>> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new article, published in Science on January 8th, suggests, instead, that a supply shock drove the decrease.
The supply shock sounds right.
I was volunteering at a state run institution, who had an addiction data science team, at the peak of the opioid crisis. I was developing ml models to predict patient dropout early in a 32 week program. The data and funding for such research was very scarce and it didn't go anywhere.
Treatment for opioid use disorder with medication is highly effective for 50% - 90% who respond well to treatment. The problem with the bottom 50% was early dropout, due to the lack of dissemination of proper treatment protocols and stigma attached to medication for treatment (methadone). I stopped following the work, I became too sensitive, it was pretty depressing.
The pandemic coupled with the increase in illicit fentanyl was just tragic in what it did to people. I remember reading the DEA research, where the precursor for fentanyl came from china and was manufactured and distributed from mexico. Mexico was also manufacturing high quality meth and displaced most of the meth labs in america, coming with increases in meth overdose during the same period. The fentanyl was so cheap compared to traditional heroin manufacturing.
I'm glad the supply seems to have dried up. It was nuts, what was going on a few years ago.
Channel 5 did a good piece on "Tranq" which lets China skip the Mexican part of the supply chain as they can mail the finish product straight to the US.
Since the article suggests there must have been a change in china to cause this it seems likely they just moved from fentanyl to tranq.
Lots of people were getting fent analogs straight from China. Which had me wondering. The guys that I knew that ordered/distributed it (ex-marines that had pill addictions after Iraq/Afghanistan) would get different analogs randomly I guess, and would test each batch on themselves. Some were way more sketchy than others, and they ultimate caught a case with a body from a new batch. Could the less deaths be because of the analogs in production at the time?
You can live with a sustained opioid addiction permanently without major issues. That’s the entire basis of methadone clinics - controlled dispersement of opioids at a level that solves cravings and allows the addict to be functional. It is very sad we don’t allow pharmaceutical grade opioids to be given to addicts in a controlled way, it would eliminate the purity variance that causes overdoses, and prevent the poison mixed in to increase street profits from destroying bodies (tranq, etc)
In Switzerland they can get actual, state grown, heroin. Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even.
And you don't SEE any issues like in the US (or UK) around here at all.
> Clean heroin is one of the least problematic substances appearantly, less problematic and more "everyday friendly" than Methadon even.
Least problematic is too strong of wording. Consistent opioid use will take a large toll on the body and mind. A therapeutic level of dosing could possibly be better than severe chronic pain depending on the situation, but even chronic pain patients have to deal with a range of negatives and side effects that are only tolerable because they’re less bad than their severe chronic pain.
Chronic opioid use induces a lot of changes in the body and mind. The initial euphoria isn’t sustainable, as everyone knows, but long term use induces even further changes that predispose users to deeper depression and can even begin to augment pain signals.
Opioids are in a class of drugs that are unusually deceptive because users who more or less control their dosing will talk themselves into thinking they can do this forever without real negatives. They can go for years before the cumulative negatives become too obvious to ignore.
For addicts deep in cycles of rehab-relapse extremes, going to a maintenance program and achieving stability is definitely better than continuing the cycle indefinitely. However it comes with a high price relative to sobriety. I think it’s important to not downplay the effects of being on opioids for years and years.
The comment was about heroin. Were you offered heroin?
Is cocaine and marijuana available from the government too? If not, what relevance is your comment?
Was this the first and only time you were waiting at a bus stop in Switzerland? If so, perhaps a notable story, if not then we'll need more information to conclude how bad this thug problem really is in Switzerland.
Langstrasse is as close to a red-light district as you'll find in Zurich.
It's gotten a lot better over the last couple of years, but stating that you were offered drugs there is like being offended that you walked past a casino in Vegas.
Lmao as a kiwi living in UK it's definitely a bad thing. Can't go on a night out in London without half dozen dudes trying to sell you coke. Same dudes who are waiting in alleys waiting to mug people when they get the chance.
If you ever see >1 person just standing around and not walking somewhere in London early in the morning just stay the fuck away from them. And if they start heading your way, run.
I know how annoying this can be, especially in some countries this behaviour is often directly associated with criminality. Here in Switzerland dealers are often (not always) just that, they make enough to not bother with anything else. They don't look like "dirty" junkies, they don't bother stealing from tourists, they basically don't look for any extra attention when the business is rolling anyway.
Survival bias: the police would come down on them on hard if they were scene as disrupting social order. They have to not look dirty to survive, Swiss police are no joke.
Is it too long, too little or what? Red light districts, official or not are the place to get drugs in european towns. Langstrasse is basically an official place for that, at least the most official Zurich has.
If you think cocaine and marijuana are comparable/interchangeable with heroin, you might want to educate yourself on the topic a bit more before trying to make a quip.
