Connection, compassion and hope — those are the three key elements members of the Milwaukee Overdose Response Initiative (MORI) say helped lower overdose deaths to levels unseen in Milwaukee County since 2016. “It’s MORI in conjunction with this whole community,” Jonathan Belott, a lieutenant with the Milwaukee Fire Department, told the Wisconsin Examiner. 

“We don’t live in a silo,” said Belott, who’s led the overdose response initiative since its inception in 2019. “We have so many of our different partners that we have come to rely on to get people the help that they need throughout this community.” 

Last year there were 383 fatal overdoses in Milwaukee, the lowest number in a decade, according to the county’s overdose dashboard. That marked a significant reversal of the recent overdose epidemic that peaked in 2022, with 674 fatal overdoses in Milwaukee, fueled by widespread contamination of cocaine, heroin, prescription pills, and other substances with the powerful synthetic opioid fentanyl.

As the crisis accelerated in 2019, Belott was assigned to head a new strategy. “I didn’t even know what I was getting into in that moment,” he told the Examiner, sitting beside fellow firefighter and team supervisor Robert Rehberger and peer support specialist Amy Molinski — both members of the overdose response initiative — at the team’s homebase fire station on Fiebrantz Avenue. 

“I didn’t understand even the full impact of what it was,” said Belott. “I was kind of just told, ‘Hey, you’re going to be this guy.’ But the more you get into it, the more you see how it has been impacting people’s lives over these years…We watched those numbers go up and up…Just a crazy amount of people.”  

Between 2017 and 2025, 4,582 people died across Milwaukee County. Nationwide, overdose deaths became more common than those caused by homicide, car accidents or suicide. The people who died were brothers and sisters, fathers and mothers. Some were children younger than 5, others were elders in their 70s. Most were people between 20 and 60 years old. They were unhoused, working class and wealthy people from numerous ethnic and racial backgrounds. Even in Milwaukee — one of America’s most segregated cities — addiction and death have never discriminated.

Every year seemed worse than the last as record-breaking numbers of Milwaukeeans died. “And then we saw just a little decline,” said Belott. Overdose deaths fell by more than 30% in 2024, followed by a sharp drop in 2025. “You’re talking 50% less people dying over the course of the three years,” Rehberger said of the most recent numbers.  

“I’ll say it’s bittersweet,” said Molinski. “And I’ll say that because the number of deaths that we have are still too many. It’s unfortunate that it had to get as high as it did before people were willing to do anything about it.”

Milwaukee’s sharp decrease in overdose deaths mirrors a nationwide trend, tied to stepped-up treatment and harm reduction efforts as well as a shrinking fentanyl supply.

Building a program from scratch

Belott credited Michael Murphy, who served on the common council, with helping steer the first $100,000 to the fire department to start an overdose reduction program. “To his credit, he recognized that we had to do something different than what we were doing,” Belott told the Examiner. 

Although it was just enough money to get a program off the ground, there were questions about what such a program would actually look like. “We had to make the program from absolutely nothing,” said Belott. “Like this didn’t exist anywhere that we knew. …We didn’t base it off anything.” The team itself started off very small. “It was like three hours a day for Monday through Friday,” said Rehberger. “And now we got four teams going out every day doing this work. And it’s just proud to see like,  something come from it.”

The Milwaukee Overdose Response Initiative started by using the fire department’s access to 911 call data to identify people who had survived an overdose within the last 24-48 hours. From there, team members would go out to find those people, and see whether there was any help they could provide. “Help” doesn’t have to mean pressuring someone to go into rehab — although the Milwaukee overdose team also regularly works to get people into treatment programs. With time, the team realized that “help” can also mean getting someone clothes, food, providing them with narcan and other harm reduction supplies, and offering compassionate and non-judgmental support.

Molinski recalled one girl who called the overdose response team because she needed a ride to her psych appointment. “It’s cold, she didn’t want to walk,” Molinski recalled. “So we picked her up and we took her there. We stopped at the food pantry along the way so that she could get some food.”

“Help” can also mean checking in on family members who recently lost a loved one to the overdose crisis, and ensuring they have access to the resources they’ll need to process their loss. Belott said that acts like these are about providing “basic humanity for the people that we work with.” Molinski echoed the sentiment. “It’s helping to eliminate some of the struggle,” she told the Examiner. “We all want to quit when it’s hard.”

The Milwaukee overdose team also had to focus on how it would grow to meet those needs. Like Belott, Rehberger didn’t know what to expect when he joined the team. “I volunteered but I didn’t really know exactly what I was volunteering for at the time,” he told the Examiner. When the team decided to add addiction peer support specialists, Molinski, who is employed by Community Medical Services, a medication-assisted treatment clinic, was brought on. The team’s vehicles, modestly marked with the fire department’s logo and “community paramedics” on the trunk, usually carry two firefighters and one peer supporter.

