Fentanyl has made the overdose crisis more deadly in America
Prescription opioids had created a susceptible group of people; illicit fentanyl then greatly increased the risk. The countries which managed to keep their rates of overdose deaths lower didn’t all adhere to the same approach.
The fact that 27-year-old model Presley Gerber died on September 20 has once again brought addiction and overdose into the public eye. Although the Santa Monica police are treating the death as a possible overdose, the Los Angeles County Medical Examiner has clearly stated that the cause and manner of death are still being deferred until further testing is carried out. This difference is important since a suspected overdose is not the same as a confirmed toxicology report, and a serious investigation should not turn uncertainty into a headline.
The full national picture has already been recorded. The final CDC data indicate that 79,384 Americans died as a result of drug overdoses in 2024. Provisional figures for 2025 show 69,973 deaths, and the most recent CDC surveillance predicts 67,798 overdose deaths in the 12 months ending March 2026. The drop is genuine and significant. The CDC described it as “meaningful progress, but too many people still die from drug overdoses.” Although America is moving in the right direction, the most up-to-date international analysis still ranks its overdose mortality much higher than that of most other rich countries. (CDC)
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The opioid crisis today wasn’t started by fentanyl; it began with a significant increase in the medical use of opioid painkillers. According to the FDA’s opioid timeline, OxyContin was approved in December 1995 as a controlled-release version of oxycodone. Sharp increases were then observed in the number of cases of abuse, overdose and death, and in 2003 the FDA cautions were issued to Purdue Pharma regarding its advertisements which downplayed the serious risks. Later CDC data revealed that the sales of opioid pain relievers had quadrupled between 1999 and 2010, with U.S. prescribing rates rising and then reaching their peak between 2010 and 2012.
It doesn’t follow that all opioid prescriptions were unreasonable or unnecessary since opioids are still essential for the treatment of severe pain, for cancer patients, and in palliative care. However, the extent of exposure is significant. In 2020, Purdue Pharma admitted to three federal felony charges related to fraud and kickbacks. According to the Justice Department’s case file, Purdue kept on promoting its opioid products to over 100 healthcare providers whom it had reason to believe were diverting opioids. The era of prescribing led to widespread opioid exposure at a time when illegal drug markets were also developing.
The case of celebrities dying shows just how blurred the line has become. The official investigation carried out in Minnesota found that Prince died in 2016 from a lethal amount of fentanyl in his body. Tom Petty’s death in 2017 was determined to be an accident due to mixed drug toxicity involving fentanyl, oxycodone, benzodiazepines and other medicines. The two cases were not the same and therefore neither should be taken as an example of every overdose. Yet they do demonstrate the way in which pain treatment, the use of multiple medications, dependence and powerful synthetic opioids can lead to a fatal outcome.
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The most enlightening international comparison is that of Japan. An international analysis carried out by the Commonwealth Fund using 2022 mortality data found that there were about 324 overdose deaths per million people in the United States and 6.2 per million in Japan. The authors warn that national definitions and reporting systems are not exactly the same, and therefore those figures should not be regarded as if they were laboratory measurements. Nevertheless, the extent of the difference is extraordinary. (Commonwealth Fund appendix)
Europe is situated between those two extremes. According to the European Union Drugs Agency, it was estimated that there were at least 7,589 drug overdose deaths in the EU in 2024, the mortality rate amounting to approximately 25 deaths per million people aged 15 to 64. The rates among individual European countries varied from about 3 to 112 per million, which shows that Europe as a whole does not suffer from a single drug problem or have one successful solution. (EUDA)
The case of Japan indicates that it is important to reduce the initial amount of opioids prescribed. When American and Japanese general practitioners were compared, the Japanese doctors were found to have prescribed opioids much less frequently in both acute and chronic cases. Moreover, the research points out that opioid analgesics are strictly controlled in Japan under the Narcotics and Psychotropics Control Act and that the country did not see the same increase in opioid use as experienced in the United States.