Imagine you are sitting in a room. Your child is in front of you. A scary man sits next to them. The man says:
“Your child is a drug addict. They are addicted to opioids. I am the devil, without any care in the world other than making money. The choice is yours. Would you rather they inject clean heroin made by a pharmaceutical company in your country, or banish them forever as street addicts slavishly doing what it takes to score their fix?”
When facing the devil I’m voting for my tax dollars to give them clean heroin made by my country. That is what every parent wants when faced with an addicted child
Its definitely easier to beat addiction if you aren't living on the street, selling everything you have and are injecting one of the most horrible shit substances but instead you are using a clean, safe alternative that is provided by the state together with prevention programs (which is usually the model for this) - how is it a false dichotomy?
Or are you someone who assumes you just need to "use willpower" and "stop" being an addict?
I assure you its not so easy with opiates.
Hordes of American soldiers were doing heroin in the Vietnam war.
When they came back to America we were expecting a massive addiction epidemic. It never happened. Overall, all the soldiers who came back lost the addiction.
Little known phenomenon about addiction that can’t be fully explained yet. What you say is true, but the person you responded to, what he says has an aspect of the truth as well. Look into it.
> Despite initial fears, high substance abuse rates during the war did not entirely translate to enduring addiction issues post-war. A year after returning home, only 10% of Service members initially detected as drug positive reported using opiates after detoxification, and just 7% reported re-addiction
> VA initially found itself unprepared for the sudden increase in drug cases.
You’re wrong, and the “historical record” you’re citing is actually the same record the NPR piece is summarizing.
What that NPR piece is pointing at is the Lee Robins follow up result that became famous precisely because it violated the folk story of heroin addiction being inevitably chronic. A later review of Robins’ findings summarizes it bluntly:
In Vietnam, high heroin use and dependence. After return, only about 10% tried heroin, and only about 1% became re addicted in the first year.
Now compare that to the VA history page you linked as a “gotcha.” It says the same thing in slightly different numbers:
One year after return, 10% reported opiate use, and 7% reported re addiction.
So no, “not entirely” and “7%” are not a refutation. They are the punchline.
You can argue about whether it is 1% or 7%, depending on definitions and measurement, but the qualitative point survives trivially: it was nowhere near the relapse pattern people expected for heroin addiction, which is why NPR is telling the story in the first place.
Your OUP line about some vets shifting to other drugs is also not the contradiction you think it is. “Some people continued using substances” does not falsify “heroin dependence largely remitted when the environment changed.” Those are different claims. If anything, substitution strengthens the “context and cues matter” thesis, because it implies the Vietnam setting was uniquely good at sustaining heroin use, not that heroin had permanently rewired everyone’s brain.
Also, “VA was unprepared” is about bureaucracy, not epidemiology. The VA being behind the curve tells you the system wasn’t ready for the volume of cases showing up at the door, not that “everyone stayed addicted forever.”
If you want to be precise, the correct statement is:
Most soldiers who were using heroin in Vietnam did not remain heroin addicted after returning home, and relapse was low relative to expectations, which is exactly why this became a canonical example in the first place.
There is also very often a psychological aspect, which explains why some addicts are able to stop "cold turkey" if the psychological/contextual aspect of their addiction changes.
Usually the fastest and most effective way out of an addiction is medication assisted treatment, which means having a doctor control your dosage with a clean supply of the drug or a less addictive substitute that targets the same receptors.
The problem is not the opioids themselves as a chemical. They are tolerated well and have minimal side effects. The main issue is that street opioids are of uncertain purity, and cut with toxic chemicals. This causes overdoses when a batch is too strong, and various health issues from the harsh toxins.
A properly managed opioid addiction can be permanent. For a decade millions of Americans were addicted to opioids (OxyContin, Vicodin, etc.) prescribed by doctors. When the state cracked down they were forced to go on the street to get their medicine, which is when the opioid crisis exploded
And we learned zero from the change after shutting down the Purdues. The electorate just wants to see drug users punished, not treated. Even though treating cheaper, more humane, and has way better outcomes.
I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw:
I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid.
Well, addiction or not, the main question is what medics call "quality of life" -- whether a patient can life their life to the full potential.
There are millions of people addicted to caffeine, the most popular psychoactive substance in the world, but as it usually doesn't prevent them to live their life and "be a productive member of society", no one cares of treating caffeine addiction, save for religious societies.
My point is -- is methadone addiction "better" than fentanyl in that regard? If yes, than that's ok.
My complaint was about the forced increasing of dosage. They literally would not allow the patient to wean off of it. So yes, it might be an improvement over the shit on the street but it's diabolical that they force patients to continually increase their dose rather than gradually decreasing it.
I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies.
> They literally would not allow the patient to wean off of it
If true that clinic needs to be reported. Patients have a right to taper down and exit treatment.
When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.
So that maybe why the clinic was firm about trying to increase you friends dose.
OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry.
> Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.
How does this work? Naively, I'd expect addicts to up the dose of the "other substances" if they can't reach their high. Or does methadone outright "block" the other substances' effects?
