Dr. Janette Nesheiwat on the Fentanyl Crisis: Progress Made, Work Remaining

The United States has recorded a real drop in drug overdose deaths, but the fentanyl crisis is still far from over. Preliminary federal data projects roughly 69,000 overdose deaths for the 12 months ending January 2026, a 13 percent decline from the prior year. Overdose deaths peaked near 110,000 in 2022 and have been falling since. For physicians who spent years watching the numbers climb, that trajectory is encouraging. But for doctors like Janette Nesheiwat, who treated substance abuse  overdose patients and has worked on federal opioid policy, it’s a step forward in a problem that’s far from solved.

Fentanyl is still the dominant driver of overdose deaths in the U.S. In 2023, synthetic opioids, primarily illegally manufactured fentanyl, were involved in roughly 69 percent of all drug overdose deaths. Since 2016, fentanyl has been the leading cause of opioid overdose mortality. It displaced both prescription opioids and heroin as the primary killer. More than one million Americans have died of drug overdoses since 2000, the majority of them opioid-related.

A Physician Who Has Seen It Directly

Dr. Janette Nesheiwat’s exposure to the opioid crisis isn’t academic. As a practicing urgent care and family medicine physician in New York City, she treated patients throughout the epidemic, including during the COVID-19 pandemic years when overdose deaths spiked sharply. She served as chair of the Make America Fentanyl Free Program, a role focused on education of the opioid crisis, and she spoke at the White House Opioid Summit, where she brought a physician’s clinical perspective to a conversation often dominated by law enforcement and legislative voices.

Her position has been consistent: frontline physicians need a seat at the table when the country makes decisions about both treatment, prevention and education. That argument carries some weight coming from someone who has seen withdrawal, overdose, and addiction up close in an emergency setting resuscitating overdose patients and not just in policy papers.

That dual focus, treating patients while engaging in policy, reflects a broader tension in how the U.S. has handled fentanyl. Supply interdiction alone hasn’t closed the gap. The DEA has worked hard and seized more than 55 million fentanyl-laced pills in 2024, down from 80 million the year before, but trafficking offenses kept rising, reaching 3,639 in fiscal year 2024. As long as demand persists and illicit supply chains hold, the death toll isn’t going to zero.

What Drove the Decline

The drop in overdose deaths that began in 2023 has continued, and researchers have attributed it to several overlapping factors. Wider distribution of naloxone (narcan), the overdose-reversal medication, has played a role in saving lives.  It became over the counter no longer requiring a prescription.  Expanded access to buprenorphine and other medications for opioid use disorder has contributed. Researchers at the University of Maryland have also pointed to changes in the drug supply itself, arguing that Chinese regulatory action in 2023 on fentanyl precursor chemicals may have reduced both the availability and potency of illicitly manufactured fentanyl reaching the U.S.

But the decline isn’t uniform across the population. Overdose death rates remain highest among American Indian and Alaska Native men and older Black American men, per federal data. The communities hit hardest in earlier waves of the epidemic are still carrying a disproportionate burden, and the gap isn’t closing at the same pace as the national numbers.

Nesheiwat has addressed this disparity in her public health work, emphasizing that treatment access and community-level interventions must reach the people most affected, not just those with the easiest path to care. Her clinical background in one of the country’s most densely populated cities gives that argument grounding in what the care gap looks like day-to-day. She held meetings with Senators in the nation’s capitol advocating for these issues impacting Americans.

The Supply Problem Hasn’t Gone Away

Most illicitly manufactured fentanyl enters the United States through Mexico, with precursor chemicals historically sourced from China. The geopolitical dimensions of that supply chain mean that domestic public health efforts operate alongside and sometimes against broader foreign policy priorities. Federal enforcement has grown more aggressive, but the volume of fentanyl moving through illegal channels remains large enough to sustain an ongoing crisis even as deaths decline.

A single gram of fentanyl, roughly the size of a sugar packet, contains enough of the drug to kill 500 people. Its potency makes it dangerous across the broader illegal drug supply, where pills sold as oxycodone, Xanax, or other drugs are regularly found to contain fentanyl. Many overdose victims don’t have a history of opioid use disorder and don’t know they’ve consumed it.

A new threat is also entering the picture. A veterinary sedative called medetomidine has been detected in the illicit fentanyl supply in growing numbers. Unlike fentanyl, medetomidine can’t be reversed by naloxone. In New York City alone, this drug contributed to 134 fatal overdoses in 2025, up from 18 the year before. Nationally, forensic lab detections rose from 247 cases in 2023 to more than 8,000 in 2025. The tools that have been driving the decline in deaths may not work as well against this next layer of the problem.

What Dr. Nesheiwat Has Argued For

Across her public health work and policy roles, Nesheiwat has pushed for a response that treats the opioid crisis as both a medical problem and an educational awareness problem. She advocated for greater physician involvement in federal drug policy, stronger interdiction of fentanyl precursor chemicals at the border, and expanded treatment access in underserved communities. Her work at the White House Opioid Summit and through the Make America Fentanyl Free program, put her in rooms where those decisions get made. She is a strong advocate of prevention through education especially when it comes to our youth as many young teens who overdose are unaware that what they are consuming may be laced with deadly fentanyl and that one pill can kill. One pill could mean their last breath taken.

She’s now working at Walter Reed National Military Medical Center, focused on a different patient population. But her background in the opioid crisis remains part of her public health record, continued advocacy for Americans, and the issue she spent years working on hasn’t resolved itself. The focus is still on high risk populations, our youth and veterans.

The death toll is moving in the right direction, but the fentanyl crisis remains unresolved. Whether that holds depends on the stability of the illegal drug supply, the durability of treatment funding, and how quickly the public health system adapts to what’s showing up next in the drug supply. Three consecutive years of declining deaths represent real progress. But nearly 70,000 deaths a year are still a crisis.