The overdose crisis is turning around

Overdose deaths are falling at a pace the United States has not seen in decades. Centers for Disease Control projections show a nearly 25% decline for the twelve months ending in April 2025. But the meaning of that decline shows up long before it appears in national reports. It shows up in a son who makes it home from work, in a daughter who stays in treatment long enough to rebuild her life, in the quiet, daily act of someone returning home to the people who love them. It shows up in having another table setting at the holiday dinner.

These moments of return do not happen by chance. They happen because public policy finally aligns with evidence and because communities were able to use tools we already know save lives. Policymakers expanded access to medications for opioid use disorder, protected telehealth for addiction treatment and widened community access to naloxone. People are home for the holidays because life-saving systems were finally allowed to fully function.

Whether this progress continues depends on the choices we make now. As we head into 2026, the foundational policies that saved lives this year could disappear before the next holiday season.

Lifesaving tools that have driven the decline remain vulnerable. Medications for opioid use disorder — especially buprenorphine and methadone — cut the risk of death by more than half. Yet for years, federal rules and insurance barriers have kept these treatments out of reach. Even now, many patients face bureaucratic paperwork hurdles, such as prior authorization requirements, which interrupt care and separate patients from necessary prescriptions. States have worked to close these gaps by expanding mobile treatment programs and embedding addiction treatment into primary care, specifically in Texas and Massachusetts.

These changes increased the odds of survival, but the initiatives remain under-resourced and at-risk. In recent years, telehealth has become one of the most powerful drivers of improved access. Research shows that patients who begin treatment virtually stay in recovery at similar or higher rates than those who start in person. While skeptics remain, the data confirm that telehealth provides quality care without increasing overdose risk. This is especially important to rural counties and households without reliable transportation, where telehealth means the difference between care instead of a crisis. But in 2026, those flexibilities will vanish unless Congress acts.

Additional changes to insurance coverage expose how quickly people can lose access and be pushed out of treatment. Medicaid covers nearly half of non-elderly adults with opioid use disorder, paying for the critical treatment services that get people to recovery. But this backbone is weakening. During the unwinding of pandemic protections, more than 23 million people have lost Medicaid coverage, which is often due to paperwork errors rather than changes in eligibility. This number is estimated to increase significantly following the passage of the One Big Beautiful Bill, which according to the nonpartisan Congressional Budget Office (CBO), will slash Medicaid and Children’s Health Insurance Program (CHIP) spending by nearly $1 trillion over a decade and eliminate over 10 million people from the programs. Similarly, the CBO warns that about 1.5 million Americans will be uninsured in 2026 if Congress delays extending the ACA enhanced tax credits.

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Congress has the power to address these lapsing policies in 2026 and needs to act — just as it did with the bipartisan reauthorization of the SUPPORT for Patients and Communities Act, which promises to continue federal funding for core recovery programs and to address overdose. 

But maintaining the status quo is not enough to resolve the fracture points where people still fall out of care. In 2026, Congress should pass legislation to ensure that Americans who are most vulnerable to fatal overdose, such as those entering and leaving jail and prison, receive evidence-based, lifesaving treatment. Congress can grow the treatment workforce by funding and expanding peer recovery support workers. These proposals follow the same evidence that drove the decline in 2025.

The drop in overdose deaths this year is real. It reflects years of work by clinicians, community groups, families and bipartisan lawmakers who chose data over dogma. But a decline does not equal victory. It equals a narrow window of opportunity. The difference between momentum and reversal now runs through the legislative decisions that will shape 2026. 

Just like this holiday season, families will gather again next December. Some seats will be filled because of the policies that worked in 2025. Others will stand empty if those policies unravel in 2026. The country already knows which choices save lives. What remains unclear is whether it will keep making them.