Shelby County's reported opioid-related death rate has fallen for four straight years, dropping from 55 per 100,000 people in 2022 to 30 per 100,000 in 2024. County health officials say the decline is real and still trending downward, although the county's overdose surveillance is provisional and subject to revision. Shelby County's reported overdose death rate nevertheless remains higher than both Tennessee's and the nation's.
Dr. Bruce Randolph, director of the Shelby County Health Department, has attributed part of the turnaround to wider access to naloxone, the overdose-reversal drug sold under the brand name Narcan, telling WREG that availability was a factor. The health department has documented a 100 percent increase in its own naloxone distribution, a change officials identify as one possible contributor to the falling death toll, not proof of a single cause.
That increase shows up in the numbers people are actually picking up. Nearly 5,000 boxes of naloxone were collected in fiscal year 2026, compared with roughly 2,500 boxes in fiscal year 2024 — each box containing two sprays. Some of that supply now comes from a vending machine the health department operates in Hickory Hill, giving residents a way to grab naloxone without a face-to-face visit.
A Persistent Gap With State and National Rates
Despite the progress, Shelby County's drug overdose death rate remains more than 13 percent higher than the Tennessee state average and 40 percent higher than the national average, per the same WREG report. The county's latest data recorded 138 suspected overdose deaths, most of them involving Black men. That marks a demographic shift Randolph says has taken hold over recent years.
What the official records show
The four-year decline should be read as a trend in preliminary local surveillance, not a finalized count. According to the Shelby County Health Department, its overdose data are based on suspected deaths and are provisional, meaning the county's 2024–2026 figures may change as cases are completed. The Tennessee Department of Health separately reported that statewide drug overdose deaths fell in 2023 for the first time since the state began monitoring overdose data in 2013, but that finding does not by itself confirm four consecutive annual declines in Shelby County. Naloxone access has expanded alongside the local decline, but the available figures do not establish that distribution alone caused fewer deaths. The county says free harm-reduction kits containing two naloxone doses and 10 fentanyl test strips are available at clinics including Shelby Crossing, Hickory Hill, Millington, Cawthon and Southland Mall. Tennessee's behavioral-health agency also says two naloxone products became available over the counter beginning in fall 2023, broadening access beyond public-health distribution.
“That has flipped now,” Randolph said, describing how the pattern of opioid-related deaths has changed from what county data showed seven years ago, when deaths were roughly 60 percent white and 40 percent Black, male or female. Today the toll falls disproportionately on Black men, a reversal Randolph has watched play out through the county's ongoing case data.
Older Users and the Fentanyl Factor
Randolph also pointed to risks facing older drug users, who he said may be more vulnerable because of longer-term drug use and other health complications. He said fentanyl is increasingly being mixed into street drugs, sometimes without users' knowledge. That contamination can expose people using methamphetamine, cocaine, crack or other substances to an opioid they did not intend to take. More broadly, Randolph said, any increase in drug use raises the chance of an accidentally fatal dose.
Keith Burgess, a former addict turned advocate, has lived that danger firsthand. “Narcan has saved my life more than once,” Burgess told the station, a firsthand account of the drug's role in keeping users alive long enough to seek help. Groups like We Fight Monsters, whose work in addiction assistance includes co-founder Ben Owen and Nicole Hart, are among those connected to the recovery support the health department also points people toward, alongside its own information on Narcan and addiction recovery resources.
The National Picture Mirrors the Local Trend
Shelby County's decline tracks a much larger national shift. Opioid overdose deaths across the United States fell from 79,358 in 2023 to 54,045 in 2024, according to KFF. Total drug overdose deaths nationwide dropped from 105,007 to 79,384 over the same period, a 24 percent decrease, with declines in fentanyl-involved deaths driving much of that overall drop. Provisional federal data suggest opioid deaths kept falling through 2025.
The national declines were not evenly spread. KFF's analysis found that opioid death rates in 2024 remained highest among adults ages 26 to 64, American Indian and Alaska Native people, Black people, and males, even as every demographic group saw improvement from the year before. Young adults ages 18 to 25 saw the sharpest decline nationally, dropping 42 percent, underscoring how unevenly the crisis — and its retreat — has touched different age groups.
The Health Department continues publishing provisional suspected opioid-related weekly reports, including a summary for the week ending in early September 2026. Those reports offer residents an ongoing snapshot, but the figures can change as investigations are completed, so they should not be treated as final death counts.
