New population estimates from the U.S. Census Bureau place Mobile as the state’s second-largest city, behind booming Huntsville and ahead of Birmingham and Montgomery, both of which saw population declines according to the most recent estimates from the U.S. Census Bureau.

Mobile’s new status takes into account the city’s 2023 annexations of neighborhoods in Mobile County that were expected to add about 20,000 to the city’s population. According to revised Census estimates, the city jumped from less than 190,000 before 2020 to almost 210,000, pushing it well ahead of Birmingham which, for 2024, had an estimated population of 196,818.

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However, despite its annexation bump, Census estimates show Mobile is still losing population, dropping by over 500 over the past year to an estimated 201,367. Birmingham and Montgomery are also continuing to see population declines. If current trends prevail, the three cities seem destined to continue jockeying back and forth. Currently, the population estimates have Birmingham in third, just in front of Montgomery, at 195,818.

The biggest surprise of the estimates was the small Jefferson County hamlet of Brookside, which had the highest population growth rate of any municipality in the state at 13.2%. The town added 158 residents, bringing its total to 1,357 residents. The town has a new neighborhood under construction that appears to be drawing new residents. Small towns and cities around Huntsville and in Shelby and St. Clair counties, outside of Birmingham, saw higher rates of growth in percentage terms, as did suburban cities around Montgomery. Small towns in Wiregrass surrounding Dothan and Enterprise also showed growth in percentage terms. And several Baldwin County communities ranked near the top in terms of percentage growth.

In terms of growth in numbers, the city of Huntsville is the state champ, drawing in another 4,174 new residents in 2024. The City of Madison, Huntsville’s suburban neighbor, added 3,007, ranking third in the state in numeric growth, and Athens, which also borders Huntsville, added 1,641, ranking fourth.

The City of Foley in Baldwin County grew by 3,012, ranking second in the state in numeric terms and tying for second in percentage growth at 12%. Foley’s fellow Baldwin County city of Loxley also grew 12%. Fairhope added 1,011 according to the estimates, ranking 8th in the state. Gulf Shores and Daphne also ranked in the state’s top 20 in the number of residents added.

Cross state rivals Tuscaloosa and Auburn continue to grow with Auburn adding 1,310 to edge out Tuscaloosa’s gain of 1,272 new residents. Auburn also has the secret weapon of Opelika next door, which added 1,313 new residents in 2024. That far outpaces Northport which grew by 280. Together, Tuscaloosa and Northport have about 150,00 residents compared to Auburn and Opelika’s 120,000.

The sharp drop in overdose deaths in 2024, both nationally and in Jefferson County, wasn’t an accident, according to members of the task force that works to combat the epidemic of drug-related deaths. Instead, it resulted from public policy changes and the geographically targeted deployment of resources.

Figure 1. Trends in Accidental Drug and Opioid Overdose Deaths in Jefferson County, 2012-2024. Source: Jefferson County Coroner’s Office data.

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Thanks to those interventions, Jefferson County saw its first decline in overdose deaths since 2018. According to data from the Jefferson County Coroner’s Office, drug overdose deaths peaked in the county in 2023, with 483 accidental drug-related deaths. That is more than double the number of people who died by homicide (197) in Jefferson County in 2023. And it is more than triple the number of overdose deaths Jefferson County experienced in 2012.

Accidental overdose deaths from opioids began rising in the 1990s with the proliferation of prescription pills. That was followed by a resurgence in heroin use, which was in turn followed by the arrival of fentanyl, an extremely potent synthetic opioid. Beginning in 2020, traffic fentanyl surged into Jefferson County, resulting in a skyrocketing death toll from overdoses.

In Jefferson County, the arrival of fentanyl hit the Black community especially hard. Historically, White deaths from drug overdoses had greatly outnumbered Blacks. But by 2023, Black overdose deaths eclipsed whites.

Figure 2. Trends in Overdose Deaths By Race, Jefferson County. Source: Jefferson County Coroner’s Office data.

