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July 14, 2025
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Corey Davis
Amy Lieberman
Czarina Behrends
Jul 14, 2025
June 2025
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See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
The United States continues to experience a nearly unprecedented level of drug-related health harms, with over 105,000 Americans dying of overdose in 2023 alone.1 Although overall overdose deaths declined slightly from 2022 to 2023, rates for Black people continued to rise.1 Stimulants such as cocaine and methamphetamine are increasingly involved in overdose deaths, and xylazine and other contaminants continue to be prevalent in the illicit drug supply.2
Although overdose is the most obvious and devastating harm related to the epidemic, other drug-related morbidities have increased nearly in lockstep with overdose deaths. Most of these harms stem from lack of access to injection and smoking equipment among people who use drugs (PWUD).3, 4 Injection-related HIV outbreaks have occurred in several states, and syringe sharing continues to be a major cause of HIV infection.5-8 Acute hepatis C infections, most of which are caused by syringe sharing, doubled from 2015 to 2022.9, 10 Endocarditis and other skin and soft tissue infections are at or near all-time highs as well.11-13 Facilitating a transition from injecting drugs to inhaling or smoking them is an evidence-based method of reducing this injection-related harm, but legal barriers currently limit access to safer smoking equipment in most states.
Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2003–2023. National Center for Health Statistics. 2024; 522
Friedman J, Shover CL. Charting the fourth wave: geographic, temporal, race/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010–2021. Addiction. 2023; 118(12): 2477–2485.
Sharhani A, Jorjoran Shushtari Z, Rahmani A, et al. Incidence of HIV and HCV in people who inject drugs: a systematic and meta-analysis review protocol. BMJ Open. 2021; 11(1):e041482.
Kadri AN, Wilner B, Hernandez AV, et al. Geographic trends, patient characteristics, and outcomes of infective endocarditis associated with drug abuse in the United States from 2002 to 2016. J Am Heart Assoc. 2019; 8(19):e012969.
Rich JD, Adashi EY. Ideological anachronism involving needle and syringe exchange programs: lessons from the Indiana HIV outbreak. JAMA. 2015; 314(1): 23–24.
Cranston K, Alpren C, John B, et al. Notes from the field: HIV diagnoses among persons who inject drugs—Northeastern Massachusetts, 2015–2018. MMWR Morb Mortal Wkly Rep. 2019; 68(10): 253–254.
Northern Kentucky Tribune. Health departments share CDC recommendations to address HIV among people who inject drugs. 2019. Accessed June 28, 2025. nkytribune.com/2019/01/health-departments-share-cdc-recommendations-to-address-hiv-among-people-who-inject-drugs/
Des Jarlais DC, Sypsa V, Feelemyer J, et al. HIV outbreaks among people who inject drugs in Europe, North America, and Israel. Lancet HIV. 2020; 7(6): e434–e442.
Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018; 108(2): 175–181.
Centers for Disease Control and Prevention. 2022 Viral hepatitis surveillance report. 2022. Accessed January 3, 2025. https://cdc.gov/hepatitis-surveillance-2022/hepatitis-c/?CDC_AAref_Val=>
Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002–12. Health Aff (Millwood). 2016; 35(5): 832–837.
Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in drug use-associated infective endocarditis and heart valve surgery, 2007 to 2017: a study of statewide discharge data. Ann Intern Med. 2019; 170(1): 31–40.
Barocas JA, Eftekhari Yazdi G, Savinkina A, et al. Long-term infective endocarditis mortality associated with injection opioid use in the United States: a modeling study. Clin Infect Dis. 2021; 73(11): e3661–e3669.
