Current overdose trends underscore the folly of the war on drugs

The number of deaths from illegal drugs in the United States, which has risen almost every year since the turn of the century, is expected to drop significantly this year. The timing of this reversal poses a problem for policymakers who want to prevent drug abuse by disrupting the drug supply.

These politicians include Republican presidential candidate Donald Trump, who promises to use the military against drug traffickers, and his Democratic opponent, Vice President Kamala Harris, whose platform also relies heavily on supply-side tactics. Neither candidate seems to have internalized the lessons of the “opioid epidemic,” which showed that drug law enforcement is not only ineffective but counterproductive, compounding the harm it is intended to mitigate.

In the first two decades of this century, the annual number of drug-related deaths increased fivefold, reaching a record high of nearly 108,000 in 2022. That year, illicit fentanyl accounted for 90 percent of opioid-related deaths and more than two-thirds of all drug-related deaths.

“We have addressed the drug and fentanyl crisis head-on and achieved the first reduction in overdose deaths in more than 30 years,” Trump boasts, referring to the 4 percent decline between 2017 and 2018 that looks like a blip in retrospect. The upward trend continued in 2019 and included a record 30 percent jump in 2020, Trump's final year in office.

Last year, the Centers for Disease Control and Prevention (CDC) recorded a 3 percent decline in fatal overdoses, similar to the 2018 decline that Trump cites as evidence of his success. But unlike the 2018 decline, this one appears to be continuing: According to preliminary CDC data, the death toll for the year ending April 2024 was 10 percent lower than the death toll for the year ending April 2023.

Nabarun Dasgupta and two other drug researchers at the University of North Carolina found that the nationwide downward trend indicated by the CDC's preliminary numbers is consistent with state-level death data and overdose cases reported by hospitals and emergency responders. “Our conclusion is that the decline in overdoses is real,” they write, although “it remains to be seen how long it will last.”

Although replacing street drugs with methadone or buprenorphine reduces the risk of overdose, it doesn't appear that expanded access to such “medication-assisted treatment” can explain the recent decline in deaths, say Dasgupta et al. But they think it's “plausible” that wider availability of the opioid antagonist naloxone, which quickly reverses fentanyl and heroin overdoses, has played a role.

In contrast, Dasgupta et al. find it “unlikely” that anti-drug operations along the U.S.-Mexico border have helped reduce overdoses. They point out that recent seizures at the border have primarily been of marijuana and methamphetamine, rather than fentanyl, the main cause of overdoses. In addition, retail drug prices have fallen in recent years – the opposite of what would be expected if the seizures were effective.

Supply-side policies, doomed to failure given the economics of prohibition, have not only failed to reduce drug-related deaths; they have had the opposite effect.

Prohibition makes drug use much more dangerous because it creates a black market where quality and purity are highly variable and unpredictable. And efforts to enforce prohibition only increase these dangers. The crackdown on painkillers, for example, drove nonmedical users to black market substitutes. Legally produced, reliably dosed drugs were replaced with dubious street drugs, made even more questionable by the proliferation of illegal fentanyl caused by prohibition.

This rigorous approach has succeeded in reducing the number of opioid prescriptions, which fell by more than half between 2010 and 2022. At the same time, the number of opioid-related deaths has more than tripled and the annual number of opioid-related deaths has almost quadrupled.

Trump and Harris seem unfazed by this debacle. Trump envisions “a comprehensive naval embargo on the drug cartels,” while Harris seeks to “interrupt the flow of illegal drugs.” They promise to achieve the impossible while glossing over the costs of sticking to a strategy that has failed for more than a century.

© Copyright 2024 by Creators Syndicate Inc.