The Country's Overdose Deaths Are Falling. Arizona's Are Climbing — and Washington Just Cut the One Thing Proven to Help.

Tom Langdon Hill spends August in Tucson driving to the places people are most likely to be overdosing and dying alone: underpasses, washes, the strips of shade behind strip malls where the ground temperature can hit 150 degrees. Hill trains outreach workers for the Certified Community Health Specialists’ Foundation, and this year his organization has reversed 700 overdoses in Pima County alone. “The main thing in Arizona that differentiates us from the rest of the country is heat,” he told KOLD News 13 in August — heat that dulls a person’s ability to feel themselves overheating even as fentanyl slows their breathing, a second, quieter way for the same drug to kill.

Nationally, this is supposed to be the good-news year. The country cut its overdose death toll by more than a quarter in twelve months, and it is still not enough to keep Arizona’s numbers from going the other way. The CDC’s newest provisional count, released alongside a new public data hub on August 31, puts the national twelve-month toll at 67,798 deaths — down 12.3% from the year before, building on a 2024 decline that a new Commonwealth Fund analysis covered by STAT News calls “unprecedented.” Brown University epidemiologist Brandon Marshall told STAT it is “unprecedented to see overdose deaths come down so dramatically, so quickly.” Arizona logged 2,988 overdose deaths in 2025, up from 2,531 the year before — an 18% increase in the same twelve months the rest of the country was celebrating its steepest single-year drop in a decade. The state’s overdose rate, at 43.5 per 100,000, now runs roughly twice the national average, and Filter Magazine’s analysis of CDC data found Arizona among a cluster of western states — alongside New Mexico, Colorado, and Montana — still climbing while the national curve bends down.

If you are using in Phoenix or Tucson this month, or loving someone who is, the national numbers are not lying to you and they are also not describing your state. Both things are true, and the gap between them is the story.

Why the same drug supply is producing opposite outcomes 1,900 miles apart

The Commonwealth Fund report doesn’t credit one intervention for the national decline — it credits a stack of them working at once: naloxone distributed at a scale that finally matches the size of the crisis, medication for opioid use disorder reaching people who couldn’t get it before, and, in states like New York, a sevenfold increase in access to that medication inside prisons. Virginia’s overdose deaths fell 40% after the state saturated its highest-risk communities with naloxone. Maryland cut deaths 25% over five years by roughly doubling how much naloxone it handed out. None of that is exotic. It’s distribution, at volume, of a drug that has existed for fifty years.

Arizona has naloxone too — Tempe just expanded free kit access through its fire stations and CPR classes this week, and Capt. Paramedic Kevin Johnston told KJZZ that a meaningful share of the overdoses his crews reverse are accidental — an infant, an elderly patient on multiple prescriptions, not the person a stigma-driven mental picture of “overdose” usually conjures. But naloxone reverses an overdose in progress; it doesn’t touch what’s driving more of them to happen in the first place. Two forces are doing that work in Arizona specifically. The first is pharmacological: the state’s fentanyl supply has been shifting from counterfeit pills, which at least deliver a roughly consistent dose, toward powder, which does not — a change that makes every single use a fresh guess at potency. The second is literal weather. Fentanyl and methamphetamine already suppress the body’s ability to regulate its own temperature; running that chemistry through a Tucson summer, where nearly half of this year’s heat-related deaths in Pima County also involved an overdose, turns an ordinary use into a race against a body that can no longer cool itself down.

Arizona has naloxone too — Tempe just expanded free kit access through its fire stations and CPR classes this week, and Capt.

A national decline built on programs a state can’t fully access, while the local risk factors that program was built to survive are getting worse, isn’t a paradox. It’s a forecast.

The system that was supposed to catch people is also the one accused of exploiting them

Arizona’s overdose numbers are climbing inside a state that is simultaneously untangling one of the largest Medicaid fraud schemes in the country’s history — a scheme that targeted the exact population this data is about. Since 2021, according to Axios Phoenix’s reporting on the ongoing investigation, roughly $2.8 billion in fraudulent billing flowed through unlicensed sober-living operators who recruited patients — disproportionately Native American, many recruited off reservations with promises of housing and treatment — into homes that billed AHCCCS, Arizona’s version of Medicaid, for care that was never delivered. Some patients told investigators they were kept using drugs or alcohol, not helped to stop, because a client still in active use was a client whose Medicaid number could keep generating claims. At least 40 deaths have been tied to those homes. The state has suspended 364 providers and still has roughly 200 cases open.

