Since their peak less than three years ago, opioid overdose deaths dropped nearly by half as of October, according to a Stateline analysis. The drop comes as a shrinking fentanyl supply has made the drug weaker and less deadly and volunteer efforts get more people into treatment.

The weaker fentanyl tracks to a crackdown on materials used to make fentanyl in China around the time U.S. deaths started dropping in 2023. Some experts see it as a welcome, but possibly temporary, break for states in a scourge that boosted crime as people who are using the drugs sometimes fall into homelessness and steal to support fentanyl habits.

The numbers and rates of opioid overdose deaths fell for all races between 2023 and 2026, according to more detailed data from the federal Centers for Disease Control and Prevention analyzed by Stateline. That’s in contrast to an earlier trend from 2019 to 2023, when rates dropped only among white people and rose sharply among Black and Indigenous Americans.

Ohio had the nation’s largest decrease since mid-2023, when the nation’s opioid overdose deaths peaked. Ohio has seen fewer deaths but more risky behavior lately as fentanyl supplies dry up and people turn to substitutes tainted by animal tranquilizers.

Ohio is seeing a difference in the bottom line, said Erin Reed, director of RecoveryOhio, the state agency charged with reducing overdose deaths.

“We’re seeing things you would expect — like reductions in emergency department visits and reductions in Medicaid costs,” Reed said. “But we’re also seeing a positive impact on violent crime and recidivism, and I think this is really, really encouraging. At the end of the day, people want to be safe.”

Sarah Beckman, 36, stopped using illicit drugs 11 years ago when she learned she was pregnant with her first child. Now she works through Hamilton County’s Quick Response Team to help Ohio residents who use fentanyl.

When overdoses peaked a few years ago, the team started spending more time talking to people after overdoses.

“We saw overdoses were going up and up, and going out two days a week was not enough. We expanded it to full time,” Beckman said. “That window is so small. It has to be kind of a perfect storm for an individual to be, like, ‘OK, I’m ready.’”

Even if people aren’t ready for treatment, kindness can help build trust and prevent some of the thefts and arrests that lead to police involvement, as it did for her when she stole to get money for drugs and was charged with resisting arrest, she said.

“When you’re in the midst of addiction you need help with everything. For us it’s just meeting people where they are and saying, ‘Hey, are you hungry? Do you have enough clothes?’” Beckman said. “You’re showing consistency and empathy, and by doing that you can slowly move someone closer toward accepting overdose prevention materials or hopefully, eventually, treatment.”

Nationally there were 46,066 opioid overdose deaths in the year ending with October, barely more than half the peak of 86,075 in June 2023 and the lowest since April 2017. The numbers, often delayed because of the process of determining overdose deaths, were released this month based on information available March 1 by the federal National Vital Statistics System.

Deaths fell the most in Ohio, West Virginia, Virginia and Florida since June 2023, but increased in Alaska, Arizona and Nevada.

In Ohio, annual deaths fell 63% from about 4,300 in June 2023 to about 1,600 as of October 2025.

As in many other states, deaths in Ohio started falling before 2023, but then dropped more sharply — 34% in that year alone, said Reed.

Arizona and Nevada, however, saw deaths increase since the national peak in 2023. Arizona’s border crossings with Mexico are among the largest fentanyl smuggling points in the country, with fentanyl traffic dominated by the Sinaloa Cartel in Mexico. One Arizona crossing, the Port of Lukeville, was the site of the largest fentanyl seizure in U.S. Customs and Border Protection history: 4 million fentanyl pills hidden in a trailer brought to the border by a 20-year-old U.S. citizen in July 2024.

The state’s notorious summer heat exacerbates overdose deaths, according to recent research.

Plentiful supply from the border may help explain continued increases in Arizona, said Will Humble, executive director of the Arizona Public Health Association, a public health workers organization.

Political infighting over how to spend the state government’s share of $1.2 billion in opioid settlement money hasn’t helped, he said. The state attorney general, governor and legislature have gone to court over plans to use some of the money to balance the state budget.

