The Day America Got Better and Arizona Got Worse: Reading the 2025 Overdose Data

On May 13, 2026, the Centers for Disease Control and Prevention released its provisional overdose-death count for the 12 months ending December 2025. The number is 69,973. That is the lowest the country has seen since October 2019 — before the pandemic, before the fentanyl-only era, before xylazine, before the synthetic-soup wave of 2024 and 2025. It is a 13.9% drop from the year before. It is the third year in a row that the number has gotten smaller.

Forty-five states moved with that national trend. Oregon dropped 35%. North Carolina dropped 34%. New York dropped 32%.

Arizona did not. According to the same release, Arizona’s overdose deaths rose by an estimated 17.3% over the comparable period — putting it alongside New Mexico (+21.3%) and Colorado (+10%) as the three states moving in the opposite direction from everyone else. The Phoenix Field Division of the Drug Enforcement Administration also reported a 79% increase in fentanyl-powder seizures in 2025 versus 2024.

Then, the same day, a state audit landed raising questions about $50.9M of opioid settlement money the Arizona Department of Corrections, Rehabilitation and Reentry had directed toward hepatitis C treatment for inmates — without the documentation the settlement agreement requires linking those infections to intravenous opioid use. ADCRR has agreed to a corrective action plan by September 30. Attorney General Kris Mayes has opposed further sweeps of settlement money.

Two stories. One day. We think it’s worth holding them in the same frame.

What the national number actually tells us — and what it doesn’t

The 14% decline is real, and the structural drivers behind it appear to be holding. Naloxone availability is broader than it has ever been. Buprenorphine prescribing is sustained under the extended DEA telemedicine flexibility through December 2026. Drug-checking infrastructure has matured in many states.

What the national number does not tell us is whether the curve is flattening, whether the drug supply has been stable enough to sustain the decline, or what happens when the supply shifts. The DEA’s May 12 public safety advisory — issued the day before the CDC release — warned that fentanyl is being cut with substances naloxone cannot reliably reverse: xylazine and medetomidine (not opioids; not naloxone-responsive), nitazenes and cychlorphine (opioids; may require multiple naloxone doses). The Center for Forensic Science Research and Education estimated cychlorphine to be roughly 10 times more potent than fentanyl.

Said another way: the national decline is held together by a complicated set of variables. If any of them give, the curve can turn. Arizona may simply be the first place we’re seeing that happen.

Why Arizona, specifically

There is no single explanation, and the people closest to the data are careful not to offer one. But three patterns are worth naming.

Polysubstance use is intensifying. Arizona Department of Health Services reporting suggests that fentanyl combined with methamphetamine — not fentanyl alone — is driving an increasing share of fatal overdoses. Stimulants act on a different pharmacology than opioids; the cardiovascular load is different; the overdose presentation can be different; and naloxone, which reverses opioid overdose, doesn’t reverse stimulant toxicity. A meth-and-fentanyl death is not a fentanyl-only death wearing a different costume. It is a different clinical event.

Border-proximity supply. The Phoenix DEA’s 79% increase in fentanyl powder seizures is one signal among many that the Arizona supply has gotten cheaper, more potent, or both, even as supply elsewhere has stabilized. Powder fentanyl is a different risk profile than counterfeit pills; the dose-per-unit variance is higher.

Treatment-access lag. Arizona has historically ranked 49th of 51 jurisdictions for behavioral health access. Fewer than one in twenty Arizonans with opioid use disorder receive medications like buprenorphine or methadone. When the national decline is being held up by treatment uptake elsewhere, that gap matters more, not less.

These three are compounding, not additive. A state with high polysubstance prevalence, a strained supply chain, and the country’s weakest treatment infrastructure cannot ride the national curve.

Why the audit matters in the same frame

The $50.9M question is not, on its face, about overdose. It is about whether settlement money is being spent in line with the terms of the agreement that produced it. Treating hepatitis C in inmates with a history of substance use is unambiguously good medicine — that is not in dispute. The audit raises a documentation question: were those infections tied to intravenous opioid use specifically, as the settlement agreement requires?

ADCRR’s medical director told staff in May 2024 that 3,850 of 3,900 patients treated had a history of substance use disorder. ADCRR has agreed to develop the documentation the audit recommends.

The reason it matters for the overdose conversation is this: Arizona has up to $1.215 billion in opioid settlement funds coming over 18 years. That money is the most powerful lever the state has to close the access gap that is keeping Arizona on the wrong side of the national line. How it is spent — what is documented, what is contested, what counts as “approved use” — is not a bureaucratic footnote. It is the policy infrastructure that decides whether the 2026 number looks more like 2025’s or more like Oregon’s.

How it is spent — what is documented, what is contested, what counts as “approved use” — is not a bureaucratic footnote.

What a person reading this should do with it

If you are an Arizonan, the national headline is good news that may not be your news. If you are using opioids — yours or anyone else’s, including counterfeit pills — every dose this year is more likely than last year to contain something naloxone cannot fully reverse on the first dose. The harm-reduction floor has not moved: carry naloxone. Carry more than one dose. Don’t use alone. Call 911. But the ceiling on what naloxone can do is lower than it was in 2023.

If you are a family member, the 988 Suicide & Crisis Lifeline is still the first call. Maricopa County also operates a crisis response system that is staffed 24/7, and Sonoran Prevention Works distributes naloxone statewide.

If you are looking for treatment, the access gap is the access gap, but it isn’t fixed. AHCCCS uses federal State Opioid Response grants to extend services to underinsured and uninsured Arizona residents regardless of Medicaid eligibility. That door is open. Knowing it exists is the first step through it.

Why this matters for people in recovery

Numbers don’t make somebody die. People die in particular places, on particular days, often with people they love nearby. The 14% national decline is real, and it is the result of a decade of effort by hundreds of thousands of people. The Arizona divergence is also real, and it is going to be the result of effort by people who haven’t started yet. If you live here, that includes you. If you love somebody who lives here, that includes you. The data is not the story. The data is the map. The story is what we choose to do with it.

Need help right now?

• Crisis & suicide: 988 Suicide & Crisis Lifeline (call or text 988)
• Statewide AZ crisis line: 1-844-534-HOPE
• Find treatment in Arizona: Rize Recovery
• Free naloxone in AZ: Sonoran Prevention Works