<p>The difference between surviving an overdose and dying from subsequent ones often depends on the actions taken in the hours and days afterward.</p>
<p>A person overdoses at work. A colleague administers naloxone, reversing the overdose, and that individual does not contribute to the national death count.</p>
<p>However, what follows is critical. The individual may wait days for Medicaid approval for medication that could prevent another overdose. The community program responsible for follow-up may be uncertain about its federal funding. If the person is incarcerated, treatment may cease.</p>
<p>While the U.S. has improved its ability to reverse overdoses, ensuring that individuals remain alive six months later requires a functional system that supports them from rescue through treatment and into recovery.</p>
<h2>Progress is not a guarantee</h2>
<p>Federal data indicates that 79,384 people died from drug overdoses in 2024, with the overdose death rate decreasing by 26.2% from 2023, marking the steepest single-year decline on record. Early provisional estimates suggest that deaths continued to decline in 2025, to approximately 69,973.</p>
<p>Despite this decrease, nearly 70,000 overdose deaths in a single year highlight the ongoing public health challenge posed by the overdose crisis.</p>
<p>Declining death rates do not necessarily mean that the treatment system is effectively reaching those in need. The most recent National Survey on Drug Use and Health reports that approximately 47.2 million individuals aged 12 or older required treatment for a substance use disorder, but only about 7.6 million received it. Among those with opioid use disorder, only about 16% received medication. Until this gap narrows, the progress made remains at risk.</p>
<h2>Rescue and recovery are the same policy</h2>
<p>Federal overdose policy is fragmented across various programs, agencies, and funding streams, yet these interventions function as a continuum. Naloxone prevents death, Medicaid finances treatment, peer specialists connect individuals to care, and federal grants support the workforce and community organizations that provide these services. Weakening any part of this system affects the entire continuum.</p>
<p>The House FY 2027 appropriations report illustrates this disconnect. It maintains funding for major state treatment grants at $1.6 billion for State Opioid Response grants and about $2 billion for the Substance Use Prevention, Treatment and Recovery Services Block Grant. However, it eliminates funding for harm reduction, including support for naloxone access. Sustaining these gains requires funding the entire continuum rather than just parts of it.</p>
<h2>What Congress can still do this year</h2>
<p>One crucial step is to maintain funding for State Opioid Response and block grants while continuing to support harm reduction efforts that reach high-risk populations.</p>
<p>A year-end health package presents an opportunity for Congress to bolster the care continuum. The bipartisan, bicameral Due Process Continuity of Care Act would allow states to retain Medicaid coverage for eligible individuals held before trial. Currently, many lose coverage while awaiting trial, which increases overdose risk during this period. Individuals are 40 to 129 times more likely to die of an overdose in the first two weeks after release compared to the general population, and overdose is the leading cause of death for those leaving incarceration. Continuing buprenorphine or methadone treatment during this time can reduce the risk of death by approximately 75%.</p>
<p>For many in this population, Medicaid is the primary payer for treatment. When coverage lapses, treatment often ceases. A study found that only 30% of those who left jail on medication continued receiving community treatment a month later, compared to 7% of those who left without it. Maintaining coverage is essential for continuity of care and is a fiscally responsible choice, as gaps in treatment lead to worse outcomes and higher costs.</p>
<p>Congress could also advance an updated PEER Support Act. Identical bills in the House and Senate have bipartisan support and address a common issue in treatment systems: a shortage of trained personnel to assist individuals in accessing and maintaining care. The bill would enhance federal recognition of peer support specialists, preserve the federal Office of Recovery, and investigate employment barriers that prevent qualified individuals with lived experience from entering the workforce.</p>
<h2>Do not mistake a good year for a finished job</h2>
<p>The greatest error Congress could make is to interpret declining overdose deaths as a sign that the crisis is resolving. This progress is the result of sustained investment in treatment, harm reduction, recovery support, and the workforce that supports these initiatives. The gains are fragile, and reducing support now could hinder or reverse progress.</p>
<p>The true measure of progress is whether a person who survives an overdose can begin treatment promptly and remain engaged in care in the following months, even if they experience incarceration. Congress has a strategy that is beginning to yield results. The current task is to protect and complete this strategy.</p>
<p><em>Libby Jones is the associate vice president of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. Jones leads the initiative’s advocacy efforts, advancing federal policies to reduce the overdose death rate in the United States by expanding access to treatment and recovery support services.</em></p>