Don't Credit Drug Warriors for Reducing Overdoses

While a federal crackdown reduced opioid prescriptions, the number of opioid-related deaths soared

By Jacob Sullum of Reason. 

"During their presidential campaigns, Donald Trump and Kamala Harris both promised to fight substance abuse by disrupting the drug supply. Recent trends in drug-related deaths underline the folly of that approach.

According to preliminary data from the Centers for Disease Control and Prevention (CDC), the death toll from illegal drugs during the year ending in April 2024 was 10 percent lower than the number during the previous year. This would be the largest such drop ever recorded—a striking contrast to the general trend during the previous two decades, when the number of drug deaths rose nearly every year.

Nabarun Dasgupta and two other University of North Carolina drug researchers found that the downward national trend indicated by the CDC's provisional counts was consistent with state-level mortality data and with overdose cases reported by hospitals and emergency responders. "Our conclusion is that the dip in overdoses is real," they wrote in September, although "it remains to be seen how long it will be sustained."

Does this apparent turnaround show the war on drugs is finally succeeding? Dasgupta et al. deemed it "unlikely" that antidrug operations along the U.S.-Mexico border had helped reduce 
overdoses. They noted that recent border seizures had mainly involved marijuana and methamphetamine rather than illicit fentanyl, the primary culprit in overdoses, and that retail drug prices have been 
falling in recent years—the opposite of what you would expect if interdiction were effective.

While replacing street drugs with methadone or buprenorphine reduces overdose risk, the researchers said, it did not look like expanded access to such "medication-assisted treatment" could account for the recent drop in deaths. But they thought it was "plausible" that broader distribution of the opioid antagonist naloxone (commonly known as the brand Narcan), which quickly reverses fentanyl and heroin overdoses, had played a role.

In contrast with naloxone programs, which help reduce drug-related harm, prohibition magnifies it by birthing a black market in which quality and purity are highly variable and unpredictable. Efforts to enforce prohibition increase those hazards. The crackdown on pain pills, for example, pushed nonmedical users toward black market substitutes, replacing legally produced, reliably dosed pharmaceuticals with iffy street drugs, which became even iffier thanks to the prohibition-driven proliferation of illicit fentanyl.

That crackdown succeeded in reducing opioid prescriptions, which fell by more than half from 2010 to 2022. Meanwhile, the opioid-related death rate more than tripled, while the annual number of 
opioid-related deaths nearly quadrupled.

Drug warriors, in short, should not get credit for reducing overdoses. But they do deserve a large share of the blame for creating a situation in which an annual toll of more than 100,000 deaths looks like an improvement."