUDA recorded at least 7,600 overdose deaths in 2024, a figure the agency presents as a minimum. Opioids remain the leading cause of fatal overdoses among analyzed cases, most often combined with other substances. Cocaine is gaining ground: it featured in about a quarter of fatalities, according to twenty reporting countries providing two years of data.

This remains incomparably smaller than the United States, despite the EU's larger population. The two do not count exactly the same thing: the comparison provides an order of magnitude rather than an exact ratio.

In France, the medications used to treat dependence also figure among those that kill. Methadone was involved in 280 deaths in 2024, or 3.9 per 1,000 patients treated; buprenorphine in 58, or 0.6 per 1,000. Heroin-related fatalities continued their steep decline, cocaine-involved deaths dropped, while deaths involving ketamine, cathinones, and MDMA increased. Nitazenes accounted for only one recorded death.

In total, the ANSM's DRAMES survey included 718 deaths in 2024, mostly directly caused by the substances, the remainder resulting from falls, drowning, or trauma. Victims were men in 79% of cases, with an average age of 39. More than six in ten died at home.

These figures represent minimums. When a physician suspects an overdose, they place the death under a medico-legal hold, and the autopsy result rarely makes its way back to the cause-of-death registry kept by Inserm, which thereby misses many cases.

Globally, the WHO estimates that about 600,000 deaths were attributable to drug use in 2019, nearly 80% of them linked to opioids, and that about 125,000 people died from an opioid overdose that year. Yet an opioid overdose remains a death an antidote can stop, provided someone is there.