Understanding the Opioid Crisis: A Public Health Approach

The opioid crisis, notably the rise of fentanyl, is primarily a public health issue, not just a criminal one. Strategies for addressing opioid use disorder emphasize treatment over punishment, focusing on supportive services along with medication. As overdose deaths decline since 2023, ongoing vigilance and comprehensive treatment approaches are still needed.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

“The Opioid Crisis”

If you follow the news at all, you’ve probably read or heard about the opioid or, more recently, the fentanyl crisis. It was and continues to be an issue in national and local elections, with every candidate claiming they will solve the problem.

The problems with opioids are alternately framed as legislative, criminal, political, economic, immigration, and terrorism issues.

Opioid use is fundamentally a public‑health crisis, not merely a criminal justice problem.

Opioid use disorder, OUD, is a chronic medical condition that can lead to fatal overdose, infectious disease, and long‑term disability. Treating it as a health issue means providing life‑saving care rather than punishment. Options include medications for opioid use disorder, low‑barrier treatment, and widespread naloxone access.

The harms extend far beyond the individual’s health:

  • unstable housing and homelessness, which then increase overdose risk and disrupt continuity of care;
  • job loss and reduced workforce participation strain families and local economies; and
  • parental substance use endangers children, causes early life trauma, and intergenerational instability.

Effective responses require combining treatment with supportive housing, employment services, childcare, and legal and social support so people can stabilize their lives while receiving care.

This recent article, which I am sharing with permission, reviews current statistics on opioid use in the United States and some of the approaches to dealing with the problems that result.

Drop in opioid overdose deaths nears 50% since 2023

by Tim Henderson, Oklahoma Voice
March 23, 2026

Since their peak less than three years ago, opioid overdose deaths dropped nearly by half as of October 2025, 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.

Helping Addicted Persons

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, 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.”

Erin Reed, director of RecoveryOhio

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?’

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.”

Sarah Beckman, recovered drug user

Where Opioid Deaths Decrease or Increase

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. Arizona is one of three states with more opioid overdose deaths as of October 2025 than at their national peak in 2023, according to a Stateline analysis.

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.

Colors indicate the percentage of increase or decrease in overdose deaths in each state.
The lighter shades indicate decreased overdose deaths. The darkest shades show increased deaths.

A “Fentanyl Supply Shock”

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.

Vigilance Still Needed

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,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.”

Keith Humphreys, in Science magazine

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.

This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network that includes Oklahoma Voice, and is supported by grants and a coalition of donors as a 501c(3) public charity.

Oklahoma Voice is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oklahoma Voice maintains editorial independence. Contact Editor Janelle Stecklein for questions: info@oklahomavoice.com.

From Treatment to Recovery

Preventing overdose death and finding treatment options are the first steps to recovery. Treatment may save a life and can help people struggling with opioid use disorder get their lives back on track. Treatment can counteract addiction’s powerful effects on the brain and behavior. 

The overall goal of treatment is to return people to productive functioning in their family, workplace, and community.

Opioid use disorder treatment can vary depending on the patient’s individual needs, occur in a variety of settings, take many different forms, and last for varying lengths of time.

Evidence-based approaches to treating opioid use disorder include medications and combining medications with behavioral therapy. A recovery plan that includes medication for opioid addiction increases the chance of success.

Medications used in the treatment of opioid use disorder support recovery by normalizing brain chemistry, relieving cravings, and preventing withdrawal symptoms. The evidence for medications to support successful recovery is strong. (source-CDC Overdose Prevention)

SAMHSA’s National Helpline

SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

 1-800-662-HELP (4357)

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

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Dr. Aletha

Transforming Mental Illness Diagnosis and Treatment with Biomarkers

In this article I discuss potential use of biomarkers to diagnose and treat psychiatric disorders, particularly depression. Research is underway to identify these which could improve diagnosis and treatment, though concerns about cost, insurance, and privacy persist. Adequate funding for research is crucial.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

Imagine you consult a physician for a problem. The doctor asks you questions and examines you. Then you have blood tests, cultures, X-rays,a CT scan or MRI. You hope these tests show what is “wrong” so the doctor can treat you.

But what if all the tests are “normal”? Normal tests suggest that your symptoms may be due to a cause for which there is no biomarker.

A biomarker is a diagnostic test that indicates a specific disease or condition.

biomarker-A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease.

Both physicians and patients would like a biomarker for every disease. But many common conditions do not yet have a biomarker.

