‘Too soon to celebrate’ but ‘very promising’: Opioid-related deaths decline in Boston in 2024

Opioid-related deaths dropped sharply in Boston last year, hitting a nine-year low, according to a new analysis by the Boston Public Health Commission.

Public health leaders believe some interventions, like distribution of the overdose-reversing drug naloxone, are helping — but they say the biggest contributing factor may be what’s in the illicit drugs themselves.

In 2024, there were 169 opioid overdose deaths in Boston — a 38% drop from the prior year, in line with the national trend. Opioid-related overdose deaths across the country dropped about a third last year, according to new data from the Centers for Disease Control.

“We are obviously pleased to see this decrease in overdose mortality,” said Dr. Bisola Ojikutu, Boston’s Commissioner of Public Health.

Deaths among Black men and Latino men in Boston, in particular, dropped by over 50% from 2023, the commissioner pointed out. Those groups have traditionally been disproportionately impacted by opioid-related deaths.

“[We’re] hoping that these decreases and what we’re seeing will continue,” Ojikutu said.

She noted there’s been a shift in the chemical makeup of illicit drugs. Research by Brandeis University has shown that Boston street drugs now contain less of the deadly opioid fentanyl.

“But I would also caution us [not] to jump to conclusions here, because our drug supply is also volatile,” Ojikutu said. “I think it’s important for us to stay vigilant and to continue this work to understand our drug supply better.”

Just why the numbers fell so much last year is a topic of great interest to researchers studying the opioid crisis, said Dr. Andrew Kolodny, the medical director for the Opioid Policy Research Collaborative at Brandeis University’s Heller School.

He admitted that, as a doctor who treats opioid use disorder, he’d been hoping the answer was better access to treatment. In Boston, Ojikutu says the city distributed over 23,000 doses of naloxone in 2024, focusing on neighborhoods like Roxbury and Dorchester where they saw an increase in opioid overdoses.

“When one looks, though, at the data, what we don’t see is a dramatic improvement in access to treatment that begins in the fall of 2023,” Kolodny said, when the rate of opioid overdose deaths began to fall. “What we see are pretty steady improvements over time. And that’s true for naloxone as well.”

But Kolodny agrees that primary explanation is more likely the reduction of fentanyl in street drugs. Why fentanyl’s declining brings in a whole host of other factors: a crackdown on the precursor chemicals, or potentially higher costs in fentanyl production, he said.

As the amount of fentanyl has dropped, Brandeis researchers have increasingly found illicit drugs are being mixed with a veterinary sedative called xylazine. It’s not an opioid and is less likely to cause an overdose. At the same time, though, he said, xylazine would never be considered “safe.”

“It’s addictive,” he said. “And people who are using it regularly will experience withdrawal from xylazine, which is distinct from opioid withdrawal. When someone is given naloxone, if there was a lot of xylazine in the drug that they used, they may be less likely to respond well to the naloxone, because the naloxone won’t revive someone from the xylazine.”

While public health interventions like expanding access to naloxone have played an important role in saving lives, more research is needed to study the decline in opioid deaths and make sure the trend continues, Kolodny said.

“It’s really too soon to celebrate because, despite the significant drop in overdose deaths, there are still thousands of Americans dying every year from an opioid overdose,” he said. “So we still have a very long way to go. But the steep decline in overdose death is certainly very promising, and it’s something we need better answers for.”