>> 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.
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)
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.
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.
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.
> 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.
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.
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.
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.
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 ?
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.
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.
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.
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.
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.
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.
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.
> 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.
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.
"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.
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.
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
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.
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.
archive: https://archive.is/C0Y0G#selection-1303.143-1303.175
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?
>> 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.
The initial spike in overdose deaths were largely caused by government crackdowns on pharma drugs.
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)
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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.
Edited slightly for clarity.
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.
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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.
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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.
It makes a great deal of sense.
> deaths dropped months before purity did
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.
> 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).
Hence, less Fentanyl = less chance of ODing.
> I’ve heard a plausible explanation
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.
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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.
The article does allude to that as possibility towards the end, even though it's not included in the paper on which its primary focus is.
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.
So the problem IS that people are putting in too much (even if accidentally) ?
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.
Surely as time goes on and wealth inequality increases, the number of people "susceptible" to deaths of despair will only increase.
But this attitude smells an awful lot like the stupid person's eugenics. Let's not cater to it.
well if you read to the end of the article you might find out.
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.
If the cost didn't go up, it can't have been a supply shortage. Even at its US peak, there wasn't much of a "fentanyl epidemic" in Mexico either.
The overprescription of opioids in the US (especially in the past) is hardly a secret.
“Even as quality worsens, prices in drug markets are sticky, so the decreasing potency probably meant people were taking less fentanyl.”
Enshittification sucks but turns out a very certain type of enshittification is actually good for society.
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 ?
Drug trade participants don't consider the long run.
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.
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 would postulate that people learning how to more safely handle and dose fentanyl would be the biggest reason for ODs to drop.
How would you explain the increase in hospitalisation, Emergency Services deployments, and fentanyl drug purity in Q1 2025 then?
Sudden unlearning of aquired knowledge seems unlikely.
See: Figure 1 graph set page 4 - https://www.science.org/action/downloadSupplement?doi=10.112...
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.
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I wonder if the eradication of the heroin supply from Afghanistan following the Taliban takeover has had an effect?
Possibly re-directed some of the fentanyl to other markets where addicts could no longer get heroin? Thus reducing supply elsewhere?
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.
Anyway, the epidemic plateaued by the start of 2022, then went down after August 2023; Source https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Why did the death rate slow down for one year, then go down many months before any sign of supply changes?
The article says that deaths peaked in mid 2023. Narcan was approved for over the counter use in March 2023.
That suggests a plausible alternative cause.
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.
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maybe all the addicts are running out? know it sounds like a troll but with very high death rates on newer drugs... is it really a crazy idea?
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.
Some of this is covered in The Hidden Cost of Trump’s Trade War on China (March 18, 2025) - https://www.nytimes.com/2025/03/18/opinion/trump-china-trade...
written by a former deputy assistant secretary for US international narcotics and law enforcement affairs.
ADDENDUM: 20 page PDF of data, graphs, suppleentary material from the original 8th January 2026 Science paper
Did the illicit fentanyl trade experience a supply shock? Kasey Vangelov et al (doi/10.1126/science.aea6130)
here: https://www.science.org/doi/suppl/10.1126/science.aea6130/su...
Different articles confirming this with multiple approaches and data points
https://www.npr.org/2026/01/08/nx-s1-5661523/biden-made-big-...
https://www.psypost.org/sudden-drop-in-fentanyl-overdose-dea...
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.
[0] - https://www.whitecase.com/insight-alert/mexico-imposes-tempo...
[1] - https://www.whitecase.com/insight-alert/mexico-reinstates-ta...
[2] - https://www.whitecase.com/insight-alert/mexico-proposes-sign...
[3] - https://www.whitecase.com/insight-alert/mexico-formalizes-an...
[4] - http://international-economy.com/TIE_Sp03_Rosen.pdf
[5] - https://www.europol.europa.eu/media-press/newsroom/news/larg...
[6] - https://balkaninsight.com/2024/07/24/fentanyl-central-europe...
[7] - https://www.brookings.edu/articles/the-foreign-policies-of-t...
[8] - https://www.occrp.org/en/project/how-a-crew-of-romanian-crim...
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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.
https://en.wikipedia.org/wiki/Piperidine#List_of_piperidine_...
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.
No, it was in doubt.
Now fentanyl is produced from readily available precursors in Mexico. In underground labs: https://www.nytimes.com/2024/12/29/world/americas/inside-fen...
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.
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So presumably Venezuela is not a factor, as the administration claimed?
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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.
https://cdn.jamanetwork.com/ama/content_public/journal/jaman...
Right, these are Biden’s policies. Biden was superior on border and immigration issues.
That’s good then the situation ought to be even better now.
> 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.
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.
"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.
I'm skeptical of that last one.
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.
A major factor is Narcan being far more available and usable by people who are not trained.
Is there a graph of the decline in overdoses with time?
Your explanation suggests an exponential decay (ignoring aggravating conditions, like seasonal temperature, violence, ...)
In the article, yes. https://d9258mdc7ql01n.archive.is/C0Y0G/696eb2f917764f004c5f...
> 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.
There is also a never ending supply of destitute and destined-to-be-destitute in America. The people may change but the problem persists.
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> to the supply of users
I think there is a word for this...
That seems the most plausible explanation.
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.
It’s nice when the government has a leader committed to keeping drugs out of the country
And offer presidential pardons to those who sell it inside, illegally
I can’t tell if GP is wry about Biden, or committing Type I error over Trump.
But yes today the questions are about how we treat politically-connected smugglers. What are the odds on a Justin Salsburey pardon?
It started 2023. who was the leader back then?
And when supply catches up, overdoses will spike because addicts tolerance will have decreased.
Perhaps the closure of the southern border a year ago might have played some role in this.
2025 is not even in the dataset so no
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
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.
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The paper is talking about a pre-trump downturn. Blowing up boats had nothing to do with it.
The article is about how overdose deaths began falling in 2023, so perhaps you owe 2023's "dear leader" an apology.
If so it is Biden who is owed the apology.
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.
hint: fentanyl doesn't travel from Venezuela to the US.
Exactly right. The article says it starts in China, travels to Mexico before being smuggled across the border.
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> dear leader
lol what, this is insane, we don't live in 1984
I'm not so sure...
Stop taking drugs, get out and enjoy life. It’s really pretty simple. Most of society works that way.
Some drugs, like opioids, create a physical addiction. Their body cannot function without the chemicals.
Saying "Stop taking the drug" to those people is equivalent to saying "Stop eating". The body cannot physically function then.
Nicotine is also a chemical that induces a physical addiction.
Surprisingly, THC (marijuana) does not, apparently... Someone can stop cold with no physical issues, only psychological ones.
Black & white thinking is easy. Nuance is hard though and might even lead to empathy.