The United States has the world’s highest rate of overdose deaths. According to the Centers for Disease Control, more than 100,000 Americans have died from overdose each year since 2021—more than from gun shots and car crashes combined. By 2023, scholars Alison Athey, Beau Kilmer, and Julie Cerel reported in the 

 (AJPH), one in four Americans knew someone who died by overdose. Over two-thirds of these fatalities—nearly 200 per day— involved synthetic opioids, mainly fentanyl, per the National Institute on Drug Abuse. And meth-related deaths and disease are spiking as new, even more powerful and toxic forms of methamphetamine flood the market (as reported in 

 by researchers Rachel A. Hoopsick and R. Andrew Yockey in 2023).There is significant debate about the best way to respond to this crisis. In recent years, drug policy has swung away from punitive drug-war tactics and toward public health-based harm reduction approaches. Harm reduction rests on the premise that while all drug use entails risks, attempts to eliminate it entirely have failed. Indeed, using punishment to try to deter drug use and eliminate illegal drug markets has itself caused significant harm, including by spurring the development of new synthetic drugs like fentanyl.

Some media outlets fuel public alarm, cultivating fear and heightening the desire to "get tough" on people who use drugs.

Advocates argue that since drugs cannot be made to go away, policy should focus on reducing the harms associated with their use. Harm reduction policies begin by “meeting drug users where they are,” without judgment, and helping them avoid some of the worst possible outcomes associated with continued drug use. Distributing naloxone, a medication used to reverse overdoses, for example, saves lives and helps to explain the recent downtick in overdose deaths. Similarly, providing sterile syringes to people who inject drugs has dramatically reduced the spread of HIV/AIDS and hepatitis C. Harm reduction approaches also include medicine-assisted treatment for opiate use disorder—maintaining dependent users on methadone, buprenorphine, or diamorphine (prescription heroin)—an approach that research shows is the most effective treatment available and reduces the risk of overdose by half.Since the 1990s, harm reduction policies have spread to dozens of countries around the globe. Their effectiveness is now widely recognized, including by the World Health Organization, the American Medical Association, the American Public Health Association, the Centers for Disease Control, and the National Academy of Sciences. To be sure, harm reduction policies do not reduce all of the harm and violence associated with illicit drug markets. Nor do they provide a solution to the marginalization and dispossession that underlie the most destructive forms of drug misuse. But they can, and do, reduce the disease and death caused by illicit drugs.

Stigma is not the solution to the drug crisis

A global reference on drug markets, trends and policy developments, the World Drug Report offers a wealth of data and analysis and in 2025 comprises several elements tailored to different audiences. The 

web-based Drug market patterns and trends

 contains the latest analysis of global, regional and subregional estimates of and trends in drug demand and supply in a user-friendly, interactive format supported by graphs, infographics and maps. 

 provides an overview of selected findings from the analysis presented in Drug market patterns and trends and 

the thematic chapters of Contemporary issues on drugs

, while Special points of interest offers a framework for the main takeaways and policy implications that can be drawn from those findings.

The World Drug Report 2025 is aimed not only at fostering greater international cooperation to counter the impact of the world drug problem on health, governance and security, but also at assisting Member States in anticipating and addressing threats posed by drug markets and mitigating their consequences.

World Drug Report 2025

The overdose crisis doesn’t just shatter our families, it fractures our communities.

The losses go deeper than one person, one family or one neighborhood. They ripple out into classrooms, workplaces and the spaces we all share. They cross borders between cities, states and nations.

But in a time when people are searching for connection and safety, overdose also reminds us that our lives are deeply intertwined.

We often instinctively protect our own – our children, our parents, our siblings. We believe in second chances for our loved ones but struggle to extend that same compassion to others. But what if we saw each other as one big family, bound not just by blood, but by shared experiences, responsibility and commitment to each other?

This International Overdose Awareness Day let’s imagine a new meaning of what family can be. A family driven by hope, love and action. We are one big family – not just because we share in the pain of loss, but because we share in the power to change what comes next.

This August 31, we move beyond awareness. We organize, we show up, and we take action. Because no one should carry this grief alone. Every story shared, every voice raised and every step we take brings us closer to a future free from overdose.

International Overdose Awareness Day 2025

This feature zooms into the drug deaths crisis in British Columbia, now the leading cause of death for people aged 10 to 59 in the province. Declared a public health emergency in 2016, this crisis has pushed over 16,000 people into premature death and continues to worsen due to a toxic and unpredictable drug supply.

The short documentary outlines the origins and evolution of the crisis, the challenges with current responses, and difficulties in moving toward decriminalised frameworks.

Advocates, health and legal experts, and bereaved parents highlight the urgent need for a safe supply, expanded access to treatment and policies that are grounded in public health rather than punishment.

Canada: Everything you need to know about B.C.'s toxic drug crisis

This environmental scan examines the current state of harm reduction (HR) education in Canadian nursing programs, highlighting significant gaps in preparing nurses to work effectively with people who use drugs (PWUD). While nursing codes of ethics and professional standards explicitly align with HR principles, our findings reveal that HR education remains inconsistently integrated into nursing curricula across Canada.

