The difference between surviving an overdose and dying from the next one often comes down to what happens in the hours and days afterward.
A person overdoses at work. A colleague reaches for naloxone and knows how to use it. The overdose is reversed, and that person never enters the national death count.
What happens next is quieter but just as consequential. The person may wait days for Medicaid approval for medication that could prevent another overdose. The community program responsible for follow-up may not know whether its federal funding will continue. If the person is booked into jail, treatment may stop.
America has become better at reversing an overdose. The harder task is making sure that person is still alive six months later, and that takes a functioning system that carries people from rescue through treatment and into recovery.
Progress is not a guarantee
Federal data show 79,384 people died from drug overdoses in 2024, with the overdose death rate down 26.2% from 2023, the steepest single-year decline on record. Early provisional estimates suggest deaths kept falling in 2025, to roughly 69,973.
Even so, nearly 70,000 Americans dying in a single year keeps the overdose crisis among the nation’s deadliest public health challenges.
Declining deaths do not mean the treatment system is reaching the people who need it. According to the most recent National Survey on Drug Use and Health, roughly 47.2 million people aged 12 or older needed treatment for a substance use disorder, and only about 7.6 million received it. Among people with opioid use disorder, only about 16% received medication. Until that gap narrows, the ground we have gained stays vulnerable.
Rescue and recovery are the same policy
Federal overdose policy is fragmented across separate programs, agencies, and funding streams, but in practice, these interventions work as a continuum. Naloxone prevents death, Medicaid finances treatment, peer specialists connect people to care, and federal grants support the workforce and community organizations that deliver these services. Weaken one part and the whole system suffers.
The House FY 2027 appropriations report shows the disconnect. It largely holds funding for major state treatment grants steady, with $1.6 billion for State Opioid Response grants and roughly $2 billion for the Substance Use Prevention, Treatment and Recovery Services Block Grant. Yet, it eliminates funding for harm reduction, including support for naloxone access. Holding these gains means funding the whole continuum rather than parts of it.
What Congress can still do this year
The most important step is to hold State Opioid Response and block grant funding steady while continuing to fund the harm reduction efforts that reach people at the highest risk.
A year-end health package offers an opportunity for Congress to support the care continuum. The bipartisan, bicameral Due Process Continuity of Care Act would let states keep Medicaid coverage in place for eligible people held before trial. Today, many people lose that coverage while awaiting the outcome of a case, before any conviction. The weeks right after someone leaves custody carry the highest overdose risk of any recovery point, partly because tolerance drops during any break in use. People are 40 to 129 times more likely to die of an overdose in the first two weeks after release than the general population, and overdose is the leading cause of death for people leaving incarceration. Continuing buprenorphine or methadone through this period reduces the risk of death by roughly 75%.
For most of this population, Medicaid is what pays for that treatment. When coverage lapses, treatment tends to lapse with it. In one study, only 30% of those who left jail on medication were still receiving community treatment a month later, compared with 7% of those who left without it. Keeping coverage in place holds that thread together and is the fiscally responsible choice, since gaps in treatment produce worse outcomes and higher costs.
Congress could also move an updated PEER Support Act. Identical House and Senate bills have bipartisan backing and address a shortage every treatment system runs into: too few trained people to help others enter care and stay in it. The bill would strengthen federal recognition of peer support specialists, keep the federal Office of Recovery in place, and examine the employment barriers that keep qualified people with lived experience out of the workforce.
Do not mistake a good year for a finished job
FROM $1,000 TO $149: TRUMP JUST UNLOCKED THE BIGGEST DRUG PRICE DROP IN 60 YEARS
The greatest mistake Congress could make is to read declining deaths as evidence the crisis is resolving itself. This progress reflects years of sustained investment in treatment, harm reduction, recovery support, and the workforce behind them. The gains are also fragile, and pulling back now could slow or reverse them.
The real measure of progress is whether a person who survives an overdose on Tuesday can begin treatment on Wednesday, stay connected to care in the months that follow, and keep that care even if they spend time in jail. Congress already has a strategy that is starting to work. The job now is to protect it and finish building it.
Libby Jones is the associate vice president of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. Jones leads the initiative’s advocacy efforts, advancing federal policies to reduce the overdose death rate in the United States by expanding access to treatment and recovery support services.