Is the decline in drug overdose deaths more related to the increased availability of naloxone, improved treatment for people who use drugs, or changes in the street drug supply, which while still quite toxic may be less so due to adulteration with other chemicals?
A recent article in NPR, The pipeline of deadly fentanyl into the U.S. may be drying up, experts say , speculates that the recent drop in overdose deaths being observed in many parts of the nation might be due to less fentanyl on the street. While they sight numerous experts, there does not appear to be a clear consensus.
Connecticut deaths declined by 13.7% between 2021 and 2023, but the percentage of deaths involving fentanyl were essentially the same –86% in 2021 and 2022 and 85% in 2023. It is possibly however, that while fentanyl was still present in 85% of the deaths, the amount of fentanyl in any package might have been less now that it was in 2021. For example, adding the cheaper xylazine to a batch while subtracting some of the far more expensive and deadly fentanyl would keep the percentage still testing positive for fentanyl the same. It might lead to fewer deaths, as the batch would be less potent, and the addition of xylazine, which through its sedating effects can prolong a person’s high and thus lead to fewer times having to use.
Are dealers using less fentanyl because it is cheaper to use additives or are they using less fentanyl because there are short on supply? Or maybe the drug cartels have realized it is in their best interest to sell a less toxic mix? Fewer deaths mean less heat on their organizations. Back in 2023, the Sinola organization allegedly ordered its members to stop trafficking fentanyl or face death. This appears to have just been a publicity stunt as the DEA has continued to report record seizures.
Is the fentanyl supply low due to increased seizures? Some experts in the NPR article claim that is so, but I have trouble believing this, considering the ease with which fentanyl can be manufactured and smuggled into the country.
If I had to wager, I would say deaths are down due to both increased naloxone availability (along with the hard work of harm reductionists across the country), and changes in the drug supply that may make it potentially safer (although still quite toxic). Either way, we will need a longer-term time frame to judge if this is just a temporary drop or a true turning point in the crisis.
There is no time to rest. If fentanyl is in the mix, the drug supply will remain extremely deadly and as long as people are dying of overdoses, there is more naloxone that needs to be distributed.
Carry on, harm reduction soldiers.