If covered at all, HR education is often embedded within other courses rather than recognized as a core component. This results in uneven exposure to HR content among students, leaving many nursing graduates unprepared to implement HR approaches in their practice. The inclusion of HR education is also heavily dependent on individual faculty interest and initiative. Stigma toward substance use and a lack of faculty readiness to teach this content remain major barriers. 

Curriculum constraints further limit the depth of HR education. With an already overcrowded curriculum and minimal emphasis on HR in entry-to-practice guidelines and licensing exams, instruction on HR is often superficial. The lack of this education has a direct impact on patient care, perpetuating stigma, and discrimination in healthcare settings.

Environmental scan on the current state of harm reduction education in nursing

Drug seizures were perceived by officers as a means to increase safety for PWUD.

Public health recognized an increased risk of overdose for PWUD following seizures.

Public health is concerned about building and maintaining the trust of PWUD.

PWUD understood drug seizures to increase drug market instability.

PWUD saw seizures as removing drug culture knowledge and rupturing social networks

A growing number of studies suggest that police efforts to disrupt illicit drug markets through the removal of illicit drugs can result in unintended harms to people who use drugs by increasing overdose risks. However, little is understood about the perceptions, expectations, or experiences of those who implement, experience, and/or are impacted by these seizure events.

We conducted semi-structured interviews (N = 54) with police, public health and local nonprofit professionals engaged in overdose prevention efforts, and people who use drugs (PWUD) in Indianapolis, Indiana—a city where drug seizures have been associated with excess overdose—to examine how each of these groups perceive these events. We use a journey mapping framework to analyze expectations for each of these personas around the shared scenario of drug seizures.

Law enforcement drug seizures are routine and are perceived by police as interconnected, longitudinal attempts to dismantle drug supply networks. Public health and local nonprofit professionals described potential harms stemming from drug seizures but reported lacking the shared information and inter-agency collaboration necessary to provide a meaningful response. PWUD reported negative health consequences and increased risk of overdose following drug seizure events. PWUD use multiple strategies to reduce perceived harms from drug seizures.

Seizing drugs whenever, wherever, or with whomever they are found has become an accepted policing practice in the United States, ostensibly to reduce risk of drug-related harms. This study offers a new perspective to the growing evidence that this standard practice may result in a myriad of negative public health outcomes for the community. Research, such as this, that engages the lived experiences and perceptions of directly impacted people, is essential for understanding and mitigating these harms. Those most impacted by drug seizures – PWUD – should be at the center of developing, implementing, and evaluating public health and harm reduction efforts to reduce the harms associated with drug seizures.

Journey mapping drug seizures among police, public health and local nonprofit professionals, and community members who use drugs

International drug policy is shifting—thanks in no small part to the tireless efforts of the harm reduction movement. This new primer in the

 series unpacks a major advocacy win: the first CND resolution on overdose prevention in over a decade, which recognises key harm reduction measures after years of campaigning and resistance. The publication explains what was agreed, why it matters, and how you can use it to demand stronger, evidence-based responses in your country.

Translating UN commitments into action - An advocacy primer on CND resolution 67/4

The alarm is sounding in the UK's first drug consumption room.

A man in his 30s has overdosed in the "using space" – a room in the Glasgow facility where nurses supervise injections in eight booths.

He had only arrived at The Thistle minutes earlier, animated about being searched by police on the Gallowgate.

Staff rush to help, bringing him from his seat to a crash mat on the floor.

Our film crew is ushered out of the area while an ambulance is called and staff work to save his life.

Eddie Kearney, a harm reduction worker, tells us that the man had already taken drugs three times that day.

"He's using a 'snowball', he's using heroin and cocaine," he explains.

"He's been in there two minutes and he's on the floor."

We are filming in the centre after being granted two days of exclusive access to the pioneering and controversial consumption room.

Less than an hour later, the alarm sounds again, for another man in his 30s.

He had been led to reception by workers from a charity, then made his way to the booths to inject heroin.

Lynn Macdonald, the service manager, tells us it is another medical emergency.

"The first four weeks, there were no medical emergencies, and then this week we've had five.

"It could be a batch of drug that is problematic. People are noticing a difference in the heroin when they making it up, saying they are noticing a green tinge to it."

More paramedics are on their way, she says.

Both men are brought round using the overdose reversal drug Naloxone, before being seen by paramedics. The second is taken to hospital.

Lynn Macdonald later told us: "I am absolutely convinced that had we not been present during the overdoses we've seen within the Thistle, then people would not have survived."

In the 12 weeks since The Thistle opened in the east end of Glasgow, there have been 16 such overdose incidents.

A total of 180 people have visited the unit and more than 1,200 injections of street-bought heroin and cocaine have been supervised.

A total of 27 people have been referred to other services, including housing, by staff.

The service, which follows similar programmes in 18 other countries, seeks to reduce drug-related harm in a hardcore population of injecting users in one of the most deprived communities in Glasgow.

It is hoped that by providing a safer space it will allow medical staff to prevent overdose deaths, reduce blood-borne viruses and clean-up a local area that, historically, has had a major issue with discarded needles and drug debris.

