After 25 years of persistent rise, drug overdose deaths in the US fell by record amounts in 2024 and 2025. Down 38 percent from 2023, overdose deaths have now reached pre-pandemic levels. Opioids, in particular synthetics like fentanyl, remain present in a majority of overdose deaths, highlighting that increased access to opioid addiction treatment and decreased access to opioids are the two primary factors driving the declining death rates. Treatment options have improved, thanks to a concerted effort to make available naloxone, an overdose-reversing drug, and new policies allowing the use of methadone at home. Billions of dollars of opioid settlement funds flowing into all kinds of treatment systems and educational efforts have helped as well. On the drug supply side, causal theories are a little looser. China may have helped tamp down on a fentanyl precursor; the population of people who use drugs in the first place is thought to be declining; and the pandemic-specific effects that created a “perfect storm” for drug abuse have subsided with time. Realizing these declines provides a source of hope in drug addiction treatment circles, who want to keep the momentum going and reverse not just a few years, but a few decades of drug overdose trends.