Sarah Donald of Pearl, Miss., left, who has been in recovery for nine years, receives naloxone nasal spray from an organizer at the state’s Save a Life Day in September. Overdose awareness is continuing to save lives, but overdoses and deaths have spiked in some areas this year. (Photo by Vickie D. King/Mississippi Today)

Illicit drug overdoses and the deaths they cause are trending down this year, despite spikes in a handful of states, according to a Stateline analysis of data from the federal Centers for Disease Control and Prevention.

A handful of places with rising overdoses are responding to the problem with cooperation, they say, by sharing information about overdose surges and distributing emergency medication.

“The national conversation is just about warships in the Caribbean and drones and borders,” said Nabarun Dasgupta, who studies overdose trends at the University of North Carolina. “It discounts this huge groundswell of Americans taking care of Americans. There’s a huge amount of caregiving and tending to the needs of local communities that is being done in a non-flashy way because this is hard, slow work.”

Overdose deaths have been dropping steadily since 2023. As of April, the latest date available, deaths were at 76,500 for the previous 12 months — their lowest level since March 2020. A pandemic spike in overdose deaths drove the number as high as almost 113,000 in the summer of 2023, according to federal statistics.

President Donald Trump has ordered more than a dozen military strikes against boats in the open waters of the Caribbean and the Pacific Ocean since Sept. 2, claiming without publicized evidence that their occupants were drug runners bringing narcotics to the United States. Nearly 60 people have been killed.

The bulk of deadly fentanyl is smuggled over the border with Mexico in passenger cars, according to a September report by the federal Government Accountability Office. Chemicals and equipment, mostly from China, are smuggled in via cargo trucks, commercial ships, airplanes and the mail, according to the report.

A more timely indicator of overdoses — nonfatal suspected overdose patients in hospital emergency departments — was down 7% this year through August compared with 2024, according to Stateline’s analysis of CDC statistics.

The nonfatal overdoses were up for the year in only a few states and the District of Columbia. The largest spikes were 17% in the district, 16% in Rhode Island, 15% in Delaware, 11% in Connecticut and 10% in New Mexico, with smaller increases in Colorado, Pennsylvania, Wyoming, South Dakota, Utah, New Jersey and Minnesota.

Other states saw drops in nonfatal overdoses: Maryland had the largest decrease through August, about 17%.

But Baltimore had an attention-grabbing cluster of 42 overdoses between July and October, all within the same neighborhood. No fatalities were reported. The cluster led the city to set aside $2 million in October for more mobile services, harm reduction and social supports to fight overdoses.

New Mexico is seeing more overdoses and more deaths than the previous year in three counties on the Colorado border. In response, New Mexico is distributing both warnings and naloxone, an opioid-overdose antidote.

Officials are giving naloxone to storekeepers near overdose sites and alerting those seeking services about the deadly threat in the local supply.

“We started planning naloxone saturation and different types of outreaches so we can hopefully stem this from getting even worse,” said David Daniels, harm reduction section manager in the New Mexico health department.

“Putting messaging directly into clients’ hands is extremely valuable. That might be, ‘If you’re choosing to use, don’t use the regular amount. Maybe you should use a quarter of it. Test it out first,’” Daniels said.

The three counties in New Mexico — which include the capital city Santa Fe, ski resort Taos and Española, the setting of the 2023 TV black comedy series “The Curse” — saw about 438 more deaths from July through September than they did during the third quarter of 2024, according to Stateline calculations. That’s more than double the 383 overdose deaths for the area during the same time period last year.

Roger Montoya, a former Democratic state representative who runs an arts nonprofit in Rio Arriba County, said most of the deaths there have been among homeless substance users.

A local hospital has responded with programs to get treatment for more people, and his own Moving Arts Española group concentrates on helping children and young people break a cycle of economic despair that often leads to addiction and homelessness, he said.

“We try to redirect and strengthen the resiliency of young people who largely are being raised by grandparents and kin because mom and dad are either dead, on the street or incarcerated,” Montoya said.

