Opioid use disorder today: the history, data, and what’s changing

Opioid use disorder (OUD) has touched every part of the country, affecting families, communities, and people from all walks of life. It’s a complex issue with a long history, but it’s also one we’re learning more about every year. 

While the challenges and risk factors of substance use are real, so is the progress, especially when expanding opioid addiction treatment and understanding what works.

In recent years, synthetic opioids like fentanyl have changed the landscape of overdose risk. But 2024 brought some hopeful news: for the first time in years, fatal overdoses declined significantly across the United States. 

That drop in death rates didn’t happen by accident. It reflects efforts on many fronts: harm reduction, better access to treatment, overdose prevention, and a growing understanding of how to support people through recovery.

We work closely with people in the thick of this crisis, whether they’re seeking help for the first time, managing long-term recovery, or navigating setbacks. Our team includes licensed providers trained in addiction medicine, and we’ve seen how quickly the landscape is shifting, from the rise of fentanyl to the quiet power of Medication-Assisted Treatment.

We’re not just reading the data. We’re treating patients shaped by it. Every statistic you see in this article reflects real people. The ones we listen to every day during virtual appointments, the ones finding stability after years, and the ones still needing care.

In this article, we’ll take an honest look at how opioid use has changed over time, what the latest numbers show, and how medications like Suboxone® are reshaping recovery. For additional information, we’ll also explore the rising role of stimulants like cocaine in overdose deaths and why looking at the full picture matters.

If you’re reading this and it feels personal, you’re not alone. So many people are quietly carrying the weight of this, and it’s okay to feel overwhelmed or unsure. This overview is here to offer clarity, share useful data, and highlight how far we’ve come and where support is still needed.

How we got here: a brief history of opioid use in the U.S.

If you’re looking at current overdose trends or trying to understand how OUD became so widespread, it helps to take a step back. This didn’t happen overnight. 

The history of opioids in the U.S. spans decades, shaped by evolving medical practices, changing drug supply, and the growing need for more supportive treatment while considering their misuse potential.

Prescription pain medications: the early years

In the late ’90s and early 2000s, many doctors did what they thought was best: helping people manage pain, sometimes leading to the non-medical use of these medications.

At the time, prescription opioids like oxycodone and hydrocodone were seen as safe, and often handed out for everything from back injuries to post-surgery recovery.

But what wasn’t widely understood yet was how easy it could be to develop a dependence on opioids and their fentanyl analogs (these are chemical alterations of fentanyl). For some people, a legitimate prescription slowly turned into something more. When the pills ran out, but the pain or the cravings didn’t, it became harder to stop.

Over time, we saw more people showing up in emergency rooms, struggling with opioid-related complications, and the need for treatments like methadone became evident. The warning signs were there, but treatment systems weren’t always ready to meet people where they were.

Heroin use follows prescription trends

When prescription opioids became harder to get, many people who had grown dependent on them started turning to heroin.

For many, it wasn’t a choice as much as a survival response. And for those who struggled to find support, that lack of help wasn’t their fault.

People who wanted help often found closed doors in the form of long waitlists, judgment, or care that didn’t feel safe or welcoming. And so the cycle continued.

The rise of synthetic opioids

Around 2013, synthetic opioids, especially fentanyl, began showing up more often in the drug supply. 

Fentanyl is much more potent than heroin or morphine, and small amounts can be dangerous. What made things especially dangerous is that people didn’t always know it was there. It was often mixed into heroin, cocaine, or pressed into pills made to look like something else.

This made overdoses more sudden and harder to prevent. First responders had to change how they approached emergencies. And people using drugs, whether occasionally or regularly, were now facing risks they might not even see coming.

Where we are now: recent data on drug overdose deaths

Understanding where things stand today with OUD is more than simply tracking numbers. These statistics represent real people and communities doing their best to respond. 

The good news is that things are shifting in a more hopeful direction, especially in reducing fatal drug overdoses.

A decline in drug overdose death rates in 2024

For the first time in several years, overdose deaths in the U.S. have gone down, and not just by a little. In 2024, there were an estimated 80,391 overdose deaths. 

That’s a nearly 27% decrease from 2023, and the lowest number since 2019.

It’s a step in the right direction. And while the work is far from over, this progress reflects a lot of effort across the country, from public health teams and healthcare providers to individuals and families pushing for safer solutions.

This decline was seen across nearly every state, suggesting that efforts around prevention, treatment access, and harm reduction are starting to make an impact. That kind of progress is proof that change is possible.

For those who have been through so much already, every step forward matters.

Some key contributors to this drop include:

• Wider access to naloxone (Narcan), a medicine that can quickly reverse an opioid overdose and save lives when given in time. Naloxone works to reverse all types of opioid overdoses, but multiple doses may sometimes be necessary with fentanyl analogs.
• Expanded treatment options, including medications like Suboxone®, which reduce cravings and help people stay in recovery longer.
• Shifts in the drug supply, including increased awareness about fentanyl and fewer contaminated pills making their way into communities.