“Many other states are way ahead of Arizona when it comes to distributing the state portion of the opioid settlement dollars,” Humble said. “It could be there are fewer interventions because the state dollars are locked up. There’s this dispute in Arizona over who gets to decide. Many other states are not having this jurisdictional issue.”

On the national stage, opioid overdose deaths fell across demographic groups. Even older Americans, whose overdose death numbers had surged earlier even as they fell for other groups, saw a 25% decline from 2023 to 2025, about half the national decrease, according to the Stateline analysis.

In a sign of a weaker fentanyl supply, the Drug Enforcement Administration said in December that 29% of the pills it seized in fiscal 2025 contained a lethal dose of fentanyl, down from 76% in fiscal 2023.

“These reductions in potency and purity correlate with a decline in synthetic opioid deaths,” the DEA said.

Keith Humphreys, a health policy professor at Stanford University who testified to the U.S. Senate in 2023 about increases in accidental overdose deaths among older adults, told Stateline that a “fentanyl supply shock” originating in China made fentanyl supplies weaker. That would include fentanyl-tainted cocaine, which had caused many deaths among older Black men, Humphreys said.

“This likely includes some long-term cocaine users who had the bad luck to get cocaine that had fentanyl in it,” Humphreys said in an interview. White women are more likely to overdose on prescription drugs in order to commit suicide, a trend that would be less likely to be affected by fentanyl supply, he added.

Humphreys and a team of other researchers, in a Science magazine report published in January, found a “drought” of fentanyl that could be traced on the social media platform Reddit.

Elevated mentions of a “drought” started in May 2023, nearly the same time as overdoses began to drop, their research found. Also, the Drug Enforcement Administration reported decreasing potency in seized fentanyl and fewer seizures, both indicating a shortage of supply.

“Drug dealers often adapt to supply shortages by lowering purity more than raising prices,” the report stated. The likely reason: China cracked down on source chemicals for making illicit fentanyl. Such “precursor” chemicals typically arrive from China and are processed in Mexico before being smuggled into the U.S. as illicit fentanyl.

“Actions by the government of China that resulted in greater scrutiny of production and export of precursor chemicals, including the removal of online advertisements and several marketplaces,” may have been what caused the drought in fentanyl and thus saved lives, the report concluded.

The DEA concluded that Mexican fentanyl producers were cutting potency because they were having a hard time finding source chemicals from China, the report noted. That makes it likely supply is the biggest reason for the drop in deaths, not enhanced U.S. border searches or other actions such as the Trump administration’s attacks on drug boats off the South American coast. Those boats are typically used to transport cocaine rather than fentanyl.

Data shows a similar drop in overdose deaths in Canada, where fentanyl supplies are usually produced from Chinese chemicals inside the country rather than smuggled in. That’s another reason to suspect that China’s crackdown affected both countries, despite differing policies and law enforcement strategies.

In their Science article, Humphreys and the other researchers noted that the recent decline in deaths offers the chance to prepare for future opioid-related problems.

“The incentive to restore the fentanyl trade will persist as long as there is demand for the drug,” the authors wrote. “It may be wise to use the current drought as an opportunity to ramp up the prevention and treatment programs that have evidence of decreasing demand.”

There have been some more recent upticks in death numbers.

Colorado saw an increase in synthetic opioid overdose deaths starting in late 2024, according to a Common Sense Institute report released this month. The institute is nonpartisan but has ties to the Republican Party, and concluded the state needs stiffer penalties for fentanyl possession and distribution, similar to Texas law. Opioid overdose deaths in Colorado are down 9% since the national peak in 2023, according to the Stateline analysis.

In Ohio, the recent trend among people who use fentanyl is to find pills spiked with an animal tranquilizer that causes severe addiction, said Beckman, of the Hamilton County Quick Response Team. Three recent clients survived overdoses but required emergency treatment, she said.

“We can educate people in the community: ‘Hey, your drugs are not what you thought they were, that’s why you’re experiencing all these weird side effects,’” Beckman said. “These substances are so severe that a traditional detox hasn’t been able to handle them.”