Layer that on top of the overdose data and the pattern sharpens: Arizona is a state where the people most at risk of dying have, in living memory, also been the population a segment of its own treatment industry treated as a revenue stream rather than a caseload. That history doesn’t cause today’s rising death toll on its own. It does help explain why trust in “the system” — insurance, licensed treatment, a stranger offering help — is not something you can assume a person using drugs in this state walks in with. Every naloxone kit Tom Hill hands out in a Tucson wash has to do the work of earning that trust back one interaction at a time.

We have watched a government decide that a cheap thing keeping people alive sends the wrong message before, and pay for that decision in bodies. In 1988, Congress attached a rider to a federal spending bill banning any federal dollars from funding needle-exchange programs, reasoning that a government-funded syringe looked too much like an endorsement of drug use. The ban held for 21 years, through the peak of the HIV epidemic among people who inject drugs, until Congress finally lifted it in 2009. Public health researchers spent those two decades documenting, in real time, how many HIV infections a plainly available intervention could have prevented. Nobody got those years back. The shape of that argument — that making survival cheaper and easier is somehow the irresponsible choice — is exactly the shape of the argument now being made again.

Washington just restricted the tools Arizona needs most

That history isn’t abstract this year. STAT News reported in April that SAMHSA guidance, following a January executive order, now bars grantees from using federal money for anything that could be read as “facilitating illegal drug use” — a phrase broad enough to have already ended federal support for distributing fentanyl test strips and to be complicating funding for syringe service programs nationwide. A modeling study reported by Psychiatric News — a single trade-press source we’re citing with that caveat attached, not as settled fact — projects that a sustained federal pullback from syringe services specifically could cost roughly 40,000 additional lives over five years, 16,000 of them from overdose alone, among people who inject drugs. Whatever the precise number turns out to be, the direction of the mechanism is not in dispute: these are the programs the Commonwealth Fund credits with the national decline, and they are the programs now losing the federal backing that let them scale.

Sarah Wakeman, an addiction physician at Mass General Brigham, offered STAT a harder read on why deaths are falling nationally at all: some of the decline, she said, may simply reflect that so many people already died that the population left at highest risk is smaller than it was. That is not the story anyone wants attached to a “good news” headline, and it is also a reason the newest cuts land harder in a state like Arizona, where the at-risk population isn’t shrinking — it’s still growing into a supply and a climate working against it at the same time.

If you’re on a case management team this week, the concrete question worth raising isn’t whether harm reduction works — it’s whether your own program has actually checked what the new SAMHSA guidance means for your federal grant dollars. Several programs nationally didn’t realize test strips or syringes were affected until an audit flagged it after the fact. Ask before you’re the one explaining the gap to a client.

Several programs nationally didn’t realize test strips or syringes were affected until an audit flagged it after the fact.

Here is what your state government hasn’t undone, whatever else changes in Washington: Arizona’s $1.194 billion in secured opioid settlement funds is still flowing — $10 million of it went to five rural county sheriff’s offices in June for reentry programs alone — and naloxone is still free, still legal for anyone to carry in Arizona regardless of insurance, prescription, or immigration status, and still the single most reliable thing standing between a bad batch and a funeral. If you are using alone this week because that’s the only option you have, that’s the one thing in this story that hasn’t been cut, hasn’t been delayed by a fraud investigation, and doesn’t require anyone’s approval to use on yourself or on someone next to you.

None of that closes the gap between a national number that’s finally moving in the right direction and a state number that is not. Tom Hill will be back out in the heat this week, doing the arithmetic of a 700-reversal year against a death count that keeps climbing anyway, because the tools that would actually bend Arizona’s curve — the ones Virginia and Maryland leaned on to bend theirs — are the ones a federal memo just made harder to fund. The country solved part of this problem this year. Arizona is proof that “part” is still a body count.