Every state experienced this shift a little differently, but the overall direction is encouraging. 

Real change can happen when harm reduction, treatment access, and public education come together. It’s a hopeful sign, and one worth holding onto.

Still, experts caution that while this progress is meaningful, it’s definitely not the time to let up. It’ll take continued focus on treatment, harm reduction, and education. Public health authorities promote training on the use of naloxone, including administering naloxone, to reduce overdose deaths.

What we know about fentanyl deaths in 2023 and 2024

In 2023, synthetic opioids (again, primarily fentanyl) were part of the vast majority of overdose deaths.

According to data shared by SAMHSA, there were an estimated 106,363 overdose deaths in the 12-month period ending in August 2023. Of those, about 80,609 deaths involved opioids, and the vast majority of those were linked to fentanyl.

Fentanyl, which is approximately 50–100 times more potent than morphine, played a major role. In some cities, like Philadelphia, fentanyl was present in over 80% of all overdose deaths, and often alongside other substances like cocaine or methamphetamine.

But by 2024, that trend began to shift. Experts believe the drop in overdose deaths was closely tied to a reduction in fentanyl-related deaths. While the data is still being finalized, it’s a sign that increased awareness, access to fentanyl test strips, and earlier intervention are making a difference.

That said, fentanyl hasn’t gone away. It still poses a serious risk, especially when mixed with other drugs without the person knowing. For people using any illicit substance, even occasionally, the risk is very real and often requires immediate medical attention.

That’s why tools like naloxone and Suboxone® matter so much. They don’t just help people survive. They offer safer ways to step into treatment and recovery, without waiting for a crisis.

The rise in drug overdose deaths involving cocaine and other stimulants

Even with the encouraging drop in opioid-related deaths, there’s another piece of the picture we need to talk about. Overdose deaths involving cocaine and other stimulants have been steadily rising, especially when these drugs are mixed, intentionally or unknowingly, with opioids like fentanyl.

This matters because it reflects a growing trend in what’s called polysubstance use, which means using more than one type of drug at the same time. It’s more common than many people realize and carries serious risks.

Cocaine and fentanyl: a dangerous combination

Many overdose deaths don’t involve just one drug. In recent years, a growing number of cases have involved combinations, particularly stimulants like cocaine mixed with powerful opioids like fentanyl.

In some cities, up to 70-80% of stimulant-related overdose deaths also involved fentanyl or another synthetic opioid.

For some people, mixing drugs is intentional. For others, they may not even know fentanyl is in the substance they’re using. 

That’s one of the hardest parts: fentanyl can be mixed into cocaine, methamphetamine, or counterfeit pills without any clear sign. And because fentanyl is so potent, just a tiny amount can be enough to cause an overdose, especially for people who haven’t used opioids before and haven’t built up any tolerance.

Why this matters

If you’re worried about someone using cocaine, it’s helpful to know:

• The presence of fentanyl may not be obvious.
• Even occasional or non-opioid users are now at risk if fentanyl is involved.
• Test strips and education can make a difference.

This is why more public health programs are offering free fentanyl test strips and encouraging people to carry naloxone, even if they don’t use opioids themselves. Fentanyl test strips (FTS) can identify types of fentanyl in illicit drugs.

How Suboxone® is shaping a new path in recovery from opioids

For years, the story of opioid addiction in the U.S. often followed a difficult cycle: quitting cold turkey, struggling through withdrawal, relapsing, and facing the risk of overdose. It was exhausting, physically and emotionally, and for many, it felt like there were few real options.

But that started to change when medications like Suboxone® became more available. Suboxone® combines buprenorphine, which helps ease cravings and withdrawal, with naloxone, which helps prevent misuse. 

Together, they support recovery in a way that’s steady, evidence-based, and life-saving.

Why Suboxone® matters

Suboxone® does much more than simply reduce symptoms. It gives people space to breathe. To focus. To heal.

Research shows that people who take buprenorphine long-term are 34% less likely to die from overdose than those who don’t. 

And that’s just one part of the story.

Here’s what makes Suboxone® such an important tool:

• It calms cravings. That alone makes relapse much less likely.
• It brings relief. When withdrawal symptoms aren’t overwhelming, recovery feels more doable.
• It lowers overdose risk. Buprenorphine helps block more dangerous opioids from taking hold.
• It supports real-life recovery. Many people can return to work, reconnect with family, and feel like themselves again. 

This isn’t theory; it’s backed by research. In France, when buprenorphine became widely available in the 1990s, overdose deaths dropped by nearly 80%. 