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

Thousands of low-income people living with HIV could be losing drug coverage as states impose limitations on HIV assistance programs amid constrained budgets — raising alarms over consistent access to lifesaving medications.

Many factors are putting budget constraints on state programs, including federal funding — which has remained flat for years and hasn’t been adjusted for inflation — increased drug costs and rising insurance premiums.

The Ryan White HIV/AIDS Program is the national safety-net program supporting more than 600,000 low-income people living with HIV across the nation. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Congress has kept key drug assistance funding at $900.3 million annually since 2014. New enrollments for state programs jumped 30% from 2022 to 2024, in part because states cut off pandemic-era Medicaid assistance.

As of January, at least 18 states have pulled back their Ryan White AIDS Drug Assistance Programs, known as ADAPs, in some way, according to a March 2 analysis by health research group KFF and a report by the National Alliance of State and Territorial AIDS Directors, which offers consultation for states.

There are roughly 1.2 million people in the United States living with HIV, and about 1 in 4 people get support from a state drug assistance program.

A disproportionate number of HIV/AIDS patients are gay, bisexual and other men who have male-to-male sexual contact, according to the federal Centers for Disease Control and Prevention. LGBTQ+ communities have been targeted in recent years by some federal and state policies, including the rollback of civil rights, shutting down a youth mental health hotline, restricting health care access, and imposing discussion and book bans in public schools.

Florida has introduced the most dramatic restrictions on income eligibility for its HIV drug program — cutting individual eligibility for the program from 400% of the federal poverty level to 130%. That means uninsured and underinsured people up to that 400% poverty line no longer have coverage under the program.

That’s roughly slashing maximum annual income of $63,840 for an individual down to $20,748. The state says the change will prevent a $120 million shortfall.

“(That) creates an immense coverage cliff,” for example, for childless adults not eligible for Medicaid, said Amber Tynan, CEO of Big Bend Cares, a North Florida Ryan White provider. Florida is among the 10 states that haven’t expanded Medicaid eligibility under the Affordable Care Act.

Florida’s department of health didn’t respond to Stateline’s request for comment.

Delaware, Kansas, Pennsylvania and Rhode Island have also reduced income eligibility for their programs, but to a lesser extent, according to KFF. For example, Kansans with HIV/AIDS whose incomes are above 250% of the federal poverty level won’t be eligible for help with Obamacare insurance premiums. That change will affect about 230 people, the National Alliance of State and Territorial AIDS Directors estimates.

In Pennsylvania, about 1,600 people will lose HIV drug assistance coverage as the state imposes income eligibility caps at 350% of the federal poverty level.

“We cannot continue to provide services at a certain level when the funding to do so does not exist,” Neil Ruhland, Pennsylvania Department of Health press secretary, told Stateline in a statement. He pointed to drug costs and enrollment numbers that are “steadily rising while funding remains stagnant.”

Florida also is removing the brand-name drug Biktarvy, which is the only single-tablet HIV medication regimen recommended by national guidelines for those starting treatment and is the most widely prescribed antiretroviral medication nationally. There is no generic form.

The medication is highly effective at reducing a person’s viral load, meaning the virus is undetectable in blood tests and untransmittable to others.

Eighty percent of Floridians with HIV who are in the state’s program use Biktarvy, Tynan said.

“Not having the opportunity to stay on lifesaving treatment is creating quite the panic and crisis for our population,” Tynan said. “For decades we’ve worked to turn HIV from a fatal diagnosis into a manageable chronic condition, and that progress depends on one thing: consistent access to treatment. When that stability is disrupted like it has (been) in Florida, it creates real risk for patients and for public health.”

Other states (Arizona, Michigan, Pennsylvania, Rhode Island, Virginia and Washington, plus the District of Columbia) also are considering limiting which drugs they cover, according to the alliance’s report.

And several other states may impose other limits to their drug assistance program. Health agencies in Hawaii, Idaho, Montana, New Jersey, South Carolina, Virginia and Washington are considering cutting funding for core medication and support services. Others are considering implementing a six-month recertification period, restricting eligibility, putting caps on expenditures, changing covered medications and lowering assistance for insurance premiums.