These include migraine, fibromyalgia, irritable bowel syndrome, Parkinson’s disease, many skin conditions, Alzheimer’s dementia, depression, and other psychiatric disorders.

a female physician talking to a male patient

For these disorders, physicians make a “clinical diagnosis”.

clinical diagnosis-The process of identifying a disease, condition, or injury based on the signs and symptoms a patient is having and the patient’s health history and physical exam

Much of medical research is devoted to finding biomarkers for these and other conditions. This article from KFF focuses on finding biomarkers for psychiatric disorders, especially depression. Such tests could be helpful not only for diagnosis but also for guiding therapy.

But there are potential downsides, like cost, insurance coverage, privacy, and potential discrimination, as explained in the article.

Psychiatrists’ Use of Biomarkers Could Open a New Window Into Mental Health Diagnoses

by Jamie Ducharme, March 17, 2026

Amanda Miller was 30 and pregnant with her second child in Hershey, Pennsylvania, when she developed depression. After she gave birth, her depression worsened. It was joined by a slew of unexplained health problems.

Miller, a neuroscientist, said she saw several psychiatrists and got prescriptions for drug after drug. Over two years, she tried four antidepressants and two antipsychotics. None of that helped — until her primary care doctor noticed high levels of an autoimmune marker in her blood.

A specialist then ran “every test in the book,” Miller said. Eventually, she was diagnosed with the autoimmune disease lupus and prescribed an inflammation-lowering steroid. Some of her symptoms let up within hours. Her depression subsided not long after.

“I was convinced it was a placebo effect,” Miller said, “but then it kept working.”

Had inflammation been contributing to her mental health problems all along? Miller thinks so, although she can’t know for sure. Her psychiatrists never raised that possibility, she said.

Laboratory vs Clinical Diagnosing

In most medical specialties, doctors can confirm whether to pursue a type of treatment through tests, such as blood work, imaging, and biopsies. Mental illnesses, however, have historically been diagnosed and treated based on outward symptoms. That could change.

The American Psychiatric Association in a January paper included ideas for how it might incorporate biomarkers — biological indicators of mental illness that could show up on diagnostic tests — into future versions of its Diagnostic and Statistical Manual of Mental Disorders.

Diagnostic and Statistical Manual of Mental Disorders.

The DSM, sometimes called “psychiatry’s bible” because of its influence in the field, provides criteria for diagnoses. It’s used by clinicians assessing patients and by insurance companies deciding whether to cover care.

‘Coordinated’ Research Needed

Psychiatric biomarkers are not ready for widespread use yet, the paper emphasized. Scientists have researched the topic for decades, with little to show for it.

More research is needed to prove these metrics are valid and reliable enough to be used in patient care, the APA’s paper said, and other researchers have raised questions about how their use could affect health care costs, insurance coverage, and patient privacy.

Adding biomarkers to the DSM would be “a very big deal,” said Jonathan Alpert, an author of the January paper and vice chair of the APA’s Future DSM Strategic Committee.

Access to test results, along with symptoms, could streamline insurance coverage decisions and help clinicians make faster and more accurate diagnoses and treatment recommendations, he said. If patients’ biology suggested they’d respond better to one treatment than another, their doctor could waste no time in starting there.

A Prescribing “Crapshoot”

Currently, prescribing psychiatric medications can be “a bit of a crapshoot,” with clinicians unable to predict whether they will work for a particular patient, said Matthew Eisenberg, director of the Center for Mental Health and Addiction Policy at the Johns Hopkins University Bloomberg School of Public Health.

In a seminal, early 2000s trial funded by the National Institute of Mental Health, about 30% of the study’s participants with depression saw symptoms disappear with their first antidepressant treatment. That study is still one of the most robust antidepressant trials conducted — although researchers have more recently argued that fewer people are cured by these medications than its results suggest.

9 different medication pills and capsules of various colors

Such a trial-and-error approach can lead to ineffective and unnecessary prescriptions, a topic of attack by proponents of the Make America Healthy Again movement, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr. Kennedy has been especially critical of antidepressants, having linked them to violence after a mass shooting without evidence and blaming doctors for overprescribing medications for children.

HHS is analyzing psychiatric diagnosis and prescription trends and evaluating alternative mental health treatment approaches, with a particular focus on children, spokesperson Emily Hilliard said in a statement. Hilliard did not respond to a question about Kennedy’s previous comments.

Biomarkers are already used to guide treatment in other medical disciplines, such as oncology. Arizona, Georgia, Kentucky, Texas, and more than a dozen other states require insurers to cover such testing. Blood and imaging tests are now used to help diagnose Alzheimer’s disease as well.

A Future for Psychiatric Biomarkers

The APA included in its article a variety of ways psychiatric biomarkers could be used in the future — such as testing for brain activity, genetic profiles, or immune markers associated with certain psychiatric conditions, including schizophrenia and substance use disorders.

In depression, for example, about a quarter of patients have elevated levels of an inflammatory protein, called C-reactive protein, that can be found through a blood test.

