On a blustery winter morning, Keli McLoyd set off on foot across Kensington. This area of Philadelphia is one of the most drug-scarred neighborhoods in the U.S. In the first block, she knelt next to a man curled on the sidewalk in the throes of fentanyl, xylazine or some other powerful street drug.

“Sir, are you alright? You OK?” asked McLoyd, who leads Philadelphia’s city-run overdose response unit. The man stirred and took a breath. “OK, I can see he’s moving, he’s good.”

In Kensington, good means still alive. By the standards of the deadly U.S. fentanyl crisis, that’s a victory.

It’s also part of a larger, hopeful trend. Pennsylvania alone is seeing roughly 2,000 fewer drug deaths a year.

Nationwide, the number of annual deaths from drug overdoses has dropped by more than 30,000 people a year.

That’s according to the latest provisional data from the Centers for Disease Control and Prevention, comparing drug deaths in a 12-month period at the peak in June 2023 to the latest available records from October 2024.

Officials with the CDC describe the improvement as “unprecedented,” but public health experts say the rapidly growing number of people in the U.S. surviving addiction to fentanyl and other drugs still face severe and complicated health problems.

“He’s not dead, but he’s not OK,” McLoyd said, as she bent over another man, huddled against a building unresponsive.

Many people in Kensington remain severely addicted to a growing array of toxic street drugs. Physicians, harm reduction workers and city officials say skin wounds, bacterial infections and cardiovascular disease linked to drug use are common.

“It’s absolutely heartbreaking to see people live in these conditions,” she said.

Indeed, some researchers and government officials believe the fentanyl overdose crisis has now entered a new phase, where deaths will continue declining while large numbers of people face what amounts to severe chronic illness, often compounded by homelessness, poverty, criminal records and stigma.

“Initially it’s been kind of this panic mode of preventing deaths,” said Nabarun Dasgupta, who studies addiction data and policy at the University of North Carolina-Chapel Hill. His team was one of the first to detect the national drop in fatal overdoses.

His latest study found drug deaths have now declined in all 50 states and the trend appears to be long-term and sustainable. “Now that we have found some effective ways to keep people alive, it’s really important to reach out to them and try to help them improve their whole lives,” Dasgupta said.