After nearly a decade of almost year-over-year increases in overdose deaths, the tide may finally be turning in Philadelphia.

The Centers for Disease Control and Prevention announced in May 2024 an estimated 3% decrease in overdose deaths in the U.S. in 2023 compared with 2022. Shortly after, data from the Philadelphia Department of Public Health showed a similar trend: Fatal overdoses across the city decreased 7% in 2023, from 1,207 to 1,122. The city is expected to release its 2024 data in the spring of 2025.

While these declines are notable, the city’s 2023 fatal overdose numbers are three times higher than they were in 2013.

Still, if 2024 numbers confirm the downward trend, it allows a little hope into an otherwise bleak epidemic that is killing more Philadelphians than homicides, car accidents and diabetes combined.

Something may finally be working. But what?

If over a decade spent treating and researching substance use disorders has taught me anything, it’s that the overdose epidemic is what researchers and policymakers refer to as a wicked problem. Wicked problems are constantly changing, complex, interconnected knots of other problems with no clear solution.

But let’s look at what we do know about how overdose deaths in Philadelphia spiked in the first place – and why they may finally be decreasing.

The first wave of the overdose epidemic began in the late 1990s and is attributed to overprescription of opioid pain medicines. But the largest acceleration in deaths didn’t occur until after the government and health insurers implemented prescribing controls in the early 2010s. These controls led many people who were no longer able to get prescribed opioids to turn to illicit heroin.

In a phenomenon known as the “

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