But most states with overdose increases are still showing fewer deaths, mostly because the drug supply in the eastern United States is more likely to be cut with sedatives that don’t have the same deadly effect as fentanyl, though they can cause overdose.

The drugs linked to Baltimore’s mass overdoses were cut with an unusual, powerful sedative, according to federal testing. The sedative can cause people to lose consciousness but can’t itself be treated with reversal medication such as naloxone.

By contrast New Mexico’s tests on this year’s clusters generally found more deadly fentanyl than usual in the local supply, said Phillip Fiuty, a technical adviser on adulterant testing in the state health department.

“We’re not seeing the type of adulteration they’re experiencing on the East Coast. Once something is in New Mexico, there’s little to no adulteration,” Fiuty said.

Some East Coast states are seeing more overdoses but fewer deaths. Rhode Island warned of spikes in nonfatal overdose in August and September, but deaths through September were still lower than during the same period last year, according to state figures.

That’s not always the case. Connecticut reported a surge of both fatal and nonfatal overdoses near interstate highways in May and June.

“One of the factors is change in the illicit drug supply or bad batches. I think that’s what’s playing out now. The drug supply is increasingly unpredictable,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

The association has a suggested framework for community response to spikes, but cities and counties may be hampered by a new aggressiveness on enforcement and more hostility to local efforts to stop deaths, she said.

The current Trump administration has shown some reluctance to support community harm reduction techniques, she said. That includes the temporary suspension of $140 million in funds for a program called Overdose Data to Action, known as OD2A, that the first Trump administration started to sound the alarm when spikes happen.

“Given recent cuts to health care and substance use and overdose prevention services that we’re seeing, that is impacting some of the work on the ground,” Freeman said. “It’s pushing people away from being able to make the changes they need to make to change their lives. It has the potential to create more of an overdose problem.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Razor wire follows the banks of the Rio Grande on the Texas side of the U.S.-Mexico border in 2024. The Trump administration now expects about 600,000 total deportations in 2025, fewer than the 685,000 under the Biden administration in fiscal 2024. (Photo by Ariana Figueroa/States Newsroom)

The Trump administration now expects about 600,000 total deportations in 2025, fewer than under the Biden administration’s final fiscal year, as a drop in border crossings outweighs the effect of increased deportations elsewhere, according to a report released Oct. 30 by the Migration Policy Institute, a nonpartisan think tank. 

State and local officials are kept in the dark by limited information on deportations, the report noted, whether or not they support the administration’s mass removal agenda. 

There were 685,000 total deportations in fiscal year 2024 under Biden compared with the 600,000 projected by the Trump administration for this calendar year, the report states. 

During the 2025 fiscal year that ended in September, there were about 340,000 deportations, the report estimates, including both orders of removal and people choosing to end detention with voluntary departure. The Trump administration has projected 600,000 deportations for this calendar year, well short of an earlier goal of 1 million. 

Unauthorized migration at the border “plunged dramatically” from 2.1 million to 444,000 border encounters in the past fiscal year. Migrants also returned to a former pattern: People crossing the border were mostly single men from Mexico and children from Central America, after a previous surge of border crossers from around the world, the report states.

At the same time, news reports indicate that thousands of migrants who were headed for the U.S. border have reversed course and headed back through the Panamanian jungle to reach South America again. 

The lower level of border activity has made it possible for U.S. officials to send border patrol agents to cities such as Los Angeles and Chicago, the Migration Policy Institute report says. 

“The steep decrease in unauthorized arrivals at the border and return to nationalities that are easier to turn back because of existing repatriation agreements has permitted the administration to direct its focus to immigration enforcement in the U.S. interior,” the report states. 

For the first time since at least 2014, deportations from inside the United States outnumbered apprehensions at the border. 

The report noted that the administration has not updated many statistics that would help show trends. 

“It has become increasingly complicated to track results because only selective statistics have been made public,” the report stated. 