Alarms, overdoses and saving lives: Two days in UK's first drug injection room

Americans from all walks of life are deeply concerned about addiction, overdose, and the impact of fentanyl. Families across the U.S.—whether from cities, suburbs, or rural communities— desperately want to protect their loved ones and keep them alive.

When it comes to solutions, Americans broadly agree that access to treatment, the opioid/fentanyl reversal medication naloxone, and other health services are critical for saving lives and offering a path to recovery.

Yet, the Trump Administration’s and Congress’s proposed federal funding cuts pose an immediate and catastrophic threat to these vital services. By slashing Medicaid and public health grant programs, Trump’s cuts will directly hinder access to treatment, naloxone, and vital health services. The results could be devastating: more lives lost to overdose, increased suffering, and addiction spiraling out of control. We cannot let these cuts go through—every second counts.

Kassandra Frederique, Executive Director of the Drug Policy Alliance, answers urgent questions to help us understand the immense threat posed by Trump’s federal funding cuts and what can be done to protect our loved ones and ourselves.

US: Trump’s funding cuts jeopardize fentanyl overdose prevention and recovery

Supervised injection sites (SIS) offer a hygienic environment in which people can inject drugs under observation; as such, these harm reduction services have been on the forefront of the overdose epidemic. We sought to understand factors predictive of an overdose requiring an emergency response intervention at SIS in Montréal, Canada.

We used administrative data from all four Montréal SIS from 1 March 2018 – 31 October 2022 to first calculate the rate of onsite overdose requiring intervention (e.g., naloxone or oxygen administration, nurse or paramedic assessment, etc.) and descriptive statistics. We then used a logistic regression model, with generalized estimating equations to adjust for clients’ repeat visits, to test associations between onsite overdose intervention and client gender, age, drug injected (fentanyl vs other opioid vs non-opioid), most frequent injection location, frequency of injecting, duration of injecting, housing stability, attendance at multiple SIS, and time period (before or after 15 March 2020).

During the observation period, Montréal SIS received 122,509 visits from 2,127 unique clients. The rate of overdose requiring intervention was 8.16 (95 % CI 7.66, 8.68) per 1000 visits. While 278 (13 %) of clients experienced an onsite overdose intervention, these clients accounted for 64,267 (52 %) SIS visits. Transgender clients (aOR = 2.28, 95 % CI 1.18, 4.41, compared to men) and clients younger than 25 were at greater risk of experiencing an onsite overdose requiring intervention (e.g., clients 35–44 had an aOR = 0.44, 95 % CI 0.30, 0.64, compared to clients younger than 25). Injecting most often in a public place was associated with greater risk of an onsite overdose requiring intervention (aOR = 3.62, 95 % CI 3.04, 4.30), while reporting unstable housing (aOR = 0.56, 95 % CI 0.47, 0.66) and attending more than one SIS (aOR = 0.13, 95 % CI 0.10, 0.16) predicted lesser risk. Compared to clients who reported injecting daily, greater risk of overdose requiring intervention was observed among those who reported injecting 3–6 days a week (aOR = 1.48, 95 % CI 1.18, 1.85), 1–2 days a week (aOR = 2.43, 95 % CI 1.90, 3.11), and “occasionally” (aOR = 2.60, 95 % CI 2.13, 3.18), but not those who reported not injecting in the past several months (aOR = 0.44, 95 % CI 0.25, 0.79). Compared to clients who had been injecting for five or more years, an injection duration of 1–4 years was associated with reduced risk of an overdose requiring intervention (aOR = 0.79, 95 % CI 0.64, 0.98), while those newer (<1 year) to injecting were at greater risk of such an intervention (aOR = 2.11, 95 % CI 1.50, 2.97). Compared to clients intending to inject fentanyl, we observed a lower risk of an overdose requiring intervention for those injecting other opioids (aOR = 0.22, 95 % CI 0.18, 0.26) or non-opioids (aOR = 0.06, 95 % CI 0.04, 0.08). Injecting after 15 March 2020 was also associated with greater risk (aOR = 1.99, 95 % CI 1.65, 2.41).

Across four Montréal SIS, site visits with an overdose requiring intervention were associated with transgender identity, younger age, stable housing, intending to inject fentanyl, injecting less frequently than daily, injecting for either more than five years or less than a year, single site attendance, and injecting most often in a public place. Montréal SIS serve a diverse clientele who inject drugs, with differing risks of onsite overdose.

Characteristics of supervised injection site clients and factors associated with requiring overdose intervention, Montreal, Canada, 2018–2022

 IOAD 2024 showcased the power of collaboration and community action in tackling the global overdose crisis. From grassroots initiatives to international events, this year’s campaign exemplified the strength of uniting behind a shared purpose.

IOAD 2024 reached new heights, with more events, greater social media engagement, and an expanded global presence. Across the world, communities came together to raise awareness, advocate for policy change, and honour those whose lives have been impacted by overdose.

We also saw governments and leaders make commitments to addressing this preventable crisis, illustrating the growing global recognition of the urgency of ending overdose.