To answer my own question: what you described sounds like part of the standard recommended protocol, and it seems likely your friend misunderstood or misrepresented that.
I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment."
Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal
effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment."
The dose increase is described in the following paragraph:
"...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability."
In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient.
Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern.
It's possible my friend wasn't telling me the whole story or just misunderstood the program. I don't think he was actually trying to stay addicted though because after a few weeks on methadone (with increasing doses and doctors telling him that he would always be an addict for life) he decided to take the more extreme route of getting clean by quitting cold turkey. He moved to a different state and cut ties with every possible source he had to acquire the drugs.
And yet, you're comfortable accusing the people trying to cure addicts of some diabolical plot to ensnare them into permeant addiction in order to make money off them forever. Maybe next time you'll think before you propagate nonsense.
This is certainly possible, but it sounds more like what AA tells its clients. Doctors are less likely to say things like this, because it can have consequences for them.
Going cold turkey like you're saying he did is fine if (1) it doesn't kill you and (2) you're able to do it. For many people, it's just not very practical.
I don't think it's a good idea to demonize medical professionals for doing their jobs to the best of their abilities in the face of enormous challenges. That's the kind of thing that the conspiracy theorist and anti-science Robert F. Kennedy Jr. does, and it's not helping the US in any way at all.
Not that I'm aware of, it seemed rather arbitrary. The people who had been going to that clinic for a while all had massive doses, almost to a ridiculous degree. My perception was that it was to keep them hopelessly addicted. I was only peripherally involved as it was my friend who was the patient. He was very fortunate to have family with influence in the Mormon church - his family had the church send some local missionaries to help him - and they genuinely did help him escape that terrible situation.
Methadone is effective because it comes with lower respiratory fatigue.
If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down.
There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die.
In Switzerland there is state grown heroin because it should be even less quality of life inferencing than most other alternatives. They do this for a long while now and it works, most people have jobs and you couldn't tell they get daily heroin in the best quality you could imagine (for free)
Dude, caffeine ain't no heroin. I drink 2-3 coffees a day and skipping this (ie traveling on vacation, easily for a week or two) does 0 to my body, mind or sleep. I just don't feel the effect at all, I drink it purely for the taste.
There is no human in this world who could say something similar about heroin.
If people were aware in how many ways caffeine messes up a lot of people there would be. Exhaustion, migranes, anxieties, twitching, insomnia, mental issues to name a few. Most never attributed to caffeine but mysteriously going away after a person manges to kick the habit.
Your argument seems to be missing the fact that methadone clinics are serving people with an existing addiction. They didn’t create that addiction, but they can fill the desire created by that addiction in a safe manner.
The ideal situation is the client leverages methadone into a recovery/remission from addiction - but that can be incredibly hard for them to do.
If someone is addicted to ice cream, and the most effective treatment is to replace that addiction with spinach(scientifically supported), would anyone have this problem? I doubt it. People’s knee jerk reaction to any kind of “”””drug enabling”””” treatment is infuriating.
I know multiple people personally who have had their life saved by methadone. Yes that makes me biased but it also justifies the bias (alongside the many medical professionals advocating for it)
Even still today there is no reliable place to source black tar or China White or any of the traditional opium derivatives without having a fentanyl cut.
Isn't this more because the supply of poppy was cut off when the US pulled out of Afghanistan? Users want the good stuff, dealers buy the cheap and available stuff and pretend it's real.
poppy/opium/heroin production has shifted to myanmar, but there has been less production, and the synthetics are much cheaper ,so that reduces profitability for poppy
Afganistan, have set up addiction centers, where addicts are put, but it's cold turkey.
Opium poppy production is bieng eradicated
in Afganistan ,and penaltiys for drug smugglers and dealers will escalate, but a quick search shows the increadable synicism of the western press who are spinning it as "hardship for Afganinstans farmers"
I wonder how this compares to the common western situation of livestock culls. Presumably there is compensation in some cases and not in others (poppy cultivation being illegal). I suppose it's at opposite ends of a scale.
The claim that fentanyl death rates are decreasing because fentanyl products are less pure does not make much sense. Even on their provided charts, deaths dropped months before purity did.
The article points to a 50% decrease in purity, which a habitual user would compensate for by taking twice as much. Lower average purity also increases the risk of inconsistent purity, where rare batches are unexpectedly strong and carry high accidental overdose risk. Less pure fentanyl floating around might mean lower chances of unsuspecting non-fentanyl drug users being poisoned with it, but it's hard to see how this could cut into overall overdose cases.
That's a plausible lag: credible purity figures are not sourced from Mexican drug cartels. They come from laboratories at the end of a long chain of custody complicated by legal machinations, dealing with contraband having no provenance beyond its date of seizure. That it takes only "months" to wend its way though the byzantine and corrupt legal system, and the bankers hours academic process of laboratory professionals, is actually admirable.