Working on the overdose response team, Molinski grew to understand just how much people respected the Milwaukee Fire Department. “These guys [firefighters] got rolled into it, and I don’t think that there’s any way that you can’t say that that helped impact the success that we see today,” Molinski, who got into the peer support field after enduring her own battles with addiction, said. When overdose survivors “get greeted by someone in a uniform that doesn’t judge them, tries to take the shame out of what they’re doing and say ‘your life is worth saving, like not just on the street last night but moving forward,’ that means a lot,” she said.

As the overdose response effort evolved, so did team members’ understanding of the epidemic, themselves, and each other. “There was a lot of humility in the beginning,” said Molinski. “There was a lot of us having to look at one another and sometimes kindly, sometimes very directly, [saying] like, ‘Hey, what you just did wasn’t right.’” 

Molinski admitted that “I’m a little rough around the edges” and “I’ve kind of always done things my own way.” She grew to appreciate what representing the fire department meant. “So you can be you, just tone down just a little bit,” she said. “And I needed to hear that. …We learned from one another.” The firefighters learned how to loosen up and Molinski learned how to tighten up, she said, “and we were kind of able to share that with everybody as they came.” 

A conversation, not an interrogation

Firefighters who joined the team also often had to rethink how they approach people struggling with addiction. As emergency responders, Belott and Rehberger were trained to stabilize people, patch them up, and transport them to a hospital in the middle of a crisis. In order to succeed, however, the overdose response effort demanded a completely different modus operandi.

“For us, we’re not there in the crisis moment,” Belott explained. “We’re there following the crisis moment. So we have time…we sit down and we have a conversation, not an interrogation, which is what I used to do at the beginning.” 

“If you have a conversation with somebody, you learn about them…Because a conversation flows,” Molinski said. Rehberger called it “asking a question in a different way, and listening.”

This allowed team members, especially those with no personal experience with addiction, to see a whole new side of the epidemic and what it meant for people fighting to stay alive. The conversations they had affected them deeply, allowing them to experience the gratitude the people they tried to help felt  for anyone willing to treat them with dignity. “Before I came here, one of the things that I wasn’t expecting was how much relationship you grow with the people that we’re meeting,” said Rehberger. “I feel like I was just thinking that it was going to be mostly like a 911 call, you know? Like you’re helping the person in that moment.” Rehberger wasn’t used to people being so grateful on calls that they gave him giant hugs. “Never did I think that I was going to be hugging someone while on the fire department. Ever.” 

Molinski recalled her first month with the overdose response team. “It was in the middle of the summer, it was hot, they didn’t have air conditioning,” Molinski recounted. “He was wearing no shirt, he was smoking cigarettes in his apartment, and it was a lot. And as we left, I hugged him goodbye.” Belott was taken aback, quipping that Molinski was “all in.” The peer support specialist explained that it may have been a very long time since that man had felt “a caring human touch.” 

What winning looks like

Even for Molinski, who’d experienced her own addiction to heroin and other drugs, the conditions people survived day-to-day were startling. “Our stories of addiction while we were in active addiction are insane,” Molinski told the Examiner. People living with an active addiction may or may not have stable housing, regular access to food, hygiene products, transportation, work, or even trustworthy people. Sometimes, the overdose response team would find people only to lose track of them again for over a year.

“They probably lost three phones in those 18 months,” said Molinski. Yet, out of the blue, the same person who couldn’t hold onto a phone might call the overdose response team for help because they had managed to keep a team member’s business card. “I mean, think about that for a second,” said Molinski, “how hard it is to keep track of your property when you’re in active addiction, but somehow a business card was still there to call.” 

Other times, team members learned firsthand just how hard it is for people to stop using drugs. “People are trying,” said Molinski. “… not everybody is just choosing to stay in their addiction. Some of them don’t see a way out. They’ve tried and they can’t get out. And when you see that, it’s easier to treat people with a little bit more compassion. Give somebody a little bit of grace as to why they’re still in that situation.”

Rehberger remembered checking on a woman, who contacted the team saying that she didn’t have any clothes. “I didn’t know what that meant, honestly,” said Rehberger. When team members met the woman they realized that she literally didn’t have clothes to wear. So they got her clothes, then food, and then they returned to see if she’d go into treatment. When they did, the woman told them, “Honestly, I would never have gone in for treatment the next day had you not gotten me the food first,” Rehberger recounted. 