Japan also shows the risks involved in treating low prescribing as a simple answer. A study from 2024 involving patients with advanced cancer found that the availability of opioids was still very low and 38.2% of the patients in the study had severe or intolerable cancer-related pain. That is to say, a nation may be able to reduce one kind of public health problem while at the same time causing another. The aim should not be to prescribe as little as possible; it must be to achieve appropriate pain control without unnecessarily subjecting large numbers of people to long-term opioids.
Portugal has taken a different approach. Instead of dealing with cases of personal possession and use in the criminal courts, these cases are now handled by an administrative system which makes use of Commissions for the Dissuasion of Drug Addiction, although trafficking is still treated as a criminal offence. The official system in Portugal places a focus on assessment, prevention, treatment and social reintegration rather than merely removing all the consequences of drug use.
The most recent EUDA figure for Portugal shows that there were approximately 15 drug-related deaths per million people between the ages of 15 and 64 in 2023, a figure which is lower than the average for the EU as a whole, although caution is needed due to differences between years and in the methods of reporting. The fact that decriminalisation alone can be credited with this outcome is not valid. What does matter are the availability of treatment, opioid agonist therapy, naloxone, the social services, and the make-up of the illegal drug supply. (EUDA)
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It is here that the American discussion tends to become overly limited. The option is not merely between stricter drug laws and less strict drug laws; on the contrary, the stronger evidence supports a multistage approach, which involves preventing unnecessary exposure, treating addiction rapidly, making overdose reversal readily available, and reducing the likelihood that an unpredictable drug supply will result in someone’s death before treatment can take effect.
Methadone and buprenorphine are not merely symbolic measures. An NIH-funded study which involved more than 17,000 adults in Massachusetts who had survived an opioid overdose found that methadone treatment was linked to a 59% reduction in deaths related to opioids and buprenorphine to a 38% reduction over the next year. Naloxone is capable of reversing opioid overdoses, including those caused by fentanyl. Moreover, health agencies in Europe also support opioid agonist treatment, take-home naloxone, the use of sterile equipment and, in some countries, supervised consumption facilities as part of wider harm-reduction systems.
The strongest objection is that the United States has already greatly reduced the number of opioid prescriptions, even so the crisis has become more deadly. That is correct, and this is precisely the reason why reducing prescriptions is only the beginning. According to the CDC, the majority of current harm associated with fentanyl is due to illegally manufactured fentanyl, not pharmaceutical fentanyl. Fake pills can look like oxycodone or alprazolam but in fact contain fentanyl, and fentanyl can also be mixed into heroin, cocaine and methamphetamine. After this kind of supply had become widespread, simply reducing prescriptions could not on its own eliminate addiction or make the illegal market any safer.
No country has found a solution to the problem of addiction, and no policy can ensure a low rate of death. Overdose problem areas still exist in Europe. In Japan, the strict attitude towards opioids means that genuine pain is often not properly treated. Portugal’s experience cannot be attributed to a single law. The recent decline in the United States seems to be the result of a combination of changes in the drug supply, the distribution of naloxone, improved access to treatment, better data sharing, and changes in behaviour rather than due to one outstanding policy. A review by the Commonwealth Fund in September 2026 reached essentially the same conclusion: there is no single explanation for the recent decline.
The main point is more specific and practical: America had an unusually high level of opioid exposure together with an illegal market which eventually became saturated with extremely potent synthetic opioids. Countries that have much lower death rates usually broke at least one link in that chain by prescribing fewer opioids, offering easier access to treatment, adopting stronger harm reduction measures, having a street market less saturated with fentanyl, or a mix of these actions.
The next issue is whether the present decline in the United States can continue, and to this end one should look at the proportion of deaths involving synthetic opioids, access to methadone and buprenorphine, the availability of naloxone, and whether fentanyl or other newer synthetic opioids spread any further through counterfeit pills and stimulants.
The figures behind those numbers are not just abstract data points; they are families who judge their progress by whether the chair at the table remains occupied.