While no state has implemented a waiting list for drug assistance, three states — Arkansas, Louisiana and New Jersey — are considering one as a future cost-containment measure, according to the national alliance’s report.

Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center, said many of her HIV patients are under-resourced and rely on her state’s Ryan White program. She added that she’s relieved Massachusetts’ program hasn’t announced any changes as of February, when the alliance’s report was released, but that she’s worried for patients in the other states.

“We’ve taken HIV from a very serious virus, a deadly virus when it was first discovered in the ’80s, to a very manageable chronic condition because of the medicines,” she said. “It is concerning to see … that we’re sort of moving backwards by not providing that kind of care that’s so much needed, and that’s lifesaving.”

Florida bypassed a rulemaking process when it announced its changes days before open enrollment ended. In late January, the AIDS Healthcare Foundation, a global nonprofit agency, sued the state department of health over the changes. The U.S. Centers for Medicare & Medicaid Services opened a new enrollment period for Floridians losing coverage to enroll in a different marketplace plan.

In late February, Florida issued an emergency rule putting the new eligibility requirements into effect. About 32,000 Floridians get help from the state program in some way — whether it’s through local health departments or the state helping to pay for insurance premiums.

Half of those, around 16,000, will lose coverage entirely — but many others will be affected in other ways, such as losing access to Biktarvy.

“So if you remain in the program, there’s a very high likelihood that you’re still going to be impacted by some of the other changes, like the dropping of the premium assistance, the elimination of Biktarvy from the formulary,” said Tim Horn, director of medication access for the National Alliance of State and Territorial AIDS Directors. “When you take a look at all of these changes in the net, the vast majority of Florida ADAP clients are going to be impacted by this, one way or another.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Nearly a quarter of pregnant women aren’t getting prenatal care in the early stages of pregnancy, according to a new analysis from the U.S. Centers for Disease Control and Prevention.

The share of pregnant women getting prenatal care had been improving: It rose between 2016 and 2021 to a high of more than 78%, but then declined to 75.5% by 2024, wiping out previous gains.

The trend is worrying because getting care early in pregnancy can improve the likelihood of a healthy pregnancy and baby.

The decrease in early prenatal care held true for nearly all race and ethnic groups, but the drops were sharpest for Native Hawaiian and Other Pacific Islanders, Black women and American Indian and Alaska Native women.

By 2024, less than half of Native Hawaiian and Other Pacific Islander mothers received prenatal care in their first trimester — the first three months of pregnancy.

Anne Markus, a professor at George Washington University’s Milken Institute School of Public Health, said that because the statistically significant decline began around 2021, two events could explain some of the decrease: the COVID pandemic, with its associated stay-at-home orders, and the U.S. Supreme Court’s Dobbs decision in 2022 that dismantled the constitutional right to abortion.

“Both disproportionately affected, and continue to affect, communities of color, and the decline in early entry into prenatal care has been disproportionately bigger for racial and ethnic minorities since 2021,” said Markus, whose work focuses on public policy and access to health care. She was not involved in the analysis.

A lack of early prenatal care has also been disproportionately seen in “very young women who are more likely to have a pregnancy that they do not want,” Markus said. “The Dobbs decision and the fear and uncertainty it generated could be particularly relevant in explaining this disproportionate effect observed in the data.”

The share of women getting late care — beginning in the seventh month of pregnancy or later — or no care at all increased in more than half of states from 2021-2024. Utah saw the biggest rise in late or no care, followed by Massachusetts and Rhode Island. The number of Utah women getting late or no prenatal care jumped 54%, up to nearly 6% of women.

More than 1 in 10 women had late or no prenatal care by 2024 in Florida, Georgia, Hawaii, New Mexico and Texas.

“Geographic and financial barriers to accessing care are often behind late entry to recommended care, including prenatal care,” Markus said.

Late or no prenatal care decreased in six states: Arkansas, New Hampshire, South Carolina, Tennessee, West Virginia and Wisconsin.

