Nearly all Americans are aware of the U.S. opioid crisis. Overdose deaths increased sixfold between 2003 and 2023, from 12,940 to 79,358. Yearly increases have been especially steep since 2013, when fentanyl hit the streets. COVID-19 further exacerbated the crisis until a marked decline in overdoses in 2024.

The recent drop in overdose deaths is credited by public health officials largely to medications for opioid use disorder (MOUDs), particularly naloxone (Narcan) and Suboxone/Subutex. Naloxone reverses active overdoses almost immediately by “kicking” opioids out of receptors in the brain and body and blocking their return. Nasally administered Narcan, when given quickly, can literally bring overdosed users “back from the dead.”

The second drug, Suboxone, is used to prevent overdoses in the first place. Suboxone combines naloxone with buprenorphine, a powerful opioid itself. Buprenorphine spares patients from withdrawal, while low-dose naloxone limits the euphoria and risk of overdose that buprenorphine alone carries. Although patients maintain a low-level “high” and remain physically addicted to buprenorphine, low-dose naloxone prevents intense intoxication and overdoses by partially blocking opioid receptors.

Both naloxone and Suboxone have been available for more than two decades. Those who credit them with the recent downturn in overdoses point to broader distribution and availability following intensive promotion in medical journals, by healthcare systems, and by the National Institutes of Health.

Yet post-COVID-19 reductions in several causes of death have been reported. Alcohol-related deaths, cocaine overdose deaths, and suicides all trended down in 2024. This suggests an additional common cause that isn’t explained by MOUDs.

I’m not suggesting Narcan and Suboxone aren’t essential parts of treatment. Rather, I argue that the current public health narrative minimizes their drawbacks.

Opponents of Narcan have long held that it enables opioid use—a worry many public health officials flatly reject. Many of us who work on the streets, however, have heard our........

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