R.I. overdose deaths decline for second year in a row

Publicly-accessible Boxes containing Naloxone, an opioid reversal drug also known by the brand name Narcan, line up outside the East Bay Recovery Center in Warren. (Photo by Alexander Castro/Rhode Island Current)
Rhode Island saw its lowest number of fatal drug overdoses since 2020, according to health department data presented to the Governor's Overdose Task Force on Wednesday.
'This is a sign of hope,' Gov. Dan McKee said in a statement Wednesday. 'We know there is still much work ahead, but the steps we are taking are saving lives.'
This is the second year in a row that overdose deaths have dropped. There were 329 Rhode Islanders who died from overdoses in 2024, representing an 18.6% decrease from 2023, and a 25% drop compared to 2022. That means the state is well on its way to achieving its goal of a 30% reduction for 2030. The goal was set in 2022, the year a total of 436 people died of drug overdoses.
The 2024 data demonstrated another longstanding trend now broken: For the first time since 2013, cocaine-related deaths were implicated in 61% of fatal overdoses, surpassing the 57% of deaths associated with fentanyl.
All opioid-related overdoses, in fact, fell from 85% the previous year to 69% in 2024.
But more than one substance can contribute to an overdose, so distinguishing the role of cocaine or fentanyl in a death is not so neatly accomplished. A large portion of overdoses — 118 in all — involved both substances being used in tandem in 2024. About three in five people who died from cocaine also had fentanyl in their system.
The annual overdose data is compiled and interpreted by the Rhode Island Department of Health's (RIDOH) Substance Use Epidemiology Program, which finished reviewing the 2024 results last week, according to Joseph Wendelken, a department spokesperson.
The data is largely based on autopsy and toxicology findings from the Office of the State Medical Examiners. Personal medical history also informs the coroners' findings. The data does not include deaths with undetermined causes.
'Though decline is encouraging, this is still an incredible loss in our community,' Heidi Weidele, the health department's lead fatal overdose epidemiologist, told the task force Wednesday during her presentation on the data.
The scale of loss did not affect all people equally: 70% of overdose deaths in 2024 were men, a number consistent with recent years. Similarly, people ages 45 to 54 were the largest age-based cohort of overdose deaths, followed by people ages 55 to 64.
By race, non-Hispanic white Rhode Islanders comprised the largest share of overdoses at 73%, even though they were also most likely to have a history of substance use treatment.
Most of the state's overdoses were concentrated in urban areas, with Woonsocket, Providence and Pawtucket reporting the highest numbers.
Though decline is encouraging, this is still an incredible loss in our community.
– Heidi Weidele, lead fatal overdose epidemiologist, Rhode Island Department of Health
Weidele said the deceased most commonly worked in 'natural resources, construction, maintenance, and service occupations, which is similar to what we've seen in past years,' she told the task force. 'And service occupations would be things like health care support, law enforcement, food preparation, grounds maintenance, and personal care.'
Other statistics from the report painted a grim picture of the deceased leading up to final moments: Most never sought substance use treatment, or received medical treatment for a previous overdose.
Eight out of 10 died in private, in a home, garage or camper. Most overdosed alone, with no bystander present in 60% of cases.
The availability of lethal drugs has also influenced overdose trends over the years. In 2009, prescription drugs accounted for 62% of overdose deaths. By 2020, prescription drugs accounted for only 9% of fatal overdoses, while illicit drugs like fentanyl and cocaine comprised 72% of overdose deaths.
In 2024, the state actually saw 34% of deaths attributed to combinations of illicit and prescription drugs combined — the highest percentage since at least 2009.
A few uncommon culprits in overdose deaths were still marked as 'substances of concern' by the state health department. These included novel benzodiazepines, tranquilizers which belong to the much broader category of research chemicals — substances derived from or chemically very similar to legal and regulated drugs. In this case, novel benzodiazepines like clonazolam — about two-and-a-half-times stronger than Xanax — accounted for nine fatalities in 2024.
Brown University researcher: Street drugs are getting more potent and more mysterious
Xylazine, a veterinary anesthetic increasingly being used to cut street-sourced opioids, was another rogue substance that continued to impact overdose data in 2024. It was involved in 37% of opioid-related deaths.
'Every single overdose death is preventable,' Health Department Director Dr. Jerry Larkin said in a statement Wednesday. 'Recovery is within reach for every person living with the disease of addiction.'
McKee strengthened the Overdose Task Force — a coalition of more than 150 members divvied up into nine workgroups — in 2022 via an executive order, hoping to ensure a sustained state response to the opioid overdose crisis. Among the initiatives it steers are determining how to dispense opioid settlement funds, naloxone distribution networks, peer outreach, and recovery support and public awareness campaigns.
Earlier this year, Rhode Island also opened the nation's first state-regulated harm reduction site at Project Weber/RENEW in south Providence, where people can use drugs and receive medical attention in the event of an overdose. Despite a fierce floor debate in the Rhode Island House of Representatives, legislation to extend the injection site's pilot authorization was extended by the General Assembly and later signed into law by McKee on June 6.
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