Overdose deaths have surpassed 100,000 for the third straight year, according to federal data released Wednesday, a reminder that the nation remains mired in an intractable epidemic fueled by the potent drug fentanyl.

According to provisional data released by the Centers for Disease Control and Prevention, an estimated 107,543 people died in 2023, a slight decrease from the previous year. The agency described it as the first annual decrease in deaths since 2018, although experts cautioned that the numbers could rise in ensuing years and that the toll remains unacceptably high.

“It’s only a partial victory,” said University of Pittsburgh School of Public Health researcher Donald S. Burke, who believes that the death toll will keep rising, citing his analysis of decades of mortality data.

The CDC on Wednesday described the decrease as a sign that federal efforts to help prevent deaths and treat addiction in states are paying off. It could boost President Biden as he seeks reelection and Republicans rip him over border security and the flow of fentanyl synthesized by Mexican criminal groups.

“This progress over the last 12 months should make us want to reinvigorate our efforts knowing that our strategies are making a difference,” Deb Houry, CDC chief medical officer, said in a statement.

Beyond the politics and the statistics, the stories of those killed by drugs in 2023 outraged communities and anguished families across the country: the 1-year-old boy who died after accidentally ingesting fentanyl at a New York day care, five members of the small Lummi tribe in Washington state who succumbed in one week, the eight people who died in a matter of days in a Texas border county.

In Alabama, where estimated overdose deaths rose by 8% in 2023 from the previous year, Jamie O’Quinn succumbed to a years-long battle with addiction in March of that year. The 47-year-old father of four became addicted to drugs while in state prison for 16 years because of his role in a fatal car crash, according to his mother. He emerged a broken man wracked by guilt over his addiction. O’Quinn, a boilermaker, survived two overdoses before he took a fatal dose of fentanyl at his girlfriend’s home.

“He never got to know his kids,” said his mother, Miriam Stephenson, 77, of Jasper, Alabama. “He let the power of his drugs sweep him away.”

Local, state and federal officials have struggled to find answers to the addiction epidemic, which began decades ago with legal prescription pain pills flooding communities. When those pills became difficult to obtain, users turned to heroin — replaced in turn by illicit fentanyl, which often hits the streets pressed as pills.

The synthetic opioid, up to 50 times more potent than heroin, drove the skyrocketing numbers of deaths, which topped 100,000 nationally for the first time in 2021. The following year, according to federal data, the spike slowed but still reached nearly 110,000 confirmed deaths — a record high.

In 2023, the estimated number of deaths attributed to synthetic opioids such as fentanyl was 74,702, a slight decrease from the previous year.

Federal health authorities release preliminary estimates on drug overdose deaths each spring. Because of delays in reporting final data from some states — toxicology reports can take months to be finalized — the conclusive tally often differs from the predicted number.

Fatal overdose trends varied regionally, reflecting the ever-evolving illicit drug market, differences in how states approach reducing the harms of narcotics and barriers in getting treatment for substance use, experts say.

Some states, including Indiana, Kansas and Nebraska, reported significant decreases from the previous year.

In Maine, deaths in 2023 dropped nearly 16% from the previous year to about 600 cases. Gordon Smith, the state’s opioid response director, credits the investment of tens of millions of dollars in state funds to treatment centers and the hiring of nearly 50 people to help connect overdose survivors with services, he said. The state has purchased 500,000 doses of the overdose-reversal medication naloxone since 2019, most given out by harm reduction groups through the mail or syringe-exchange programs.

“Prioritizing the distribution to people who use drugs has absolutely had an impact,” said Whitney Parrish Perry, operations director at Maine Access Points, a harm reduction organization that works with the state to deliver naloxone.

But in Western states such as Alaska, Oregon and Washington, fentanyl became pervasive later than in other regions. In 2023, that led to increases of at least 27% in those states compared with the year before, according to the CDC.

In Oregon, the data shows there were just over 1,800 estimated overdose deaths in 2023, up from about 500 in 2016. The fatalities, along with public drug use and concerns about crime in cities such as Portland, prompted lawmakers this year to roll back a law that decriminalized possession of small amounts of drugs.

Caleb Banta-Green, a research professor at the University of Washington School of Medicine who studies overdose trends, pointed out that overdose deaths in his state have increased even with ample supplies of naloxone available. He stressed that communities need to improve access to treatment and tackle larger forces that drive people to addiction, such as income inequality and housing.

“We know naloxone is not the answer by itself,” Banta-Green said.

The CDC data also showed an increase in deaths involving methamphetamine and cocaine.

Alaska recorded a 45% increase in estimated overdose deaths in 2023 from the prior year. Deaths involving cocaine and stimulants such as methamphetamine also rose.

That crisis of addiction is particularly acute among Alaskan tribal communities, where access to health care is scarce, let alone doctors willing to prescribe medications such as buprenorphine that treat opioid addiction. In the rural Native American village of Ninilchik, Alaska, more than 80% of physician Sarah Spencer’s opioid use disorder patients also take meth, often to help them balance out the sedative effect of fentanyl. But no medication exists to treat dependence on stimulants, said Spencer, an addiction medicine specialist.

“Patients themselves don’t realize how dependent they have become on meth,” Spencer said.

The Biden administration said it has prioritized the drug crisis by backing increased access to buprenorphine and other opioid addiction medications, making it easier to obtain overdose reversal medications such a naloxone and providing billions of dollars in grants to help states. He also secured a pledge from China to curb the flow of precursor chemicals used to make fentanyl.

Democrats had hoped the bipartisan border bill passed by the Senate would have restrained the flow of fentanyl, allocating hundreds of millions of dollars to hiring more officers and agents to investigate and halt traffickers.

House Republicans, urged by presumptive Republican nominee Donald Trump to deny Biden a political win, blocked the bill.

The Biden campaign, in a statement, said the bill would have “dramatically reduced fentanyl coming over the border” and that Trump “cost American lives because he thought it was better for his own political interests.”

Republican politicians have tied the fentanyl crisis to the administration’s performance on the border while calling for military strikes on Mexican cartels and the designation of cartels as terrorist organizations.

Ahead of the election, that messaging has resonated with families of victims such as O’Quinn from Alabama. “Fentanyl is the worst thing that’s ever hit the United States,” said Stephenson, his mother. “Biden, he needs to close the borders.”