In previous blog posts I have speculated about the reasons behind the stunning drop in overdoses that have occurred in Connecticut (45% since November 2021) and nationwide (40% since August 2023).
The two leading theories I subscribe to are
- Drop in fentanyl purity
- Expanded naloxone distribution and harm reduction outreach.
A recent article in Science magazine, Did the illicit fentanyl trade experience a supply shock?, argued that China’s clamp down on fentanyl precursors is largely behind the drop in fentanyl purity and the subsequent drop in deaths. They cited charts that showed the decline in purity as well as a survey of Reddit posts where people increasingly talked about a drought in fentanyl.
Here in Connecticut fentanyl has always been easy to obtain (It still sells for $2 a bag on the streets of Hartford) , but its purity has largely gone down. The reason for this I suspect is down in Mexico where they used to put say, 2X worth of fentanyl in a mix of fillers, they may have lowered it to 1X in the mix. Same amount of fentanyl kilos get produced, but the kilos are half as pure. This can explain why people can still find fentanyl, it just is not as primo as it used to be.
Two new articles out in the last week offered two novel theories.
- A research letter, Structural Drivers of the Drop in Opioid Overdose Deaths in the US, published in the JAMA Psychiatry, argues that as fewer people started using and many of those who did use died, the population of users began declining. This decline was masked by the arrival of fentanyl, which was far more lethal and led to more deaths even among a declining population. The rising deaths also lead to greater harm reduction efforts, which are now accelerating the expected decline.
- A paper, Dynamics of drug overdose deaths in the United States during COVID-19, published in the International Journal of Drug Policy, argues that the three cash distributions during COVID (May 2020, January 2021 and April 2021) led to three corresponding surges in overdose deaths as people flush with cash and nothing to do, increased their drug use and often used alone.
I think both are plausible theories. We have certainly seen the median age of people dying increasing each year, which would suggest fewer new younger users. Handy cash seems like it could produce more people buying drugs to help with the isolation of COVID.
The takeaways from the articles are:
- Just because the cartels are having trouble getting fentanyl precursors now, doesn’t mean they never will again. We should be closely monitoring the drug supply and send alarms when a rise in purity is detected.
- If the federal government cuts funding for harm reduction, deaths may still go down, but not as much as they would if harm reduction is funded.
- Next time the government wants to give a large amount of cash to people at risk for overdose they might want to think of a better way to distribute the cash.
To what degree all of these theories contribute to the decline, it is hard to be know for certain. Let us both celebrate the decline and maintain our efforts. Every overdose death is preventable.