After years of grim milestones, Florida’s drug crisis finally bent in the right direction in 2024, with overdose deaths dropping 14% – a downturn so dramatic longtime forensic experts say they’ve never seen anything like it.
The total number of drug-related deaths decreased to pre-pandemic levels, with big drops in the number of deaths caused by fentanyl and cocaine, according to the 2024 Drugs Identified in Deceased Persons report by the Florida Department of Law Enforcement’s Medical Examiner’s Commission.
While the Sunshine State’s decline in overdose deaths is consistent with trends nationwide, experts can’t pinpoint one specific reason for the change. Widespread availability of naloxone, which rapidly reverses opioid overdoses; changes in the drug supply; drug-using preferences and more access to recovery options could all be playing a role in keeping more Floridians alive.
“In all my years here in Florida working death cases involving drugs, I have never seen such a decrease,” said Dr. Bruce Goldberger, a professor of toxicology at the University of Florida.
A box of Narcan containing two doses provided by the public health vending machine on York Street.
The U.S. has seen an approximately 30% decline in overdose deaths, said Ryan Marino, a medical toxicologist and an associate professor at the Case Western Reserve University School of Medicine in Cleveland. Almost every state saw a reduction in overdoses, except for some west coast states, where fentanyl is still finding its way into the drug supply, Marino said.
Even though fentanyl is still the leading drug most prevalent in overdose deaths in Florida, there was a 34% drop in 2024 compared to 2023. Occurrences of fentanyl analogs decreased by 21%, occurrences of cocaine decreased by 17%, occurrences of methamphetamine decreased by 21%, and occurrences of cathinones, also known as bath salts, decreased by 44%.
Last year, national trends showed more people who use drugs turned to smoking instead of injecting. When injecting, the effects of the drug enter the bloodstream and get to the brain in a few seconds. A person smokes by inhaling vapors released from a drug heated by indirect heat, like from a lighter, in a glass pipe.
Tim Santamour, executive director of the Florida Harm Reduction Collective, an organization that advocates for people who use drugs, said they’re still hearing from people on the street that they’re switching from injecting to smoking. They are also seeing more awareness of fentanyl in the drug market. People who use drugs now know they’re not buying heroin anymore.
“They may be using less, not using alone,” Santamour said. “Folks are kind of afraid of what’s out there and would rather come to the decision to seek treatment.”
Goldberger said other hypotheses for the steep drop in overdose deaths are the widespread use of naloxone and the prevalence of fentanyl in the drug supply is no longer increasing. “People who are using fentanyl have been using fentanyl now for several years and have developed an increased tolerance to it, and therefore less likely to overdose,” he said.
But the information in the Drugs Identified in Deceased Persons report doesn’t include data on every illegal drug on the street. It can take years for law enforcement to catch up to current drug trends, which can leave gaps in Florida’s data.
Santamour said the decrease in the number of cocaine deaths hints that the drug might be being cut with something else, not fentanyl, which has been popular in recent years.
Ellen Deming of Deming Veterinary Services holds up a syringe containing .25 mL of Xylazine, enough to sedate a deer in Jackson, Tenn., on Thursday, Feb. 8, 2024.
“They should be looking at a nationwide level and seeking everything that’s out there and testing for everything that’s out there because we never know when it’s going to show up in Florida. That’s how we missed xylazine early on,” Santamour said.
Xylazine, also known as tranq, was created to be used in veterinary offices as a sedative. The drug is most commonly added to fentanyl to enhance its effects and can cause hours-long blackouts and necrosis of the skin, which can lead to amputation. Its effects can’t be reversed by naloxone. Florida didn’t officially track xylazine until 2022, but reports of the drug surfaced in the northeast in 2019.
“We knew it was in Philly,” Santamour said. “As soon as (a) drug shows up in regular samples across the county, we should be testing for that substance.”
While the number of xylazine deaths has decreased in Florida, it doesn’t necessarily mean that there is less of the drug in the illicit drug market, Marino said. Rather, experts are thinking it might be what’s causing the drop in overdoses.
“Even though we worry about the effects of xylazine and it’s not something people want to be getting, it seems like it’s there to reduce the fentanyl concentration, so people will get the same drug effect without the risk of dying,” Marino said. “People will use less fentanyl, and they are less likely to die.”
In the 2024 data, the only drugs that saw an increase in occurrence in overdose deaths were buprenorphine and methadone. Buprenorphine, also known as suboxone, and methadone are both prescription drugs used to treat opioid use disorder. Marino said those two medicines being detected in autopsy findings isn’t necessarily a bad thing.
“It’s like saying we have a big problem with heart attack deaths, and then once we started dealing with those better we were detecting more aspirin in people who died,” Marino said. “The fact that these were listed as overdose deaths means that something wasn’t working right, but having those two medicines detected means more people are having access to them, and those aren’t necessarily causing the overdoses or the deaths.”
A recent Gallup poll shows the percentage of Americans who believe the U.S. has made progress in dealing with the problem of illegal drugs has increased to 45%, the highest Gallup has recorded since 2000. This year Florida has seen an increase in ketamine-involved deaths in South Florida. In the first half of 2025, ketamine was present in 33 deaths in Miami-Dade County, according to toxicology reports.
Ketamine, originally developed in the 1960s, depresses the central nervous system, which can cause circulatory and respiratory distress if an overdose occurs. Ketamine overdoses also cannot be reversed by naloxone.
Methamphetamine use also continues to increase nationwide, Marino said. But what he’s most worried about are the cuts to Medicaid, which is the largest payer for addiction services in the county. “A lot of these wraparound services for substance use that we consider to have been beneficial are seeing significant threats, existential threats,” he said.
Ana Goñi-Lessan, state watchdog reporter for the USA TODAY Network – Florida, can be reached at agonilessan@gannett.com.
This article originally appeared on Tallahassee Democrat: Florida reports rare drop in overdose fatalities