Louisiana recorded a nearly one-third drop in drug-involved deaths last year, marking the lowest overdose mortality the state has seen since 2020, according to new data presented this week to the Louisiana Opioid Abatement Task Force.
Nell Wilson, project director of the Louisiana Opioid Surveillance Program, briefed the task force on Wednesday (Dec. 3) with what she called “optimistic data” from the state’s vital records database, which tracks all deaths certified by parish coroners.
Wilson said the state has seen a nearly 31% decrease in drug-involved overdose deaths from 2023 to 2024. That translates to 1,700 drug-involved deaths in 2024, down from 2,456 the year before.
The decline extends across drug types. Opioid-involved deaths decreased 31.8%, deaths involving synthetic opioids like fentanyl dropped by 34.6%, and stimulant-involved deaths fell 26.5%, mirroring national downward trends.
Here are some of the biggest takeaways from the task force’s meeting.
Rural parishes moving into highest-risk category
While deaths have fallen overall, the geography of overdose mortality in Louisiana is shifting.
Wilson said 23 parishes now have age-adjusted drug-involved death rates higher than the statewide rate of 36 deaths per 100,000 residents. Rural parishes such as Claiborne, Caldwell, and Tensas — long absent from the state’s highest-risk list — are emerging as new hotspots.
“Half or more than half of the parishes on these lists are rural, which is different from when I started doing this,” Wilson said.
She noted that stimulant supplies in northern Louisiana are increasingly adulterated with fentanyl, leading to higher mortality in areas historically associated with methamphetamine use.
Washington Parish continues to report some of the highest rates in the state, and Rapides Parish has been “slowly creeping up” over the seven years the state has been tracking drug-involved deaths.
Inconsistent death records limit drug-specific reporting
Task force members raised questions at Wednesday’s meeting about why some parishes report zero opioid-involved deaths.
Wilson explained that coroners often list “polydrug overdose” or “mixed-drug toxicity” without naming a substance, making it impossible for the state to classify the drug type.
“There is a lack of specificity in death records,” she said. “If they don't put a drug name in the death record, we can't extract the data and assign a drug type.”
Because of that, Dr. Peter Croughan, one of the task force members, noted that the all-drug death rate is the strongest indicator of overall drug mortality.
Fentanyl still drives fatalities
State toxicology data show fentanyl remains deeply entrenched in Louisiana’s drug supply.
In 2024, 1,727 deceased people were tested for fentanyl through the state’s partnership with NMS Labs, with 50.8% testing positive. In 2023, that positivity rate was even higher — 58.4% of 2,413 deceased people tested.
The panel includes fentanyl analogs such as fluorofentanyl, though emerging substances like medetomidine and xylazine are not yet standard, prompting concern from task force members monitoring trends in northern Louisiana and other regions.
Nonfatal overdose visits also falling
Emergency department data show Louisiana’s drug-related visits are trending downward and remain below national averages, though officials cautioned that coding inconsistencies may obscure the full picture.
“We know ED utilization in Louisiana is actually higher than the national average,” Croughan said, suggesting some overdose cases are coded as respiratory depression rather than drug-related.
Comparing June 2022 to June 2025, Louisiana saw declines across all categories: all-drug ED visits dropped from 66.3 to 45.4 per 10,000 visits; opioid-related visits were cut nearly in half; and stimulant-related visits also declined.
Parish-level ED data showed some unexpected patterns. Tensas Parish, a tiny parish of fewer than 4,000, recorded the highest rate of residents showing up in emergency departments for drug-related visits, followed by St. Bernard and Grant.
Orleans Parish topped the list for opioid-related ED visits. Wilson emphasized the importance of using rates, rather than raw counts, when evaluating small parishes where only a few cases can produce high per-capita figures.
Treatment access expanding
The state also reported a 9% increase in buprenorphine — a Medication for Opioid Use Disorder (MOUD) — prescriptions between 2022 and 2024.
During that same period, opioid-involved deaths fell 45%.
Wilson clarified that “correlation is not causation,” but noted that increased treatment access, expanded Medicaid coverage for MOUD and widespread distribution of harm-reduction supplies all occurred during the same period.
Between 2022 and 2024, the state distributed more than 200,000 doses of naloxone and 100,000 fentanyl test strips through community programs.
“What we’ve been doing and how we’ve been evolving is working,” Wilson said.
Task force members said the data underscores the need to help rural parishes understand how to build treatment, prevention and emergency response systems. Many of these parishes have opioid settlement dollars but little capacity or clarity on how to effectively spend them.
“A lot of parishes don't even have a clue how to spend their money,” task force member Joseph Bishop, mayor of Pineville, said, calling for hands-on training and guidance.
Opioid settlement pipeline nears its end
Task force legal counsel Vic Frankowitz told members that Louisiana is nearing the end of the opioid settlement era, with only a handful of remaining cases still moving through the courts.
“We have one big and eight little ones still in the pipeline,” Frankowitz said, referring first to the long-awaited Purdue Pharma settlement, which includes the Sackler family.
After years of delays — including a challenge that reached the U.S. Supreme Court — the settlement is now moving forward. Louisiana is expected to receive roughly $69 million, with the bankruptcy process likely concluding in early 2026 and funds arriving by the second quarter of that year.
The remaining “little ones,” as Frankowitz described them, involve eight secondary or generic opioid manufacturers, including companies such as Viatris and several smaller firms. Together, those settlements will total about $7 million for Louisiana. They are expected to clear the system sometime in the first half of 2026.
Beyond those cases, the state should not expect any significant new settlement money.
“There are no other major litigation settlements on the horizon,” Frankowitz said. “The pipeline of settlements is almost empty and will be effectively empty by the middle of next year.”
Additional funds from national pharmacy settlements are also on the way. Consent judgments for CVS and Walmart were finalized at the state level last month, joining an earlier agreement with Walgreens. Frankowitz said those will “trigger the money coming down pretty soon,” pending final administrative steps.
Once the last settlements are paid out, the task force’s work will shift decisively from litigation to implementation and management. The state’s long-term focus, Frankowitz said, will center on distributing funds to local governments, monitoring spending and offering technical assistance — especially for rural parishes.
Opioid settlement spending struggles
Even as the last settlements approach final payout, Louisiana is still grappling with how to utilize the money already on hand.
A legislative audit found that although the state is expected to receive roughly $600 million between 2022 and 2038, oversight remains thin and spending is strikingly low.
As of October 2024, the task force had distributed about $98.5 million to parishes and sheriff’s offices — but only $8.6 million had actually been spent. Many local governments told auditors they were unsure how to use the funds, lacked staff to manage them or were waiting to see what others planned before taking action.
Louisiana is also one of only two states that sends settlement dollars directly to sheriffs, who are not required to file expenditure reports. Twenty-one sheriff’s offices failed to respond to the audit’s survey at all.
Tucker Trope, the task force’s accountant, told members this week that the challenges are visible in the task force’s own books. As of late October, roughly $2.8 million in settlement dollars remained undistributed because several parishes had not submitted banking information or corrections — a figure that has since dropped by about $1.8 million, but will remain a recurring issue until every parish completes its paperwork.
Auditors recommended giving the task force stronger authority to enforce spending rules, requiring sheriffs to report expenses, and providing clearer guidance on evidence-based uses such as MOUD access, drug courts, harm-reduction programs, naloxone distribution and support for people returning from jail or prison.
Task force members agreed with all the recommendations and said that expanded training and technical support — including guidance from the Louisiana Department of Health — will be critical, particularly for rural parishes that are still unsure about how to build effective programs.
This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. Support for public health coverage comes from The Commonwealth Fund.