“Returning to regular reporting of detailed data on immigration enforcement across the various Department of Homeland Security (DHS) immigration agencies could not only improve the public’s understanding of current immigration enforcement activities but also inform state and local stakeholders who want to collaborate or who are affected by enforcement,” it said.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

A child receives a standard immunization at a Coral Gables, Fla., doctor’s office in September. Since the government shutdown began Oct. 1, the federal Centers for Disease Control and Prevention has stopped providing health surveillance data that helps state and local governments track disease trends. (Photo by Joe Raedle/Getty Images)

As the federal shutdown continues, states have been forced to fall back on their own resources to spot disease outbreaks — just as respiratory illness season begins.

The shutdown has halted dashboards and expert analysis from the federal Centers for Disease Control and Prevention, which monitors indicators such as wastewater to provide early warnings of the spread of COVID-19, influenza, RSV (respiratory syncytial virus) and other infectious diseases.

The pause leaves states with less early warning on disease outbreaks, potentially endangering lives even as child vaccination rates drop amid increased exemptions and hesitancy fed by misinformation. State and local officials can combat outbreaks with targeted advice to get vaccinated and stay home when sick, but they need to know where to do that first. And residents won’t know to take precautions if they’re unaware when many in their community are falling ill.

Wastewater is particularly crucial to finding outbreaks before people start seeking treatment, said Dr. John T. Brooks, a former chief medical officer for CDC’s Emergency COVID-19 Response who retired last year.

“This is one more piece of information to each American citizen to inform their decision, like, ‘Do I want to get vaccinated, and is now the time?’” Brooks said. “It really helps protect Americans by identifying communities where you may need to ramp up, raise awareness, remind people about hygiene.”

Ericka McGowan, senior director for emerging infectious disease at the Association of State and Territorial Health Officials, said the absence of CDC involvement “could be a problem if there’s some major issue [states] miss.” Generally, states and localities gather their own health information, but many rely on the CDC for analysis and public display.

The CDC would normally display Washington state’s wastewater surveillance information along with national and regional insights, McGowan said.  Now, the information is only available on the state’s own dashboards.

Caitlin Rivers, an associate professor at Johns Hopkins University who studies infectious disease outbreaks, checked all 50 states for shutdown-related data issues. In a Substack post, Rivers said the result of the shutdown is “DIY surveillance.”

Georgia had to pause its influenza report, which would normally start this month, because of missing CDC data. However, health officials are working on a version using only state information, said Nancy Nydam, a spokesperson for the Georgia Department of Public Health. Some hospitals report cases to the state and some directly to the CDC, so there will be some information gaps during the shutdown, she said.

In the meantime, Georgia has its own data on emergency room visits showing cases of suspected COVID-19, flu and RSV declining between August and early October.

Georgia also has its own wastewater surveillance program, which provides early warning of diseases spreading in the population before confirmed cases show up in hospitals. But some states rely on CDC wastewater surveillance.

Michael Hoerger, an associate professor at Tulane University, had to pause his state-by-state wastewater reports on COVID-19 because of the lack of CDC wastewater data and an unrelated pause in data from a private wastewater reporting collective called Biobot, he said. Biobot did not respond to a request for comment.

“The pause means that we won’t have a good sense of which states are dealing with elevated transmission [of COVID-19] until the data come back online,” Hoerger said. “I can still post useful national estimates and forecasts, but that doesn’t really help with states that are outliers from what’s happening nationally.”

Hoerger’s Pandemic Mitigation Collaborative released a report in August on COVID-19 hot spots in California, and the highest state rates for COVID-19 in late September were in Connecticut, Delaware, Nevada and Utah.

For the time being, all Hoerger can do is rely on past forecasts predicting about 499,000 new COVID-19 infections a day as of Oct. 13, the first time it’s been under 500,000 since July.

“We’re in a bit of a blackout at the moment in terms of real-time rigorous data,” Hoerger said. “Fortunately, at least nationally, we’re in a relative lull in transmission.”

Like Georgia, many states can monitor wastewater on their own to track COVID-19, flu, RSV and other diseases, according to a list compiled by Hoerger’s Pandemic Mitigation Collaborative.