> which a habitual user would compensate for by taking twice as much
Habitual users are operating in a market, seeking value. They cannot afford to simply double their spend, and I'll give you one guess as to how quickly purity drops are reflected by price drops in the narcotics business, because that's all a person of sound mind should need.
No, when the purity dropped, users paid the same and got less, and died less. Believe me, I understand why this finding is unwelcome: it serves to put arrows in the "drug war" quiver, and that is anathema, in my mind as well. But knee-jerk thinking, ultimately, isn't helpful. Further, I have complete faith that the ability of drug dealers and drug users of America to produce disturbing body counts will not be diminished for long.
> They come from laboratories at the end of a long chain of custody complicated by legal machinations, dealing with contraband having no provenance beyond its date of seizure. That it takes only "months" to wend its way though the byzantine and corrupt legal system, and the bankers hours academic process of laboratory professionals, is actually admirable.
But... this relies on the idea that the purity numbers are based on "time of test" not "date of seizure". This seems like a pretty obvious thing they would have accounted for. Do you have any evidence that the published data for purity levels is delayed by several months?
> this relies on the idea that the purity numbers are based on "time of test" not "date of seizure"
No, the idea doesn't rely on "time of test" vs "date of seizure". There is no real provenance for any of this. There is no auditable trail for when any given batch of narcotics was manufactured, when it appeared in the US, how long it took to disseminate to domestic dealers, when it may have been further cut by domestic dealers, when it was sold, and when it was actually used. Even the seizure dates are dubious, given haphazard and inconsistent law enforcement handling and record keeping. There are also sampling biases, because some legal jurisdictions and law enforcement organizations are more or less cooperative than others.
All I claimed was that a delay was plausible. I am not obligated to become a narcotics market researcher in defense of my modest claim, and given the nature of all this, no amount of such effort is likely to be sufficient for you in any case.
> article points to a 50% decrease in purity, which a habitual user would compensate for by taking twice as much
I’ll be first to admit I’m generally pretty ignorant on this topic but I’ve heard a plausible explanation for how Fentanyl is actually used.
A medical professional shared with me that Fentanyl is too potent to be consumed as is. So generally, dealers use it as an additive. They lace other drugs with trace amounts of to make them more addictive. It’s the MSG of drugs.
So while ODing on say, drug A is possibly with 5 uses at once. When laced with Fentanyl, a person might OD in just 3 uses (because Fentanyl is much more potent than the actual drug the user bought).
To be blunt it was total bullshit. Pharmaceuticals have an extremely wide range of dosages. Fentanyl is on the extreme low end, benadryl an adult might take 25 mg or 50 mg, tylenol an adult might take 500 mg, and something like amoxicillin an adult might take as much as 3000 mg for a severe infection. There are standard, extremely reliable ways to prepare pills that contain the correct dosage regardless of the potency of the pure chemical.
Obviously fentanyl (or its precursor) is imported (ie smuggled) in highly pure form in order to minimize the size of the shipment. Obviously it can't be consumed in that form.
The combination of being potent and cheap to smuggle lends itself nicely to cutting other (more expensive) products with it. That's false advertising but it won't typically kill you in and of itself.
When laymen who don't know what they're doing, don't have access to proper facilities, and certainly can't set up proper quality controls process something that potent it's no wonder that things go wrong and people die. If (for example) the same victims had purchased fentanyl from a pharmacy (as opposed to whatever it was they thought they were consuming) they almost certainly would not have had any issues. Almost no one ODs intentionally.
The point is that it's not "fentanyl is toxic so you OD" it's "the person compounding the pill messed up the dosage, you took more than you thought, so you OD". This could happen just as easily with any other drug. The danger here is due to pills not containing the dosage that the consumer believes them to.
Other drugs aren't dosed in micrograms. It's pretty believable that street labs don't having the precision to get reliable dosing in such small quantities. 50/100mcg is the typical ambulance dosing of fentanyl (where it's often used as the primary painkiller) - so at 500 times smaller than that of benadryl, it would take a reasonably high-end lab (at least by mid-level drug dealer standards) to not wildly mess up the dosing all the time - even if you mixed at larger scales, that still doesn't easily guarantee a uniform blend.
It couldn't happen "just as easily" with any other drug.
LSD is dropped onto paper in solution though. So to control dose is easy since you can easy halve a dose by doubling the volume of solution. Dosing a powder/crystal is much more difficult, especially if you need to get it back out of solution.
LSD is a powder/crystal (a salt). People just don't consume opioids orally, usually. There's something similar though: skin patches, since (other than LSD) fentanyl can be absorbed through the skin.
That's "pretty believable" but it's also complete bullshit. Why do you feel it necessary to comment in an authoritative manner when you don't know what you're talking about? It's literally spreading misinformation.
