At the end of 2023, long-awaited news arrived in West Virginia and across the United States: overdose deaths were dropping. 

As former director of the West Virginia Office of Drug Control Policy, I watched the opioid epidemic escalate from prescription painkillers to heroin to fentanyl. West Virginia became, by far, the state with the highest overdose rate in the nation. 

So when early data showed a decline in overdose deaths, my colleagues and I were skeptical. We assumed it was a reporting lag or a statistical anomaly. But it’s now clear that the trend has held. 

In West Virginia, Gov. Patrick Morrisey (R) recently held a press conference highlighting the decline, citing prevention, treatment and interdiction all as potential causes. Morrisey, during his term as the state’s attorney general, deserves real credit in setting up the West Virginia First Foundation in a way that is nimble and able to respond to evolving dynamics on the ground. Because of this foresight, it has evolved to serve as a proving ground for doubling down on what works to reduce overdoses.

However, the picture is incredibly complex. States differ widely in how much they’ve invested and where. Some have achieved high naloxone saturation; others haven’t. Some emphasize recovery housing or prevention, others criminal justice reform. 

Now that the decline has arrived — and caught nearly everyone by surprise — it raises a critical question: Why now?

This isn’t just an academic curiosity. If we don’t know what’s driving this shift, we can’t say what’s working — or what isn’t working. There is, however, one possible answer, and one that’s consistent across states: the illicit drug supply may be changing. 

According to recent DEA data, the potency of street drugs appears to be dropping. Fentanyl, the dominant driver of overdose deaths for years, may no longer be as potent or widespread. In 2024, DEA lab testing found that five out of 10 counterfeit pills contained a potentially lethal dose of fentanyl — down from seven out of 10 the year before. Anecdotal reports from West Virginia support this. Some users saying their drugs no longer test positive for fentanyl, while others say they’re struggling to find substances strong enough to stave off withdrawal. 

If true, this upends everything we’ve come to expect from the drug crisis.  

Until now, the trend has been clear: drugs keep getting stronger. Escalating potency was seen as inevitable — and with it, escalating death rates. Now it appears we’re seeing the opposite, and it raises fundamental questions about where our focus should be.

In recent years, the national policy priority has shifted away from enforcement and interdiction and toward building a more comprehensive continuum of care. That shift has been necessary and overdue. But that doesn’t explain why drug potency is declining. Have cartels simply decided to reduce lethality? Doubtful. What if some elements of interdiction are having an effect? What if changes at the border or disruptions in precursor supplies from China are playing a larger role than we realize? 

We can’t afford not to find out. 

This isn’t just about celebrating a rare piece of good news. It’s also about honoring the tens of thousands we’ve already lost and protecting those still at risk. If this is a turning point, we must seize it. If it’s a temporary lull, we must prepare. Either way, we need to know exactly what’s working so we can do more of it. 

Failing to understand this moment would be more than a missed opportunity. It would be a failure to honor those we’ve lost — and to protect those we can still save. The numbers are down. But the work is far from over. 

Dr. Matthew Christiansen, M.D., MPH, is board certified in Addiction Medicine and Family Medicine and is the former director of the West Virginia Office of Drug Control Policy (2020 to 2023), as well as former State Health Officer (2023 to 2024). He is currently vice chair of the West Virginia First Foundation and chief medical officer at Valley Health Systems, Inc. in Huntington, W.Va.