Texas, for example, has not had trouble updating its data during the shutdown, health department spokesperson Chris Van Deusen said. “We do our own surveillance for most metrics,” he said. However, the state no longer gets information on new COVID-19 and RSV deaths from the federal government, he said.

North Carolina also gathers its own wastewater data and interprets it with help from the University of North Carolina and local health departments. Normally, the CDC would weigh in with its own guidance and post results on a national dashboard — actions that are paused in the shutdown, said Hannah Jones, a spokesperson for the state health department.

But even if they have their own wastewater data, other state and local health departments may rely on the CDC for analysis and guidance, said McGowan, of the state health officials group.

“Even if you collect the data, you still have to have someone who is an expert to analyze that data to give you some kind of result,” McGowan said. “A lot of localities don’t have that kind of expertise in house and they rely on the CDC for that type of technical expertise and guidance. So there’s a gap there.”

Rivers, the Johns Hopkins associate professor, wrote in her post that she sees “clouds on the horizon” in some states. There are more young children, who are most susceptible to RSV, visiting emergency rooms in Louisiana, South Carolina, Texas and Virginia, she wrote, and also more hospitalizations in Texas.

Editor’s note: This story has been updated to clarify that Washington state has its own public dashboard with updated wastewater information during the shutdown. Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Robert Thornton received personalized hospital care for COVID-19 and pneumonia in his Belvidere, Ill., home in 2024 as part of a Medicare in-home care program that expired October 1. (Photo courtesy of OSF Healthcare)

The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.

The telehealth and in-home hospital care programs were both temporary — but increasingly popular — options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.

The shutdown has prevented Congress from extending them.

More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University’s Center for Advancing Health Policy through Research.

As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.

The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.

Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that “all telemedicine is uncovered by insurance as of Oct. 1” — so she had to cancel the routine appointment.

“It was just a follow-up appointment  to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,” Wynn said. Her health insurance company later told her it still covered telehealth visits.

There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.

“It’s a misunderstanding,” Apple said. “I’m not really sure what’s happening, but it’s unfortunate and very scary. There’s so much uncertainty out there now, and we see insurance payers start to pull back.”

Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.

“In rural America, it’s often telemedicine or no medicine at all,” said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.

There’s an exception for telehealth rural residents — but only if they travel to a brick-and-mortar health care facility to get the remote health care service.

“The patients have to go to a clinic to receive that telehealth visit from a provider in a different location,” Apple said. “It kind of defeats the purpose.”

According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.

There’s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.

Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.

“This is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing — because at this point reports we’ve seen seem to suggest it is company by company, provider by provider,” said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.

The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.

The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin — all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo’s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker’s Hospital Review.

In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker’s report.

Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.

Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.

“Management scheduled a random call this morning with a super vague title. Then drop the bomb on us,” wrote one poster in Texas. “So no job. Perfect!”

In a direct message, the poster, who didn’t want their name used for fear of getting in trouble at their hospital, told Stateline, “This obviously wasn’t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn’t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.”

Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.

“We are hopeful that Congress will renew this innovative model of care in the future,” Hawthorne said.

Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program “to avoid needing to return multiple patients to a very crowded facility,” said Jennifer Junis, president of OSF OnCall, which handles home hospital care.

There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program’s start in 2020, it has helped 980 patients with home care through OSF’s Saint Francis Medical Center in Peoria.

“It is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,” Junis said. “Our digital hospital program has allowed us to free up beds for our sickest patients who need them most.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Oil pumpjacks are seen in a field near a wind turbine in April in Close City, Texas. Weak oil prices have led to recent energy layoffs in Texas and North Dakota. (Photo by Brandon Bell/Getty Images)

Friday’s jobs report is missing in action because of the federal shutdown, but economists are finding other ways of measuring apparent job losses concentrated in Midwestern states and oil country.

Unemployment could continue to rise, especially for Black people, who have borne the brunt of recent job losses.

Friday’s jobs report for September was missing because of the federal government shutdown. The U.S. Bureau of Labor Statistics staff responsible for collecting, analyzing and releasing the data have been furloughed since Wednesday.