Belott said that simply getting through the door to have a conversation was a success. “If they’re willing to sit down and talk with some strangers in uniform, that’s an amazing thing,” he said. “And we show up and they know, OK, somebody’s following up, somebody gives a crap about me.” 

Team members have dropped off birthday cupcakes to people living in homeless encampments, and celebrated “clean days,” marking milestones for people who’ve quit drugs. Molinski recalled one unhoused man the team had been trying to locate for a long time. After connecting with his grandparents, the team was able to arrange for him to get into detox before going off to a residential facility. It turned out the man was living near an alley. He conveyed to the team that he didn’t want members to park too close to the site.  So they stood near a pizza sign, yelled his name, and he came out accompanied by a friend. “My buddy needs help, too,” he said. 

The overdose response team’s efforts were the subject of intense debate in the community. Team members often found themselves fighting the stigma and shame attached to addiction. Some people were confused about why the team tried so hard, even questioning whether the city would be better off just letting people die. With patience and much labor, however, some people’s minds changed. Belott wondered, “How many 10-minute conversations have we had over the years? And how many minds [were] changed by doing that?” 

Success can be measured in concrete results like the lower number of fatal overdoses. But not every achievement can be recorded on a spreadsheet, and not every good deed results in a life saved.

About eight months into the program, team members were working with a young woman they had come to know well.  “We actually got told that we weren’t allowed to see her anymore,” said Molinski. “We were too invested…She saw us a lot. She was not in good shape. This girl was struggling. And we just kept going to see her. And we didn’t know how we were going to help her, if we could help her. We had no idea what to do.” First they tried reaching her parents, who were exhausted by their daughter’s  addiction. The mother hadn’t seen her in over 200 days, and the father didn’t want her back home because she was prone to stealing. 

Team members eventually found out that she was sustaining herself as a sex worker on Milwaukee’s North Side. Besides her addiction, she also suffered from the condition endocarditis which causes inflammation of the heart. Team members accompanied her to the hospital so that she could get a Peripherally Inserted Central Catheter (PICC) line, a procedure which frightened her.

Then one day the team got a call from a man she was staying with, saying that she was lying in the bathroom and couldn’t get up. She was rushed to the emergency room. She asked team members to bring some of her favorite treats, a Sprite and Reese’s Peanut Butter Cups, when they visited. 

It was her thirtieth birthday when the team visited the hospital and brought her a blanket and a book to read. “She was completely unconscious, unable to speak in any way,” said Molinski. “And then the day after that, her family called [Belott] and I and said, ‘We’ve made the decision to take her off of life support. And we would like to invite you guys to come and say goodbye if you would like.’” 

Molinski said that she and Belott “were too invested…We were all f-ing in…And we went, and we cried over her bed, and we said goodbye to her, and her family took her off life support, and that sucked.” Yet, Molinski also had texts that the young lady sent her saying that she loved them, and that knowing them was the first time in years that she felt that anyone cared about her. “And she died,” Molinski said, shedding tears, “but she died feeling loved.” Her parents saw that love, too. “I don’t care what anybody says…The numbers say that was a fail,” said Molinski. “They weren’t there. It wasn’t a fail. …We made that girl feel like she was worth something before she left the world. We met her too late, we couldn’t help her. But she felt loved when she left.”

Despite the loss, the team knew that they’d done something good that day. “I think about her all the time,” said Molinski. Belott, the team leader who was sitting near her and Rehberger, wiped tears from his eyes. 

“I still have a list of the books that she wanted me to bring her when she was in the hospital. I can’t delete it off my phone,” said Molinski. “She made an impact on me. And we were told to stop. And we didn’t stop.” 

What Milwaukee needs to keep overdose deaths down

Since the Milwaukee Overdose Response Initiative began its work in 2019, Milwaukee County has made great strides against the overdose and addiction epidemics. Narcan — the crucial spray-medication used to revive an overdose victim — can be found in bars, grocery stores, hospitals, restaurants, and free-to-use vending machines. Not only is Narcan carried by firefighters and other emergency responders, but ordinary people can be trained to use it. “Keep that Narcan flowing out there,” Belott stressed. 

Several Milwaukee County communities have adopted their own kinds of overdose response teams. The West Allis fire department, which recently integrated with Wauwatosa’s, has launched one such effort. The state of Wisconsin also legalized testing strips both for fentanyl and xylazine — a potent tranquilizer — allowing people to check drugs for dangerous substances before using them. New treatment centers have opened in parts of the county. Even within local jails, people are able to access medication-assisted treatment and take the first steps towards recovery.