Research has shown that people with high levels of this protein seem to respond better when given drugs that alter dopamine levels in the brain, rather than using only selective serotonin reuptake inhibitors, or SSRIs, a common type of antidepressant.

C-reactive protein still needs to be “robustly validated” as a biomarker, but it’s among the most promising currently under investigation.

APA

A “coordinated, well-funded” research effort is needed to achieve such validation, the APA wrote — a tenuous prospect since the Trump administration slashed funding for research.

The National Institute of Mental Health alone had at least 128 grants, worth almost $173 million, canceled in 2025, according to a research letter in the journal JAMA. Though some grants have since been restored, researchers relying on federal money still fear their work is vulnerable to cuts.

“There’s a great need for continued, active funding of research related to mental health,” Alpert said, but scientists will have to grapple with “uncertainties of the funding landscape.”

Ripple Effects on Coverage, Costs

Health care costs tend to be higher among patients with poorly controlled mental illnesses, due to expenses like hospital visits, outpatient appointments, and prescriptions. Some research suggests biomarker testing could save money by landing on the right treatments faster and avoiding some of these costs.

One modeling study estimated that testing to look for genetic components that may influence a drug’s effectiveness could save the Canadian health system $956 million over 20 years if used among adults with major depression in British Columbia. Another study, by Spanish researchers, found that such testing reduced costs for most of the 188 participants with serious mental illness.

Whether the same would be true in the U.S. health care system is unknown. In the short term, Johns Hopkins’ Eisenberg said, an approach that uses biomarkers could raise health care spending due to the costs of testing.

Insurers may decline to cover pricey biomarker tests, It takes a while for new science to be proven safe and effective,
And once it is, insurance companies don’t cover it immediately.”

Matthew Eisenberg, Johns Hopkins

“The Beginning of a Revolution”

Some researchers have raised concerns that insurers or employers could discriminate against people whose biological profiles suggest they’re at risk of developing serious neuropsychiatric conditions.

It’s a “critical moment” to consider legislative approaches to protect patients and train clinicians about how to appropriately use these tools, said Gabriel Lázaro-Muñoz, a member of Harvard Medical School’s Center for Bioethics.

“I do not think that the field of psychiatry is currently ready to manage this,” he said.

The mental health system isn’t ready to “jump in with both feet,” said Andrew Miller, a professor of psychiatry and behavioral sciences at the Emory University School of Medicine, who studies inflammation-related depression. But the APA’s embrace of biomarkers signals “the beginning of a revolution,” he said.

“This is a recognition … that what we’ve done up to this point has not been good enough,” Miller said. “And we can do better.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Depression

Depression is common among people who have a chronic disease such as cancer or diabetes. Fortunately, depression is treatable even if you have another medical illness or condition. Learn more about chronic disease and depression: Caring for your mental health #shareNIMH

Biomarkers in Cancer Care

Biomarker testing is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer. Each person’s cancer has a unique pattern of biomarkers.

Some biomarkers affect how certain cancer treatments work. Biomarker testing may help you and your doctor choose a cancer treatment for you.

There are also other kinds of biomarkers that can help doctors diagnose and monitor cancer during and after treatment. To learn more, visit the Tumor Markers fact sheet.

Biomarker testing is for people who have cancer. People with solid tumors and people with blood cancer can get biomarker testing.

The FDA-approved blood tests for diagnosing Alzheimer’s disease

In May 2025, the U.S. Food and Drug Administration (FDA) approved the first blood test as a tool to help diagnose Alzheimer’s disease. The test is called Lumipulse.

The test measures certain proteins, including a specific form of the tau protein. This can indicate amyloid plaques in the brain, a protein that is considered the hallmark sign of Alzheimer’s disease.

This blood test, along with other diagnostic tools can help diagnose Alzheimer’s disease. While the blood test can detect changes even before memory problems begin, it is only recommended for use in people showing symptoms of Alzheimer’s disease.

The test is still being refined and can’t diagnose Alzheimer’s disease on its own. 

What to Remember from this Post

I learned from the KFF article and the references, did you? What are your takeaways from what you read? Here are some to consider.

  • Doctors use laboratory tests and imaging to supplement information gleaned from talking to and examining patients.
  • Biomarkers for common conditions make diagnosis easier and more precise, and help guide therapy.
  • Discovery of biomarkers for other serious conditions will help patients get earlier diagnosis and more effective treatment. More research is needed.
  • New medical discoveries introduce trade-offs in cost, payment, benefit, and potential misuse.

How will you use what you’ve learned? How may you apply this information to a current or future health concern?

What more information do you need and where will you find it?

a stethoscope, a red heart and a heart ekg tracing
exploring the HEART of HEALTH

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Use this search box for related posts on this blog or other topics of interest to you.

Dr. Aletha