The jobs report is useful to economists, government agencies such as the Federal Reserve, and investors trying to gauge the state of the economy, said Elise Gould, senior economist for the left-leaning Economic Policy Institute. If the data is missing for an extended time, it could distort such forecasts, she said.

“We still have some information on the economy from other sources, yes. None of the other indicators predict perfectly. There’s no replacement for the data,” Gould said.

Still, other groups are using their own measuring tools and sharing that information. ADP, a private payroll processing company, showed a decline of 32,000 jobs for the month of September.

The result “further validates what we’ve been seeing in the labor market, that U.S employers have been cautious with hiring,” ADP’s chief economist, Nela Richardson, said in a statement.

Austan Goolsbee, president and CEO of the Federal Reserve Bank of Chicago, said in an appearance on CNBC Friday morning that the available data shows weakness in both the labor market and in attempts to control inflation, making the Fed’s job difficult in deciding whether to stimulate the economy or rein it in.

“You’re seeing deterioration on both sides of the mission,” Goolsbee said. “The BLS data is the best in the world, and it does create difficulties when you’re kind of putting up a screen and you can’t see the data.”

Indiana, while gaining some new jobs in the Kokomo area for car parts and batteries factories, saw September layoffs of more than 1,600 workers, according to state figures. That includes 248 hospitality workers at a convention center in Evansville, 200 warehouse workers at a Target distribution center in Indianapolis, 123 layoffs at a security guard firm that lost a federal contract, and layoffs at two automotive parts factories totaling 189 workers.

Ohio also saw layoffs of 768 workers starting in September at a Kohl’s e-fulfillment in Middletown.

Black unemployment, which has spiked from 4.8% in April 2023 to 7.5% in August, has likely increased again, said Joseph Dean, who monitors it for the National Community Reinvestment Coalition, which encourages more investment in underserved communities.

“If there were a jobs report, I’d expect a rise in the Black unemployment rate,” Dean said. “It’s likely due to a combination of factors: federal layoffs earlier in the year, anti-DEI efforts, and now primarily, stagnation in industries that employ large numbers of Black workers — like transportation and professional/business services.”

Another indicator of labor market trouble, initial claims for unemployment, were up 85% in North Dakota and 44% in Texas from August to September, according to numbers through the week ending Sept. 20 from the U.S. Department of Labor. Weak oil prices have led to recent energy layoffs in those states.

In another private survey that could help gauge the health of the labor market, outsourcing firm Challenger, Gray and Christmas reported Thursday that companies have reported more than 54,000 job cuts in September. That’s a slower rate than August but brings the total this year to 946,000 job cuts, the highest since the pandemic in 2020 and up 55% from the first three quarters of 2024.

The leading reason for job cuts has been actions by the Trump administration’s Department of Government Efficiency task force, the firm said, including cuts to government jobs and “downstream impacts” of the federal cuts, such as loss of funding to nonprofits.

There were also about 7,000 technology jobs lost to AI disruption in September, making it harder to land entry-level jobs, the firm said.

“Right now, we’re dealing with a stagnating labor market, cost increases, and a transformative new technology,” said Andy Challenger, a labor expert at the firm, in a statement.

In August, some of the largest increases in the unemployment rate over the previous year were in Texas cities on the border with Mexico: 2 percentage points each in Brownsville-Harlingen (to 7.5% from 5.5% in 2024) and Eagle Pass (to 8.9% from 6.9% last year). Those metro area estimates for August were released Oct. 1.

Cedar Rapids, Iowa, saw a 1.8-point increase in unemployment from 3.6% to 5.4%, and there were 1.7-point increases in Blacksburg, Virginia (from 4% to 5.7%), and Grants Pass, Oregon (from 6.1% to 7.8%).

Unemployment fell the most in Kokomo, Indiana, (down nearly 4.5 points from 10.7% to 6.2%) where Stellantis has been adding jobs in its automotive parts and batteries plants.

An earlier Stateline analysis showed New Jersey and Virginia were among the states most impacted by job losses in the second quarter of the year as federal cuts and corporate restructuring took a toll.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org