Many of those resources are also distributed by the Milwaukee Overdose Response Initiative  for free in the form of “Hope Kits.” Similar to a small plastic purse, with the word “Hope” printed on it in bright red lettering, the kits are stocked with Narcan, testing strips and contact information for treatment centers, therapy, and groups like Narcotics Anonymous and Alcoholics Anonymous. All frontline firefighters are deployed with Hope Kits.

The Milwaukee overdose response team’s work is funded by opioid settlement funds, paid out by the pharmaceutical companies that helped spark the opioid epidemic. With those funds, and additional grants, the team is able to keep the lights on and grow its coterie of firefighters, peer support specialists, vehicles, and harm reduction resources. “We’re proud of MORI,” Belott told the Examiner. 

Treatment is still in short supply. Often, the team is forced to look for residential treatment beds outside of Milwaukee County. Sometimes that’s a good idea for people who need to sever their old connections. But for those facing transportation challenges, it can be difficult. Molinski, Belott and Rehberger also said no residential treatment centers in Milwaukee have proper accommodations for people with disabilities.

“There is none. Zero,” said Molinski. “Not a single place where someone can get help in a wheelchair. Or somebody that simply hurt themselves while using and is on crutches, they also can’t go.” 

Ultimately, the greatest resource the overdose response team can provide is hope. Regardless of what they’ve done, or experienced, people’s lives are worth saving, team members said. In Molinski’s case, it was disconnection and feeling empty that led her into drug use, and it was connection and hope that pulled her out of it.  

“My life was worth saving,” said Molinski. “It would’ve been really hard to convince someone of that back in 2006, 2007…That would’ve been a tough sell. My parents were starting to wonder if it was worth it for them to keep fighting. But it was worth it!” Today, she is raising a teenage daughter, and works in a field where she can help people who struggle like she did. But to get there, Molinski had to keep trying. “I never dreamt that this was waiting for me,” she said.

This article has been edited to reflect that Ald. Michael Murphy helped steer funds to get the overdose team started, not Ashanti Hamilton.

From 2021 to 2024, a new report reveals there was a dramatic increase in the number of incarcerated residents of Wisconsin’s jails and prisons accessing medications for opioid use disorder.

“Treatment Behind Bars: Medication for Opioid Use Disorder in Wisconsin’s Jails and Prisons” by the Wisconsin Policy Forum was released Wednesday at a press conference hosted by Vital Strategies Overdose Prevention Program, a global public health organization that has been working since 2018 to use “advanced evidence-based strategies on overdose prevention and to expand access to harm reduction and treatment, particularly for populations at highest risk,” said Giavana Margo, program manager.

The report notes that “medications for opioid use disorder are an important tool to help people manage symptoms of opioid withdrawal, as well as recover from symptoms of active opioid addiction. Research also shows that individuals who are newly released from prison are at elevated risk for overdose fatalities.”

The report said there are three factors that have “likely” resulted in the higher use of opioid use disorder medications  in carceral settings:

1. The high number of opioid deaths in the state that reached a peak in 2024
2. The availability of opioid lawsuit settlement dollars from pharmaceutical companies to address treatment.
3. Federal and professional agencies promoting the medications, and pressure from the U.S. Department of Justice to offer them to carceral residents under the Americans with Disabilities Act.

A fourth factor discussed during the press conference is the higher percentage of jail and prison facilities offering the medications, encouraging wider acceptability.

Jason Stein, president of the Wisconsin Policy Forum, said that even though the number of opioid deaths has dropped noticeably since 2024, the number of overdose deaths statewide is slightly higher than vehicle deaths, making overdoses a “significant public policy issue.”

He noted that of 71 jails in the state, 58 filled out a 42-question survey fully and seven answered partially, resulting in a 97% reporting rate for the jails, while the Department of Corrections (DOC) reported data via its central pharmacy that serves all the state prisons.

The primary two opioid use disorder medications used by facilities are methadone and buprenorphine.

“Both of those medications are associated with a decrease in overdose deaths as well as improvements in other important indicators such as recidivism,” he said.

The study also looked at the use of naltrexone, another medication that is not strictly for opioid use disorder, and it also looked at the prevalence of naloxone or Narcan, which is used to reverse opioid overdoses.

The report notes that only four residents in the DOC system took buprenorphine in 2021, but 148 were receiving it in 2024, and 44 took naltrexone in 2001 — a number  that increased to 154 in 2024.

Stein said a 2021 Department of Health Services (DHS) report showed that only one-third of prisons offered any medication for opioid addiction, but by 2025 all 36 prisons were offering at least one medication.

Currently, Stein said, most Wisconsin jails — 53 of 65 that responded or 81.5% — offer one form of opioid medication. That is more than double the 25 jails, or 41%, that reported at least one medication in 2021.