The relevant technique is called "serial dilution" and it's regularly practiced in intro level chemistry and molecular biology classes. An otherwise untrained undergrad, using only a pipette and a volumetric flask, can consistently and reliably dilute samples to nanogram per liter levels. The error accumulates as some (exceedingly small) percentage of the target value per dilution step so even after 10 or more steps the error will remain well within manageable range.
The issue is not fentanyl having a power level over 9000 or whatever other nonsense. It's people who don't know what they're doing, don't have access to a proper setup, and have no realistic way to implement a proper quality control regime manufacturing pharmaceuticals.
Fentanyl didn't kill all these people. Objectively poor public policy indirectly led to the deaths of those who violated the law just as it did during prohibition.
Fentanyl isn't too potent to be consumed as-is, but the dosage is very very small. The amount of fentanyl that will kill you is literally invisible. The LD50 appears to be well under 0.01mg/kg (that is, a milligram will kill a 220lb person).
British Columbia declared the toxic drug crisis an epidemic in 2016, with the amount of deaths amounting to 6-7 a day through this period until now.
The article's theory is compelling but given the incredible amount of deaths, thousands upon thousands of deaths in BC alone, I wonder if the rate of death is declining simply because we're running out of people to kill with our indifference.
Killing addicts more quickly than creating new ones would indeed eventually lead to a decrease in drug related deaths. I would really believe this because I know of multiple people that died from ODs in a fairly short window 4-5 years and that spans a range of about 12 years of people. As in to say everyone I know age 24-36 about half of those people that were opiate users died from about 2019-2023 due to fent. All of them that I know the details of were from fake pills too, so very much related to fentanyl.
Long term you couldn't kill more than existed, asymptotically the maximum number of ODs per unit time would be exactly equal to the number created, impossible to be more.
> running out of people to kill with our indifference.
I wouldn't call it indifference. It's the drug policies that we've very intentionally adopted in the west that result in people purchasing from the black market. It's about as indifferent as the deaths due to denatured alcohol poisoning during prohibition when the additive was silently switched.
We know these policies result in mass deaths; we know other policies result in many fewer deaths; we choose the former policies.
I think that is partly because enough people consider those addicted to drugs to be subhuman - enough don't care much what happens to the addicted people. IMHO in that's because we a large political movement encourages indifference to those different from us, whether the difference is race, politics, gender/sexuality, nationality, or anything else.
Could this effect actually be more of a customer service effect?
Drug dealers were lacing things with fentanyl to make them more addictive. They were putting too much in and killing people by accident. This was bad for business in 3 ways
1) they could have saved money by using less fentanyl
2) they were killing their customers, as well as reducing the customer base this has a reputational risk.
3) They were attracting too much public interest in their activities
Therefore they found that they make more money by putting less in.
Not a drug expert, don't live in US, never took fentanyl. I just picked these 'facts' out of the comments. Before anyone says, 'you don't know what to you are talking about' in the sweet way that has crept into hn, I really don't, and don't claim to.
The problem with fentanyl is not that people are putting in too much. It’s that it’s extremely potent so it’s too easy to accidentally put too much in.
The problem is that the typical delivery mechanism for this drug is a highly-dilute injection or transdermal patch - not 'geometric' dilution into pills in Jose's basement with questionable fillers.
The substance is too potent per physical unit of weight and volume to be conveniently dosed through other means.
Maybe they completely reversed the causality, it's a demand shock not a supply shock. There are less users because they died, and they died pretty fast compared to previous opioid users. As demand diminished there was over supply and to maintain their margins provider had to lower the supply. QED.
As it's a pretty simple hypothesis to test and that it was not maybe imply that the conclusion is politically motivated. Supply-shock imply that something was done and it worked, but that the problem solved itself is not as palatable for someone politically motivated like an administration.
What happened to the theory that the deaths were decreasing because we burned through our buffer of people susceptible to deaths of despair? That always seemed reasonable to me.
Wealth inequality doesn't cause this kind of despair. We have the greatest wealth inequality in history, but also the objectively best quality of life in history by most metrics (extreme poverty, hunger, starvation, death from disease, infant mortality...)
It does not matter to me if Elon Musk makes another billion dollars if I am making more as well. That does not cause "despair" to a well adjusted person.
Extreme poverty on the other hand (which has been decreasing) does cause these deaths. When people have nowhere left to go and no hope, they to turn to drugs.
Mental illness is another cause. I wonder if we should have gotten rid of asylums.
If bothers me if he spends that money exerting an outsized influence on my political institutions, though. Wealth inequality isn't really about wealth so much as power. I really don't care if Musk or anyone else lives more comfortably than me, but I do care if they have more than one figurative vote in how my society functions.
That example of "shrinkflation" sounds like plain old fraud to me. Having a dimple at the bottom of a peanut butter container so it looks like it has more than it does should be illegal fraud, plain and simple.
the containers say how much volume they have and usually are sold with a unit price as well. seems like a much simpler and general solution than defining some legal shape of jars
I don't know - its very easy to buy what looks like the same jar and find it has less. The consumer should not be expected to be some fucking food detective, constantly working to make sure that they aren't being ripped off. Packaging should be simple enough that the volume presented to the purchaser is the actual volume.
