The Urban Overdose Crisis Eased in 2023 – But Not for Black and Native American Communities
Above: The bar graph depicts a leveling of rates in 2023 after a steep rise in earlier years, age-adjusted fatal overdoses per 100,000 population, 2010-2023.
August 26, 2025
New data from 35 large cities that comprise the Big Cities Health Coalition (BCHC) suggest that — in the population as a whole — overdose rates were relatively stable in 2022 and 2023 after 12 years of exponential growth.
Easing of fatal overdoses in urban areas may suggest that public investment in life-saving harm reduction programs is paying off. Life-saving interventions include access to medications for opioid dependence (treatments like methadone and buprenorphine), laboratory testing of street drugs to detect emerging contaminants, and distribution of medication to reverse opioid overdoses (naloxone).
However, a closer look at data by racial and ethnic subgroups reveals that overdoses are continuing to climb in some communities who have been racially marginalized due to historic and ongoing systemic oppression. Over the past five years, there were wide disparities in death rates. For example, by 2023 overdoses claimed nearly twice as many Native American (census category American Indian/Alaska Native) and Black lives compared to white non-Hispanic lives, and the upward trend is continuing in those communities.
These data suggest life-saving harm reduction programs are not reaching and/or are not having intended impacts among Native American and Black people who use drugs. Intensive effort and investment in saving lives need to be guided by the impacted communities.
Click to view infographic, "The Urban Overdose Crisis Eased in 2023 — But Not for Black & Native American Communities"
These results used new data from the Big Cities Health Inventory (BigCitiesHealthData.org), an open-source platform that the Drexel Urban Health Collaborative (UHC) manages and updates. The data platform currently includes more than 200,000 data points for over 125 metrics. Nashville, TN recently joined the Big Cities Health Coalition and their data were added to the platform. For questions about these data, contact UHC’s team lead Amy Auchincloss, PhD and the UHC data analyst Saima Niamatullah, MPH.
Stay up to date on the Big Cities Health Inventory data platform by subscribing to the platform and BCHC newsletters.
The Big Cities Health Inventory data platform is primarily supported by Cooperative Agreement Number NU38PW000033 awarded to Big Cities Health Coalition and funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.