That same principle is playing out here: when life-saving medication is easier to get through telehealth platforms, same-day access, or nonjudgmental care, people are more likely to stay in recovery.

One patient described it in plain terms:

[Suboxone®] keeps me from going off the deep end. I can work. I can live a real life on this medication.

That’s what we mean by recovery. Not perfection. Not pressure. Just stability, safety, and a path forward.

Why opioid addiction treatment is still hard to access

Even with all its benefits, only about 1 in 5 people with OUD in the U.S. are on medications like Suboxone®. 

For many, the barriers aren’t medical. They’re actually social. 

Stigma. Misinformation. The idea that using medication means you’re not really sober.

But here’s the truth: choosing Suboxone® isn’t a shortcut. It’s a strong, evidence-backed step toward lasting health. It’s a medical treatment, just like insulin for diabetes or an inhaler for asthma.

We know how hard it can be to find nonjudgmental care, especially when you’re already carrying a lot. That’s why we offer private, same-day access to Suboxone® through QuickMD, with providers who understand what you’re going through and meet you where you are. Because improving access is one of the biggest drivers of change.

Starting Medication-Assisted Treatment with Suboxone®

Deciding to start treatment can feel like a big, complicated step. If you’re unsure or scared, that’s normal. Wanting help is not weakness. It’s the beginning of something better.

Suboxone® is one of the most trusted medications used in Medication-Assisted Treatment (MAT) for those recovering from addiction to opioids.

To start Suboxone®, your QuickMD provider will walk you through when and how to begin.

Most people feel relief within a few hours of taking Suboxone®. Cravings get quieter. The physical symptoms begin to ease. And day by day, it gets easier to focus on life beyond opioid use.

Ongoing online support for opioid addiction

Suboxone® works best when it’s part of a bigger support plan. 

That might include counseling, peer support, or regular check-ins with your provider. Everyone’s recovery path looks a little different, and there’s no one-size-fits-all timeline.

You’re allowed to take your time. Whether you’re on Suboxone® for a few months or a few years, the goal is the same: to give you a solid foundation to rebuild health and regain control.

At QuickMD, we offer same-day care and ongoing support so you can start and continue opioid addiction treatment in a way that works with your life.

Need a little guidance or want quick answers? Check out our blog to help you navigate treatment, recovery, and everyday questions about OUD.

A safer path forward from drug use

Opioid use disorder has changed over the years. So have the risks, the drugs involved, and the numbers behind the headlines. 

But one thing hasn’t changed: people still recover. Every day.

Suboxone® has made that recovery possible for thousands. It helps quiet the chaos of withdrawal, lowers the risk of overdose, and gives people space to heal. It’s not a magic fix, but it can be a powerful tool, especially when paired with real support and compassionate care.

If you or someone you love is thinking about treatment, it’s okay to have questions. And it’s okay to need help sorting it all out.

Frequently asked questions about opioid use disorder

What state has the worst drug problems in the U.S.?

In recent years, West Virginia has consistently reported the highest rate of drug overdose deaths per capita, especially from opioids like fentanyl. Drug overdose deaths peaked in Virginia in 2021 at 2,622 deaths. In 2023, there were 2,463 drug overdose deaths among Virginia residents.

Other states with high overdose rates include Kentucky, Tennessee, and Pennsylvania, as well as parts of the Midwest and New England. Many rural and small-town areas have been especially impacted, often due to limited healthcare access and a delayed response to the rise of synthetic opioids.

That said, every urban or rural community is dealing with this in some way. The good news is that many states are expanding access to naloxone, increasing funding for treatment programs like Suboxone®, and launching education efforts to prevent overdoses and support recovery, showing a positive response to the crisis.

What are the common signs of opioid addiction?

Opioid addiction doesn’t look the same for everyone, but some patterns tend to show up. Risk factors for opioid overdose include age, gender, and socioeconomic status.

You might notice:

• Using more than intended or for longer than planned
• Trouble stopping, even if you want to
• Spending a lot of time getting or using opioids
• Missing work, school, or family responsibilities
• Pulling away from friends or usual activities
• Using in risky situations, like while driving
• Needing higher doses over time to feel the same effect
• Withdrawal symptoms like sweating, anxiety, or body aches occur when not using opioids

If you recognize any of these signs in yourself or someone close to you, it might be time to talk to a provider. Judgment-free care is out there, and treatment like Suboxone® can make that next step easier.

How can you tell if a drug has fentanyl in it?

You can’t tell if something has fentanyl in it just by looking at it. It can be hidden in pills, powders, and even marijuana. There’s usually no smell, taste, or color to give it away. That’s what makes it so dangerous. The safest way to check is by using fentanyl test strips, which can detect even tiny traces before you use a substance. They’re easy to use and often free through local health departments or harm reduction programs.