Finally, A Fall In American Overdoses
But it's probably not because there is less fentanyl. It's more likely Narcan, a change of recipe, and less addicts left.
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Graphs about people dying are eerie. You see a line showing 111,725 people lost their lives to overdoses in a year and it’s hard to get any sense of what that means in human terms. You know nothing about the hundred-thousand life stories, or the mothers, sons, best-friends or lovers they left behind. Was their life mostly pain until its tragic end? Or were they full of joy but had one bad pill?
The scale of the American O.D. crisis never ceases to get me. The last decade has seen well over 700,000 people perish from overdoses in the United States. That might be the biggest drug death-toll in world history. It has garnered a lot of coverage, but considering how catastrophic it is, you would think it would be an even higher priority.
So it’s alleviating that there is finally some good news - the number of overdoses has gone down for ten-straight months and reached a decline of about 16 percent year-on-year.
I want to temper celebrations though. It means that in the latest 12-month count almost 97,000 people probably died of overdoses, still an extraordinary figure. The White House and DEA announced that 14,000 lives were “saved.” But as I will get into, that is a dubious claim.
Yet considering how bad it’s been, any respite is welcome. Which leads to the crucial question of “why?” What has made the number of overdose deaths fall and what does this mean in terms of policy to make them keep falling? This is especially important as president-elect Donald Trump just threatened to start a trade war with Mexico and China over fentanyl.
Most agree there are various forces behind the drop. “Many factors have contributed to this decrease,” says Anne Milgram, head of the DEA.
But a problem with these phenomena is that it’s hard to prove which factors were most important and people point to those they favor politically. Commentators are still arguing about what caused the decline in murder in the United States from the eighties to the noughties
In narcotic deaths, a dividing line is between those who see drug use as primarily caused by supply and those who see it as caused by demand. Broadly mapping onto these positions is the law-enforcement side and what has become known as the “harm-reduction” movement.
The DEA points to, among things, taking down cartel kingpins such as El Mayo Zambada, of the Sinaloa Cartel. The Sinaloa and Jalisco cartels are the key traffickers of fentanyl, which is found in about 70 percent of lethal overdoses. “The cartels have reduced the amount of fentanyl they put into pills because of the pressure we are putting on them,” Milgram said.
Yet there is a problem with this claim. Seizures at the border indicate the supply of fentanyl is still abundant. There is no hike in street prices one would expect from lower supply. Dealers could have reduced lethality for other reasons.
Harm-reduction advocates point to, among things, better safety measures for users. The widespread use of Narcan, a medicine that reverses overdoses, has certainly had an impact.
Both these positions, however, can miss factors that are not the result of any government policy at all. In the wild world of the drug trade, what traffickers do independently has an effect. Dealers began mixing the animal sedative Xylazine with fentanyl to make what is known as tranq-dope. Paradoxically, this could be saving lives by making users fall asleep, delaying when they take another dose.
Then there is the issue of burning through the population of hard-drug users. After 700,000 overdose deaths in a decade, there could simply be less people left to die. Neither side is keen on pointing this out because it’s sounds so horrific. But that doesn’t stop the possibility it’s true.
The Road to Overdose Catastrophe
To make sense of the fall of overdoses, we need look at their rise. At the end of the 1990s, the United States suffered less than twenty-thousand overdose deaths a year, or a fifth of current levels. Heroin was still relatively niche and largely found in subcultures in big cities, with many addicts getting hooked as teenagers.
Colin Miller knew the world as a drug user before he quit and works in drug research and outreach, currently at the UNC Street Drug Analysis Lab in North Carolina. Now 42, he has some of the most in-depth knowledge and insight into street opioid use that I have heard.
“When I started using heroin, you could not find heroin in most rural areas in the U.S.,” Colin says. “You had to live in a city. You couldn’t go to bumfuck Minnesota and find someone that has dope.”
Addiction changed drastically in the 2000s with an explosive growth in sales of legal opioids like OxyContin. As documented in lawsuits and books like “Empire of Pain,” pharmaceutical companies encouraged doctors to aggressively prescribe opioids for pain relief and created a massive pool of new addicts.
“It started to hit people that were more middle-aged, middle-class,” says Colin. “People that had worked in physical trades and been injured, people that were largely stable.”
By 2011, overdose deaths had doubled to 41,000 with legal opioids the biggest killer. As the disaster became apparent, doctors were forced to be tighter about giving out prescriptions. So addicts turned to heroin.
“People switched very quickly from pills to the heroin that was available,” Colin says. “I’ve seen people that you wouldn’t imagine as a normal heroin user, some guy in their sixties, who is completely dependent on heroin now because they got scripts for four, five, six, seven, eight years for OxyContin and then those were taken away in one foul swoop.”
Mexican cartels picked up the market, buying the raw ingredient of opium from farmers in states like Guerrero (which I write about here) and using their well-worn smuggling paths over the border. Dealers down the chain set up shop deep into rural areas to meet the new demand.
Cartels began mixing fentanyl into the heroin, which increased their profits and created a stronger product. In this interview, trafficker Dámaso “Mini Lic” López said the Sinaloa Cartel began adding fentanyl in 2013 and they called it synthetic chiva.
“We sent people who worked with us to China, and there they were introduced to everything,” Dámaso said, “from…
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