The CDC compiled the report based on information from birth certificates, and includes information for all births that occurred in the United States.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. speaks during a policy announcement event at the U.S. Department of Health and Human Services on Jan. 8, 2026 in Washington, DC.  (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — Congress has approved the first public health funding bill since President Donald Trump began his second term, with lawmakers largely rejecting his proposed spending cuts and the elimination of dozens of programs. 

A bipartisan group of negotiators instead struck a deal to increase funding on several line items within the Department of Health and Human Services’ annual appropriations bill, including for major initiatives at the National Institutes of Health and the Centers for Disease Control and Prevention. 

“When you look at the differences between what was proposed and what was agreed to, it is astonishing,” House Appropriations Committee ranking member Rosa DeLauro, D-Conn., said during a hearing on the bill in late January.

The Trump administration’s budget request, released in May, called on Congress to cut funding for the Department of Health and Human Services by $33 billion, or 26.2%.

The president asked lawmakers to implement an $18 billion funding cut to the NIH, which he argued would bring the agency in line with the Make America Healthy Again agenda. 

The Trump administration proposed a $3.6 billion cut for CDC programs, including the elimination of the National Center for Chronic Diseases Prevention and Health Promotion, National Center for Injury Prevention and Control, and Public Health Preparedness and Response, all of which it said could “be conducted more effectively by States.”

The budget request said more than $1 billion should be cut from the Substance Abuse and Mental Health Services Administration, though it said the administration was “committed to combatting the scourge of deadly drugs that have ravaged American communities.”

Trump also requested lawmakers zero out any funding for the Low Income Home Energy Assistance Program, or LIHEAP, which he deemed “unnecessary.” The federal program helps millions of low-income households meet their home energy needs, via states and tribes.

The final spending bill Congress approved rejected nearly all of the major cuts. 

Collins, Murray both praise final product

Senate Appropriations Committee Chairwoman Susan Collins, R-Maine, said the bills “reflect months of hard work and deliberation and contributions from members of both parties and on both sides of the Capitol.”

“Funding for NIH is not decreased, as was proposed in the administration’s budget,” she said. “Rather, it is increased by $415 million, including increases of $100 million for Alzheimer’s research and $10 million more for diabetes research, with a focus on type 1 diabetes.” 

Collins also touted an increase in “funding for low-income heating assistance, which is absolutely crucial for states like Maine and is an issue that I have worked for years on with my Democratic colleague Jack Reed of Rhode Island.”

Senate Appropriations Committee ranking member Patty Murray, D-Wash., said the difference between Trump’s budget request and the final bills was like the difference between “night and day.”

“Our bill rejects President Trump’s asks to rubber stamp his public health sabotage,” she said. “Instead, it doubles down on lifesaving public health investments. It rejects Trump’s efforts to slash opioid response funds. It rejects his proposal to chop the CDC in half. It rejects his call to end programs like title X, the teen pregnancy program, essential HIV initiatives, and more.” 

Rare bipartisan agreement in Trump’s second term

Senators from both political parties indicated last summer they weren’t fully on board with Trump’s budget proposal and used a hearing with HHS Secretary Robert F. Kennedy Jr. in May and a separate hearing with NIH Director Jay Bhattacharya in June to highlight their concerns. 

The Senate Appropriations Committee approved its HHS spending bill on a broadly bipartisan vote in July, while the House Appropriations Committee approved its funding bill in September without any Democratic support.

Neither of the original bills went to the floor for debate and amendment votes, though negotiations to find compromise on a final bill began late last year after the record-breaking government shutdown ended in November. 

Republicans and Democrats brokered a final agreement on the HHS funding bill in late January, the first time bipartisan agreement was reached during Trump’s second term. 

Congress previously approved a series of stopgap spending bills to keep HHS up and running, mostly on funding levels and policies last set during the Biden administration. 

The House originally voted on Jan. 22 to send the package that included funding for HHS to the Senate. But it stalled after federal immigration agents shot and killed a second U.S. citizen in Minnesota and Democrats demanded changes to the spending bill for the Department of Homeland Security. 