The real issue is that those dimples prevent you from getting the last bit. I also find it very annoying that in Canada quantity is often reported in ounces. Aside from the troy ounce, i have absolutely no idea how much an ounce is and whether it measures volume or mass. The only reason we still have ounces is because of trade with the US. Since no Canadian should be buying US made stuff, we should just ban most non metric units at this point.
How good is overdose _deaths_ as an indicator of the epidemic of drug consumption ?
My point being : killing your customer en masse is bad business practice in the long run. (Or even in the medium run.)
So, the drug dealer's best interest is to reduce the potency of the drug, therefore limiting the overdoses but keeping the customers alive, and willing to get the next dose.
If it happens when the prices are high, and you're able to cut your product and see it with a higher margin, it's even more value for the sharehol... Sorry, wrong analogy.
Anyway, is the number of people _using_ fentanyl also going down ? Where are the quarterly sales number published ? What's the trend ? When is the IPO ?
Changes in purity, especially when unknown to users, is going to affect hospitalizations and such no doubt, but the people using it also adapt to the purity of a drug over a longer timespan.
Even if people wanted to its not like they can all just bring a sample of their old heroin and a sample of their stronger high fentanyl laced heroin and test their purity and calculate dosages. Which is part of the problem of the war on drugs, many methods of harm mitigation and recovery are barred from users and 90% of their drug information is based on hearsay or personal experience.
> part of the problem of the war on drugs, many methods of harm mitigation and recovery are barred from users
That is a problem for the US, sure. Australia, where I live, has supervised shooting galleries and more of an addiction as health issue approach.
That said, if you had a chance to look at the US graphs linked above - there was a plateau period of high deaths in the US of some three and half years showing no much evidence of users learning to "safely handle and dose fentanyl" followed by a sharp decrease in deaths that corresponds more with a change in policy than an increase in user knowledge.
I would suggest this may be a somewhat more complex and multivariate issue than your initial upthread postulate acknowledges.
The reporter rightly queried other researchers about this article, and all of them were skeptical that a "supply shock" could be the cause, or even the main cause. My own skepticism is because the death rate went down many months before any sign of shortage appeared.
I haven't read the paywalled Science paper, but The Economist extracted a graph which shows that the purity of Fentanyl pills was stable till the first months of 2024, then dropped sharply. The purity of the powder peaked in 2023, then went down in 2024, back to its older levels. They suppose that it proves the supply was short, but another researcher even states that the supply of Fentanyl precursors didn't change until the end of 2024.
What is your supposition here? That addicts are keeping narcan around just in case? That good friends of addicts are standing by with the spray in case it is needed? That your local opium den had staff with it on hand?
Narcan should be available, but short of a few users that know they need to keep it around, I don’t buy that making it available has meant a significant change in total outcomes because of timely deployment.
You might have got some at a rehab centre, or someone might live with a non-addict friend or partner. Community outreach workers (in cities that have embraced this stuff) might carry some around to administer.
I would be surprised if widespread availability to Narcan didn't decrease ODs.
Yes to all of the above. I knew of addicts who managed to get their hands on it many years ago when it required a prescription. Most weren't that resourceful though.
This suggests to me that the government could reduce this even further by simply outcompeting with illegal sources.
One problem mentioned was that other drugs were being laced with fentanyl. Simply supply a licensed, guaranteed clean version through a legal source at a lower price?
Then people who want actual fentanyl, supply that in the same way too.
Coffee is legal in my country, but I don't drink it. Alcohol is legal, but I drink it infrequently and in moderation. I can get codeine over the counter, but I don't take it every day.
The kneejerk explanation would be the more strict border and law enforcement under the current administration. But the chart peaks in Dec 2023 and drops in 2024, so it cannot be that.
Perhaps, then, it was Kamala Harris' success as border czar under Biden.
I thought this was already well-established public information? That fentanyl came mostly from China was never in doubt, what people were arguing about was whether this was happening with the tacit approval of the Chinese government. Then in 2023 China cracked down on it, and supplies dried up. Whether that was because it was a big enough issue to get their attention, or it was on purpose and they decided it was no longer serving their interests I suspect we'll never know, but I definitely read multiple articles in 2023 about the fentanyl crackdown in China.
Biden era cooperation with China on the issue was at the heart of this.
It wasn't about the direct supply of Fentanyl, or even (by that stage) the direct supply of Fentanyl precursor drugs .. (that gangs used to industrial shed chem lab into Fentanyl) ... this was cutting back and limiting bulk supply of the precursor precursors to shady onselling networks to starve the labs.
Was going well (as per the paper) until US / China relations went in the toilet.
