Charting the Decline of the Fourth Wave: US Overdose Deaths by Race, Geography, and Substance Involvement
Recent decreases in overdose deaths are encouraging and unprecedented. Racial gaps remained large but shrunk by a modest margin. The geography of the overdose crisis has shifted, with the West now the most affected region, which may have implications for the targeting of funding. The nature of the crisis is also shifting, as stimulants and xylazine continue to represent increasingly important public health challenges, and renewed attention to nonfatal aspects of addiction in the US is needed.
Authors
- Annick Bórquez (ORCID: https://orcid.org/0000-0002-6033-9837)
- Chelsea L. Shover (ORCID: https://orcid.org/0000-0002-0728-4101)
- Joseph Friedman (ORCID: https://orcid.org/0000-0002-5225-3267)
- Joseph J. Palamar (ORCID: https://orcid.org/0000-0002-8565-9415)
- Steffanie A Strathdee
- Tommi Gaines
- Daniel Ciccarone
Institutions
- University of San Diego (US)
- University of California, Los Angeles (US)
- University of California, San Francisco (US)
- University of California San Diego (US)
- New York University (US)
Publication Details
- Journal
- medRxiv
- Published
- 2026-01-30
- DOI
- https://doi.org/10.64898/2026.01.25.26344769
- Primary Topic
- Opioid Use Disorder Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health
- National Institute of Mental Health