The Senate voted 71-29 on Jan. 30 to send the package back to the House after removing the full-year DHS spending bill and replacing it with a two-week stopgap. The House then voted 217-214 on Tuesday to clear the package for Trump, who signed it later in the day, ending a four-day partial government shutdown.  

The package also holds funding for the departments of Defense, Education, Housing and Urban Development, Labor, State, Transportation and Treasury. 

‘Months of hard work turned into results’

House Appropriations Chairman Tom Cole, R-Okla., said during floor debate last month the process that led to the final bills proved lawmakers “can make tough decisions.”

“This is where months of hard work turned into results,” Cole said. “You see, we aren’t here for just another stopgap temporary fix. We’re here to finish the job by providing full-year funding and specifically this package addresses core areas of national consequence — defense; labor, health and education; and transportation and housing development.”

Congress is supposed to pass the dozen full-year appropriations bills by the start of the fiscal year on Oct. 1, though it hasn’t completed all of its work on time in decades. 

Last fiscal year, it didn’t complete its work at all, making March 2024 the last time Congress approved all of the funding bills. 

Cole said during debate the programs funded “aren’t abstract concepts on a page, they affect how Americans live, work, learn and travel every day.”

DeLauro said the package of bills represents “a strong bipartisan, bicameral agreement that rejects the Trump administration’s efforts to eviscerate public services and reasserts Congress’ power of the purse.”

“It provides funding levels, removing ambiguity that the White House sought to exploit in the past,” DeLauro said. “It establishes deadlines for required spending, provides minimum staffing thresholds to prevent agencies from being hollowed out and increases notification requirements to ensure the administration is complying with the laws that Congress makes.” 

HHS ends up with $210 million bump

The bill provides HHS with more than $116 billion, $210 million more in discretionary funding than the previous level and a rejection of Trump’s request to cut $33 billion, according to a summary from Murray’s office. 

NIH will receive $48.7 billion in funding, $415 million more than its current spending level, showing that lawmakers were unwilling to slice its budget by $18 billion as requested. 

Congress bolstered funding for the Substance Abuse and Mental Health Services Administration by $65 million to a total of $7.4 billion, according to Murray’s summary. Trump asked lawmakers to reduce its allocation by more than $1 billion. 

A $3.6 billion funding cut for the CDC was also rejected, with appropriators agreeing to provide the Atlanta-based agency with $9.2 billion.

A summary of the bill from DeLauro’s office says negotiators were able to keep funding for domestic and global HIV/AIDS activities, Firearm Injury and Mortality Prevention Research and Tobacco Prevention and Control, among other programs that House Republicans originally proposed to zero out. 

The legislation bolstered, instead of eliminated, funding for the Low Income Energy Assistance Program, or LIHEAP, according to a summary from Cole’s office. 

The bill, it said, “reprioritizes taxpayer dollars where they matter most: into lifesaving biomedical research and resilient medical supply chains, classrooms and technical programs that set Americans up for success, and rural hospitals and primary health care to support strong and healthy families.”

CDC program axed

The legislation does eliminate the CDC’s Social Determinants of Health program, which the agency’s website states are “nonmedical factors that influence health outcomes.” Those can include whether a person has access to clean air and water, a well-balanced diet, exercise, a good education, career opportunities, economic stability and a safe place to live.

HHS’ Office of Disease Prevention and Health Promotion writes that “people who don’t have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.” 

Cole’s summary of the HHS spending bill says that program “promoted social engineering while distracting grant recipients from combating infectious and chronic diseases.” 

The American Public Health Association urged Congress to approve the bill, writing in a statement the compromise “rightly maintains funding for most public health agencies and programs.”

“While the bill is not perfect and we disagree with cuts to several HHS agency programs included, overall, the agreement rejects the devastating cuts and nonsensical agency reorganizations proposed by the Trump administration and is a positive outcome,” APHA wrote. “Importantly, the bill also includes language to ensure that CDC and other health agencies maintain an adequate level of staffing to carry out their statutory responsibilities. 

“The bill will also ensure that Congress exercises its oversight over any future proposed agency reorganizations.”