It’s hard to believe opioid deaths are dropping when you’re walking on Vancouver’s Downtown Eastside, where B.C.'s drug crisis is most visible.

Open drug use is still common and on a dry day, you can count on seeing dozens of people unconscious on the sidewalk.

But the numbers don’t lie: overdose deaths in 2024 decreased 12 per cent in B.C. and across the country compared to the previous 12 months, according to January data from the province and March data from Health Canada.

The downward trend is even more pronounced in the U.S., where drops in fatalities of up to 45 per cent have been seen in states like North Carolina, according to the Centers for Disease Control and Prevention (CDC), which aggregates state numbers.

However, any progress could be undermined if either country sees a dramatic shift in drug supply or harm reduction measures, warns Nabarun Dasgupta, a senior scientist at the University of North Carolina’s Opioid Data Lab, which has been closely monitoring the shift in the U.S.

Dasgupta’s team in North Carolina is still trying to nail down the reasons behind the significant decrease in overdose deaths, which have been seen in all U.S. states except Nevada and Alaska.

He has three main theories, which at first appeared like total anomalies.

The first is an apparent shift toward a more varied drug supply that’s less based on fentanyl and includes lots of ingredients, like other synthetic opioids or amphetamines. Simply put, the drug supply may be getting saturated with substances that are less dangerous than large amounts of fentanyl.

“People are telling us in our field studies that the dope isn’t the same as it used to be,” Dasgupta said.

Then there’s the drug users themselves. People who regularly crunch the numbers on overdose deaths know there’s a certain cohort of people that commonly makes up a majority of fatalities. In Canada in 2024, 73 per cent of overdoses deaths happened to men aged 30 to 39, according to Health Canada.

In the U.S., about 70 per cent of overdose deaths hit men in their late-40s to mid-50s. Dasgupta suspects parts of that cohort may have stopped using drugs or could be dying of other causes.

The last hypothesis for the decline is more hopeful.

Interventions could be having a real impact. Treatment options, including lifesaving opioid reversal drugs like naxolone, which people regularly carry with them, or programs to reduce the stigma of drug use or educate young people on the dangers, might be making a dent.

It adds up, says Sarah Blyth, who says the Overdose Prevention Society saves people every day in different ways.

Still, she remains sceptical of a permanent improvement in the long-running drug crisis, as she personally knows people who have recently died from the supply. Optimism in this rolling crisis is easily broken and people are desperate to see things improve.

“No one wants to see anymore people dying,” Blyth said. “I want to see people living the best life that they can.”