“It’s more common for jails in the central and southeastern parts of our state to have multiple forms available,” he said of opioid medication. “In northern Wisconsin, it’s typically one form … such as buprenorphine.”

The report notes that offering the medications to those in jails and prisons results in a reduction of overdose deaths after release, as well as a decreased risk of death for any cause and a lower risk of reincarceration.

“We want to note that there is increased availability of these medications in both county jails and prisons around the state, making it available to thousands of individuals in 2024 at a substantial increase from 2021, but at the same time, there are some gaps, meaning access at the county level,” Stein said. “We had eight counties that stated they did not currently provide any access to these medications. We had five more counties that did not answer the survey. There are now 24 counties that provide some access to methadone, but that is still a minority, and we have a number of jails that, while they may provide continuation of existing prescriptions, they do not initiate individuals on those medications.”

He added, “We do see some opportunity … despite the challenges that may exist, to increase access; we do see some tools that local counties can turn to. One, there are more counties and private providers that are offering this service around the state, so there’s the potential for partnership, and then, as well, the availability of opioid settlement funds also makes the possibility of funding this service more practical in some cases for counties.”

Joanna Hernandez of Milwaukee shared her experience of struggling with addiction while incarcerated and the importance of continuing medication.

She recounted being arrested in 2013 in Walworth County while possessing a valid prescription for Suboxone (a medication to treat opioid addiction).

“The jail verified my prescription, but even after confirming it, they refused to give me my medication,” she said. “I was there for five days and went through very severe withdrawal. I was extremely sick and eventually segregated to a single cell. I remember guards telling me, ‘You know, this isn’t a hospital.’ As soon as I was able to post bail and get out, I used immediately. If I had been able to continue my prescription while incarcerated, I could have focused on healing and making sure my mental health medications were the right fit for me. Mental health plays a huge role in withdrawal.”

She added, “Experiences like mine show why access to medications for opiate use disorder is so important. Withdrawal in jail does not treat addiction. It actually increases the risk of relapse and overdose when people are released. Jails and correctional facilities need to treat opiate use disorder like the medical condition it is. Access to medications for opiate use disorder is about dignity, medical care and saving lives.”

Kenosha County Sheriff David Zoerner said an important part of his jail’s intake is an initial screening, so the residents get the resources they need and they also have those resources when they leave.

He noted it was a grant that provided the dollars to do the initial screening, and also stressed the limiting factor on how much his office can do is money, mostly from tax levies.

Zoerner said the most efficient way to offer methadone would be at the jail but he fears methadone could be “diverted nefariously,” so instead those who need it are driven daily to a facility, but that is also costly because it requires a deputy to transport the residents.

“My hope, based on what we’re doing right now with the early screens, is being able to work with the affected population while they’re in our custody, getting them peer support and some need therapy,” he said.  “You understand that drug addiction, behavioral health issues, mental health, they all go hand in hand, so to facilitate that through and then with new legislation, hopefully we’re going to be able to get these folks prescriptions, a 30-day supply, before they leave.”

The new legislation Sheriff Zoerner referred to is AB 604, which passed the Legislature and is waiting for Gov. Tony Evers’ signature. It would allow the state to apply for Medicaid coverage for incarcerated people, including a 30-day supply of opioid medication prior to release.

At the press conference, Adriena Hust, state team leader of Vital Strategies, shared recommendations for expanding opioid use disorder medication access in Wisconsin jails and prisons.

“The first recommendation, incarceration is not treatment,” she said.  “More should be done to avoid reincarceration. Most admissions to prison in Wisconsin are due to supervision and technical violations, rather than a new crime. While reforms are in progress, Vital Strategies recommends that Wisconsin continue to minimize revocation and eliminate incarceration sanctions for drug use while on supervision, considering reoccurring drug use is a common part of substance use treatment. Although today’s study did not deal with the issue of revocations, we know they are costly, and the savings to minimize them can go toward medication and staffing.”

Another recommendation is to make methadone and buprenorphine standard treatments for opioid use disorder.

And she said counseling should be optional and not a condition to receive medication because it is the medication that saves lives.

 “As mentioned, people are at extreme risk of dying by overdose in the first few weeks after leaving carceral settings,” she said. “It is important that re-entry planning focus on seamless continuation of medication in the community, which greatly reduces this mortality risk.”

And she noted that those incarcerated who have a right to medication under the Americans with Disabilities Act should have “recourse against violations without fear of retaliation,” in demanding medication. Lastly, she said, the state and counties should prioritize opioid settlement dollars for “opioid use disorders in jails and prisons.”

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.