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?
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.
And you don't SEE any issues like in the US (or UK) around here at all.
“Your child is a drug addict. They are addicted to opioids. I am the devil, without any care in the world other than making money. The choice is yours. Would you rather they inject clean heroin made by a pharmaceutical company in your country, or banish them forever as street addicts slavishly doing what it takes to score their fix?”
When facing the devil I’m voting for my tax dollars to give them clean heroin made by my country. That is what every parent wants when faced with an addicted child
Isn't it hardship when people with guns come to you and burn your fields?
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.
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.
I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies.
I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment."
Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment."
The dose increase is described in the following paragraph:
"...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability."
In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient.
Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern.
https://cpsm.mb.ca/assets/PrescribingPracticesProgram/Recomm...
Going cold turkey like you're saying he did is fine if (1) it doesn't kill you and (2) you're able to do it. For many people, it's just not very practical.
I don't think it's a good idea to demonize medical professionals for doing their jobs to the best of their abilities in the face of enormous challenges. That's the kind of thing that the conspiracy theorist and anti-science Robert F. Kennedy Jr. does, and it's not helping the US in any way at all.
Methadone is effective because it comes with lower respiratory fatigue.
If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down.
There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die.
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 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.
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.
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.
It couldn't happen "just as easily" with any other drug.
The relevant technique is called "serial dilution" and it's regularly practiced in intro level chemistry and molecular biology classes. An otherwise untrained undergrad, using only a pipette and a volumetric flask, can consistently and reliably dilute samples to nanogram per liter levels. The error accumulates as some (exceedingly small) percentage of the target value per dilution step so even after 10 or more steps the error will remain well within manageable range.
The issue is not fentanyl having a power level over 9000 or whatever other nonsense. It's people who don't know what they're doing, don't have access to a proper setup, and have no realistic way to implement a proper quality control regime manufacturing pharmaceuticals.
Fentanyl didn't kill all these people. Objectively poor public policy indirectly led to the deaths of those who violated the law just as it did during prohibition.
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.
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.
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.
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 overprescription of opioids in the US (especially in the past) is hardly a secret.
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?
That suggests a plausible alternative cause.
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.
You might have got some at a rehab centre, or someone might live with a non-addict friend or partner. Community outreach workers (in cities that have embraced this stuff) might carry some around to administer.
I would be surprised if widespread availability to Narcan didn't decrease ODs.
Sudden unlearning of aquired knowledge seems unlikely.
See: Figure 1 graph set page 4 - https://www.science.org/action/downloadSupplement?doi=10.112...
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.
That is a problem for the US, sure. Australia, where I live, has supervised shooting galleries and more of an addiction as health issue approach.
That said, if you had a chance to look at the US graphs linked above - there was a plateau period of high deaths in the US of some three and half years showing no much evidence of users learning to "safely handle and dose fentanyl" followed by a sharp decrease in deaths that corresponds more with a change in policy than an increase in user knowledge.
I would suggest this may be a somewhat more complex and multivariate issue than your initial upthread postulate acknowledges.
If we just listened to common sense instead of these people, society would be saved from a lot of pain.
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...
https://www.npr.org/2026/01/08/nx-s1-5661523/biden-made-big-...
https://www.psypost.org/sudden-drop-in-fentanyl-overdose-dea...
> 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...
The biggest takeaway that deserves stressing over and over again is that Things Take Time .. it generally takes 18 months and longer to substantially impact global flows.
The work has to be put in early, kept up in practice, and results are often credited to political actors down the road of time.
TTT - Piet Hein - https://www.circlepublications.net/grooks
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.
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).
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.
This is definitely part of the story. When your primary source of new addicts is prescription opioids and you cut down on the prescriptions then over time, as people die off from OD, then the OD rate is bound to drop.
The most tragic part of it, to me, is that it's usually the people who got clean who eventually OD. Once they've been clean for a short time then their tolerance for the drug drops drastically, then if they break down and do "just one dose" they make the fatal mistake of thinking they can still handle the same amount they were used to doing before. This exact scenario happened to multiple more or less close acquaintances of mine, even people who were aware of tolerance and should have known better. I'm fairly sure that it's extremely common.
"Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs." https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Someone who overdosed after taking cocaine contaminated with fentanyl would be counted as a cocaine ODD.
The Oxycontin "reforms" caused the fentanyl crisis to begin with. People often moved onto heroin and fentanyl because pharmaceuticals were no longer accessible. The massive spike in overdose deaths begun after the decline in opioid prescriptions. See the Opioid Prescriptions & Opioid Overdose Deaths graph here https://drugabusestatistics.org/opioid-epidemic/
If that's the case in the US as well, it could be that as a result there's more cocaine in the cocaine and fewer adulterants.
> 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.
Prescription pills have been a non-issue for a decade by now.
> 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.
Yup. I think that's exactly it.
The major reason for fentanyl deaths was not unintentional overdose because of poor pill quality. It was way too easy to end up with 1mg instead of 500mcg during pill mixture preparation. So _reducing_ the amount of fentanyl per pill results in a better safety margin. And users can just smoke another pill if one pill was not enough to get high, after all.
And yeah, it's just possible that the more reckless drug users are just dead by now. But to be clear, it's still absolutely horrible. We're still above the 2021 level.
https://www.dropsitenews.com/p/trump-maduro-venezuela-darfur...
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.
Your explanation suggests an exponential decay (ignoring aggravating conditions, like seasonal temperature, violence, ...)
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.
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.
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.
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.
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.