Mexico also began enacting extremely heavy handed tariffs against China and other Asian exporters like South Korea, India, and Vietnam in 2023 onwards [0][1][2][3] in order to protect their domestic manufacturing capacity against an export-driven supply shock, which hit Mexico really badly in the 2000s [4].
> Was going well (as per the paper) until US / China relations went in the toilet
Yep, but as long as Mexico continues to enact trade barriers to protect against an Asian export shock, the APIs needed for synthesis will remain difficult for organized crime to acquire.
Already, cartels have begun tariff arbitraging by targeting the CEE and the Balkans as a new base for synthetic opioid operations [5][6][7], especially because Romanian [8] and other CEE gangs had been collaborating with Mexican organized crime on financial and human trafficking crimes in Mexico for over a decade now.
The biggest takeaway that deserves stressing over and over again is that Things Take Time .. it generally takes 18 months and longer to substantially impact global flows.
The work has to be put in early, kept up in practice, and results are often credited to political actors down the road of time.
People are always talking about this precusor from China, but I have no idea what this precursor is. Are they chemicals that are useful for lots of things or is it only useful for this? Because if it is the former, then China is just selling regular ass legal chemicals because they are the worlds number 1 supplier of manufactured goods.
Fun fact: The "traditional" way of making it was extracting piperine from black pepper and reacting that with nitric acid. Nowadays it's made in other more industrial scalable ways.
But yes, the same base precursors (and their siblings) are used to manufacture ADHD meds (ritalin/concerta), antidepressants (paxil), insect repellents (picaridin/bayrepel), hair loss medications (rogaine), allergy meds (claritin), anti-psychotics (haldol), anti-diarrhea meds (imodium), and many others. And also PCP.
So it's non-trivial to prevent. The core of the issue is that the one pot Gupta method came about in the 2000s and it made it extremely easy to manufacture fentanyl using these basic building blocks for so much of the pharma industry. Not only just making it easier to source ingredients but it took out all the steps and made the process easy as hell as well.
The challenge in international drug operations was not to get China to stop selling bricks to house builders to but get China to cooperate in stopping the sale of bricks to groups that only use bricks to throw through windows and at heads.
Fentanyl is so potent that just one lab can easily satisfy all the US demand with it, around 10kg a day. That's also why it's ridiculously hard to fight, one smuggled barrel of pure product can supply the entire US for months.
So no, there is no "supply shock". There's just more free Narcan (naloxone).
Cocaine death decreases is the hard thing to explain with either theory, supply or naloxone. Fentanyl supply doesn't affect cocaine in any way and naloxone doesn't work on a cocaine OD.
Maybe some percentage of cocaine deaths are misattributed fentanyl deaths?
I also wonder if there's any link to the Oxycontin reforms. Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.
Or maybe it's actually that the drug dealers have gotten more careful. Drug dealers don't want to kill their clients, so maybe they've been purposefully diluting to make sure they get repeat customers.
> Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.
This is definitely part of the story. When your primary source of new addicts is prescription opioids and you cut down on the prescriptions then over time, as people die off from OD, then the OD rate is bound to drop.
The most tragic part of it, to me, is that it's usually the people who got clean who eventually OD. Once they've been clean for a short time then their tolerance for the drug drops drastically, then if they break down and do "just one dose" they make the fatal mistake of thinking they can still handle the same amount they were used to doing before. This exact scenario happened to multiple more or less close acquaintances of mine, even people who were aware of tolerance and should have known better. I'm fairly sure that it's extremely common.
"Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs."
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Someone who overdosed after taking cocaine contaminated with fentanyl would be counted as a cocaine ODD.
The Oxycontin "reforms" caused the fentanyl crisis to begin with. People often moved onto heroin and fentanyl because pharmaceuticals were no longer accessible. The massive spike in overdose deaths begun after the decline in opioid prescriptions. See the Opioid Prescriptions & Opioid Overdose Deaths graph here https://drugabusestatistics.org/opioid-epidemic/
Pure cocaine overdose deaths are relatively rare. Only around 5% of cocaine deaths involved pure cocaine, it's almost always mixed with something else.
> I also wonder if there's any link to the Oxycontin reforms. Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.
Prescription pills have been a non-issue for a decade by now.
> Or maybe it's actually that the drug dealers have gotten more careful. Drug dealers don't want to kill their clients, so maybe they've been purposefully diluting to make sure they get repeat customers.
Yup. I think that's exactly it.
The major reason for fentanyl deaths was not unintentional overdose because of poor pill quality. It was way too easy to end up with 1mg instead of 500mcg during pill mixture preparation. So _reducing_ the amount of fentanyl per pill results in a better safety margin. And users can just smoke another pill if one pill was not enough to get high, after all.
And yeah, it's just possible that the more reckless drug users are just dead by now. But to be clear, it's still absolutely horrible. We're still above the 2021 level.
Revealed preferences suggest otherwise and that matters because he says a lot of things, often contradictory.