Health officials nationally and in Alabama have been working to catch up with the epidemic. In 2017, Governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council, which pulled together the state departments of Public Health and Mental Health, local health providers, and a broad coalition of health care providers, drug treatment non-profits, and first responders. Much of the coordinating and data-gathering work has been funded by the Centers for Disease Control and Prevention and its Overdose Data to Action grant program. According to the CDC, factors driving the decline in overdose deaths include the “widespread, data-driven distribution of naloxone, which is a life-saving medication that can reverse an overdose; better access to evidence-based treatment for substance use disorders; shifts in the illegal drug supply; a resumption of prevention and response after pandemic-related disruptions; and continued investments in prevention and response programs like CDC’s flagship Overdose Data to Action (OD2A) program.”

OD2A funding to the Alabama Department of Public Health and the Jefferson County Department of Health has supported the creation of a data-gathering and sharing program that is providing real-time information about where overdoses are occurring. Emergency medical services providers and hospitals are reporting overdose encounters as they happen, allowing public health officials to zero in on communities and even specific neighborhoods where overdoses are on the rise. Jefferson County’s Health Department has worked with the Jefferson County Coroner’s Office, health care providers, and researchers at the University of Alabama at Birmingham and other local agencies to gather, analyze, and act on the data.

With the data mapped and analyzed, partners from the healthcare and treatment community, first responders, and public health officials routinely meet to discuss patterns and develop a concerted approach to overdose prevention. Figure 3 shows the concentration of overdose deaths by zip code, for the peak year, 2023. Using the slider and directional arrows, you can cycle through years of data to see the rising numbers and shifting geographic concentration.

Figure 3. Mapping Overdose Deaths By Zip Code, by Year. Source: Jefferson County Coroner’s Office data.

Policy changes identified and lobbied for by the Overdose and Addiction Council set the stage for the interventions that appear to be driving down deaths. First, in June of 2022, the Alabama Legislature decriminalized Fentanyl test strips. Before the change, the strips that allow the detection of potentially fatal levels of the drug were considered drug paraphernalia, discouraging their availability and use.  Then, in March 2023, naloxone was made an over-the-counter medication, increasing access to the overdose-reversing treatment and allowing for distribution in the community.

In the wake of the changes and with an influx of funding from both federal and state opioid settlement money, a coalition of groups pushed out resources and training to make the life-saving resources available. The Alabama Department of Mental Health significantly increased naloxone distribution, distributing 46,482 kits at Back-to-School events, End Addiction Walks, and conferences and trainings for treatment providers serving high-risk individuals, local and rural law enforcement officers, and first responders. JCDH has an online Naloxone education portal on its website, www.jcdh.org, and sends Naloxone Kits and Fentanyl Test Strips by mail at no cost to people who request the kits through the website. In addition, JCDH provides both products through dispensing boxes at its health centers and at distribution boxes in other community locations.  JCDH also partners with local EMS, police, fire and rescue, and some independent pharmacies to provide the supplies as well.

Using Jefferson County Coroner’s data, the Jefferson County Health Department identified particular neighborhoods where overdose deaths were on the rise. To counter the trend, the department found avenues to distribute free Naloxone and Fentanyl test strips. They also launched public information campaigns, advertising the dangers of the drugs and resources for treatment services, in some cases, displaying the messages on the public transit buses that served the affected areas.

Jefferson County Health Officer Dr. David Hicks applauded the cooperation and the progress but stressed the need to sustain the effort.

“As we continue to address the challenges posed by overdose deaths in our community, it is crucial to recognize the progress we have made and the work that still lies ahead,” Hicks said. “Our collective efforts in prevention, education, and treatment are making a difference, but we must remain vigilant and committed to saving lives. Together, we can build a healthier and safer Jefferson County.”

PARCA is involved in an effort to encourage similar efforts to share, analyze, and act on data. The Birmingham-Jefferson County Justice Governance Partnership brings together county government, municipalities, multiple law enforcement agencies, schools, health providers, non-profits, and community groups to develop a common understanding and cooperative solutions to community challenges. For more information, visit the BJC-JGP website.