Nationally, Overdose Is Still Going Down. In the West, It’s Going Back Up.

The latest overdose mortality data from the Centers for Disease Control and Prevention show that the rate of drug deaths in the United States is still decreasing, as it has continuously for the past two-and-a-half years. During that time we’ve known that the national average has not been experienced equally across the country, and that in some states overdose was decreasing at a slower pace or even going up. What’s becoming clearer now is that these states are all in the West.

The CDC’s latest monthly provisional overdose death count was published May 13. It covers the 12-month period leading up to December 2025, with 69,973 deaths projected during that time. The actual number of reported deaths so far is 68,632, with 0.26 percent of the data still pending.

Nationwide, the projected rate represents a 13.9-percent decrease compared to the 12-month period leading up to December 2024.

After overdose deaths surged past 100,000 per year during the COVID-19 pandemic, between 2023 and 2024 the rate suddenly dropped by more than 26 percent. But even then, overdose was still going up slightly in Nevada and South Dakota. The national average has continued to decrease every month, but by now that decrease has slowed to about half-speed.

By April, when the CDC released data covering the crisis up through November 2025, the projected rate of fatal overdose—while still decreasing in most of the country—was shown to be going up substantially in Arizona (+21 percent), New Mexico (+16 percent), Colorado (+10.3 percent) and North Dakota (+8.4 percent). Montana, South Dakota and Utah were all projected to be within a single death of what was recorded for the previous 12-month period.

The latest data now show overdose also going back up in Minnesota, with projected deaths for the 12-month period leading up to December 2025 increasing by 3 percent compared to a year earlier. The data also show Nebraska with the same number of projected deaths as it had in the previous 12-month period.

By percentage, the crisis now appears to be accelerating the fastest in New Mexico, with the projected rate of overdose increasing 21.7 percent compared to a year earlier. Arizona shows the next-highest increase (+18.1 percent) followed by Colorado (+10.6) and North Dakota (+8.3). In Montana, South Dakota and Utah the situation appears essentially the same as it did in the April data release.

In terms of what all this actually means, the first thing to keep in mind is that percentages are not numbers. The biggest factor that influences them is not necessarily the rate of change in overdose deaths, but the size of a state’s overall population. The 21.7-percent increase in New Mexico represents projected deaths increasing from 794 to 966. Arizona’s 18.1-percent increase, on the other hand, represents an increase from 2,531 projected deaths to 2,988. Many of the western states where overdose does not appear to be on the same trajectory as the rest of the country—Nebraska, North Dakota, South Dakota, Montana—are also among the states with the smallest population sizes, and have fewer overdose deaths to report than more populous states. So an increase of one or two deaths can look like a much bigger change when viewed as a percentage.

However, that doesn’t change the fact that there appears to be a disparity between the West and the rest of the country. All the other jurisdictions that are smallest by population size are in the Northeast, where overdose is still decreasing: Vermont (-27.3 percent); the District of Columbia (-13.8); Delaware (-6.8 percent); Rhode Island (-35.2 percent); Maine (-21.8 percent); and New Hampshire (-5 percent). 

This brings us to the data outlier: Wyoming.

The other major factor impacting this data is the nature of death investigations themselves. Cause of death is determined at the county level, through a variety of processes that may have little in common besides being chaotically underresourced. States that have medical examiner’s offices tend to produce more robust death data than those that rely on a patchwork of county coroners, who can be elected to the position without medical training. Some states use both, or alternative processes that are more obscure. Nebraska, for example, is the only state where all causes of death are determined by prosecutors. Multiple Nebraska counties have not reported a single overdose death for decades, which probably does not mean that nobody dies of overdose in those counties.

This brings us to the data outlier: Wyoming, the country’s smallest state by population size. The latest CDC data show Wyoming’s projected overdose rate decreasing 23.4 percent compared to the previous 12-month period. This represents a change from 107 deaths to 82 deaths, but even at these relatively low numbers Wyoming appears to be on a different trajectory than all the states that sit geographically above and below it.

Wyoming uses a system of elected coroners, some of whom have reportedly not been amenable to attempts to standardize their methods. According to an investigation by WyoFile, some also have financial stake in private funeral homes. They’re sometimes approached by families who don’t want a loved one to be remembered as someone who died of overdose, and would rather the death certificate say something else.

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Image (cropped) via Centers for Disease Control and Prevention