Is it just another Epstein diversion maybe?
Oil story doesn't stack up though:
- it's heavy sour oil, the tar like substance isn't economically extractable without an almost doubling in barrel price
- cheaper (existing infra) sour supply chain with Canada already meets US shale light sweet oil blending needs for a long time
- decided on maintaining stability of existing Venezuelan regime over supporting regime change
One thing that lines up so far is it does seem to be disproportionately effective at displacing column inches spent on the pending bringing to justice of Epstein entangled elites. Disproportionately because that pursuit of justice seems quite resilient in resisting partisanship breakdown.
"Supply shock" might not be the only, or even primary cause. As far as I know fentanyl is still widely available and inexpensive.
My guess is only a subset of the population is willing to both A) Use a substance like street fentanyl with known lethality. and B) Do so in a risky and unsafe manner (alone, no narcan, shooting instead of smoking, etc. etc.).
That subset of the population has already been decimated to the point we are seeing a decrease, and survivors have become more educated on how to use without dying.
My dad was a heroin addict, and while he eventually got (mostly) clean, he wryly joked to me once "you know there aren't a ton of old heroin users for a reason"
Using street drugs kills - we can put people on opiates if done in a controlled way, for the rest of their lives, we instead have gone down the road of prohibition, closing off pathways for people to get maintenance dosing of opiates.
> fentanyl powder and pills were losing potency just as overdose deaths were falling
Combined with the already dead, does this not explain things?
Illegal drug suppliers don't make money by killing their customers. Consequently, they finally got control over the potency throughout their supply chain.
Although, I'm more interested in the standard deviation of the potency than the absolute value of the potency. I suspect that is much more correlated with OD deaths.
Just a different form of supply shock - to the supply of users.
Living in downtown SF for the last two years has made it painfully obvious those using fent on the streets are not long for this world. It'd an inherently self-solving problem, grim but true.
Not all (probably not even most) destitute people become opiate addicts. People become destitute because they are opiate addicts, it's not the other way around.
The article says something along these lines. Every pandemic has a peak point when people become alarmed, and there is a clear way to avoid contamination.
It happened with AIDS when people began stopping having risky relations. It is only natural that it would also happen in drug addiction when everyone sees its devastating effects.
The same thing might be happening to tobacco and alcohol consumption.
Deaths for lack of vaccines (e.g. measles) will also behave the same way. When people see very explicitly that risky behaviour has consequences, they think twice before doing it.
> When people see very explicitly that risky behaviour has consequences
With much emphasis on the "very explicitly" part.
It seems to only work that way when it is very explicit and rapid consequences. Abstract consequences far in the future are not very effective at deterring [ entertaining | desirable | fashionable | profitable ] behavior.
"The same thing might be happening to tobacco and alcohol consumption."
I believe the data on smoking was the opposite. Showing people the terrible consequences of smoking (including very graphic images) turns out to have minimal or no effect. There was a large randomized trial in the pacific northwest some decades ago. A lot of people now point to taxes as the main driver in the decrease.
tldr; "China began warning chemical/pharma companies, closing down websites & tightening chemical controls in 2023. It is likely if not certain that China’s actions disrupted the fentanyl trade in both the US and Canada"
tl;dr blowing up boats in the Caribbean and other aggressive actions, while controversial, has probably done more to address the drug pandemic than other things tried.
Not the boats for this study (though they may help in the future ).
From the article:
“About 70% of American overdose deaths are caused by fentanyl, a synthetic opioid. Networks shift, but currently most American street fentanyl starts as building-block chemicals produced in China. Those are shipped to Mexico, where drug gangs formulate them into fentanyl and smuggle it across the border.”
The stronger border is optimistically placing more control of the problem in US hands.
So, statistics clearly show that limiting drugs supply actually works, unlike what the hard left has been saying to us (backed by social “sciences”) since the 2000s?
If we just listened to common sense instead of these people, society would be saved from a lot of pain.
I wonder if Trump pardoning multiple drug dealers will also help. MAGA doctors must have figured out that drugs from political allies or “donors” are doubleplusgood for Americans. /s
Gee I wonder why. Maybe controlling your borders actually helps prevent illicit goods from entering your country? Crazy take I know, can’t be true because it’s the T man that’s behind it
This has been talked about lately, the drop has nothing to do with trump. The data in this chart goes up to Oct 2024, several months before trumps took office.
The reasons stated in the article have nothing to do with border enforcement, and observed supply shock started before 2024. The most recent year of data mentioned in the article ended in April 2025. But by all means, if you have information these researchers don’t, feel free to share it here.
> Canada has a similar opioid epidemic but a different supply chain, largely skipping over Mexico. Because Canada saw similar falls in fentanyl strength, the researchers hypothesise that the supply shock was caused by something changing in China.
this is my best guess for the research cited (paywalled): https://www.science.org/doi/10.1126/science.aea6130
If true, the next question is what caused the supply shock?