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.
Least problematic is too strong of wording. Consistent opioid use will take a large toll on the body and mind. A therapeutic level of dosing could possibly be better than severe chronic pain depending on the situation, but even chronic pain patients have to deal with a range of negatives and side effects that are only tolerable because they’re less bad than their severe chronic pain.
Chronic opioid use induces a lot of changes in the body and mind. The initial euphoria isn’t sustainable, as everyone knows, but long term use induces even further changes that predispose users to deeper depression and can even begin to augment pain signals.
Opioids are in a class of drugs that are unusually deceptive because users who more or less control their dosing will talk themselves into thinking they can do this forever without real negatives. They can go for years before the cumulative negatives become too obvious to ignore.
For addicts deep in cycles of rehab-relapse extremes, going to a maintenance program and achieving stability is definitely better than continuing the cycle indefinitely. However it comes with a high price relative to sobriety. I think it’s important to not downplay the effects of being on opioids for years and years.
The same thinking that fueled the "Just Say No" and "this is your brain on drug's" campaigns in the 80s/90s. Because we all know that cutting off access via stone cold sobriety and absolute illegality under the law is the right solution.
I’m trying to counter the idea that a consistent heroin dependence is the “least bad substance” when there are clearly numerous drugs that are much less toxic over the long term.
I said nothing about best techniques for dealing with people who have addictions. My goal is to avoid having being read these comments and think that because they’re smarter they’ll be able to handle and benefit from a stable opioid dependence. It’s exactly how one of my friends got started
Is cocaine and marijuana available from the government too? If not, what relevance is your comment?
Was this the first and only time you were waiting at a bus stop in Switzerland? If so, perhaps a notable story, if not then we'll need more information to conclude how bad this thug problem really is in Switzerland.
It's gotten a lot better over the last couple of years, but stating that you were offered drugs there is like being offended that you walked past a casino in Vegas.
If you ever see >1 person just standing around and not walking somewhere in London early in the morning just stay the fuck away from them. And if they start heading your way, run.
Got my car totalled on the m40 by a teen with a license of 6 months who was clearly on his phone - that one I was for sure lucky, could've easily been the end of me. The police? Didn't even show up. My police report that I filled out while still shaking got a response letter of "We don't care m8".
“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
You (wrongly) assume there’s no way out of an addiction, for example.
Or are you someone who assumes you just need to "use willpower" and "stop" being an addict? I assure you its not so easy with opiates.
Hordes of American soldiers were doing heroin in the Vietnam war.
When they came back to America we were expecting a massive addiction epidemic. It never happened. Overall, all the soldiers who came back lost the addiction.
Little known phenomenon about addiction that can’t be fully explained yet. What you say is true, but the person you responded to, what he says has an aspect of the truth as well. Look into it.
This does not seem to be born out by the historical record.
> https://department.va.gov/history/featured-stories/borne-in-...
> Despite initial fears, high substance abuse rates during the war did not entirely translate to enduring addiction issues post-war. A year after returning home, only 10% of Service members initially detected as drug positive reported using opiates after detoxification, and just 7% reported re-addiction
> VA initially found itself unprepared for the sudden increase in drug cases.
Please note the "entirely" and "7%".
Also: > https://academic.oup.com/aje/article-abstract/99/4/235/13845... > Rather than giving up drugs altogether, many had shifted from heroin to amphetamines or barbiturates.
You’re wrong, and the “historical record” you’re citing is actually the same record the NPR piece is summarizing.
What that NPR piece is pointing at is the Lee Robins follow up result that became famous precisely because it violated the folk story of heroin addiction being inevitably chronic. A later review of Robins’ findings summarizes it bluntly:
In Vietnam, high heroin use and dependence. After return, only about 10% tried heroin, and only about 1% became re addicted in the first year.
Now compare that to the VA history page you linked as a “gotcha.” It says the same thing in slightly different numbers:
One year after return, 10% reported opiate use, and 7% reported re addiction.
So no, “not entirely” and “7%” are not a refutation. They are the punchline.
You can argue about whether it is 1% or 7%, depending on definitions and measurement, but the qualitative point survives trivially: it was nowhere near the relapse pattern people expected for heroin addiction, which is why NPR is telling the story in the first place.
Your OUP line about some vets shifting to other drugs is also not the contradiction you think it is. “Some people continued using substances” does not falsify “heroin dependence largely remitted when the environment changed.” Those are different claims. If anything, substitution strengthens the “context and cues matter” thesis, because it implies the Vietnam setting was uniquely good at sustaining heroin use, not that heroin had permanently rewired everyone’s brain.
Also, “VA was unprepared” is about bureaucracy, not epidemiology. The VA being behind the curve tells you the system wasn’t ready for the volume of cases showing up at the door, not that “everyone stayed addicted forever.”
If you want to be precise, the correct statement is:
Most soldiers who were using heroin in Vietnam did not remain heroin addicted after returning home, and relapse was low relative to expectations, which is exactly why this became a canonical example in the first place.
But you know, make it poetic or something. Suppose that's how religion still manages to thrive.
The ones who manage to make it out, usually have something to live for (and the will to live for it), but a lot of people have no money, no job, no career, no family, no spouse, no kids, and no good memories of life, and even if they did, there's no guarantee they'll beat the substance. Sadly for these people, it's very likely they won't see a way out of addiction.
The consensus is that "hitting rock bottom" is the only way to help an addict. But many hit rock bottom and never get up again, or don't have anything to climb for.
To me that seems to say cause of the opiod crisis doesn't exist, which probably isn't what you mean. But what do you mean?
A properly managed opioid addiction can be permanent. For a decade millions of Americans were addicted to opioids (OxyContin, Vicodin, etc.) prescribed by doctors. When the state cracked down they were forced to go on the street to get their medicine, which is when the opioid crisis exploded
What is the basis for your narrative?
What's the data corroborating this theory?
Since the article suggests there must have been a change in china to cause this it seems likely they just moved from fentanyl to tranq.
https://www.youtube.com/watch?v=925wmb-4Yr4&t=1623s&pp=ygUPY...
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...
If true that clinic needs to be reported. Patients have a right to taper down and exit treatment.
When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.
So that maybe why the clinic was firm about trying to increase you friends dose.
OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry.
https://www.samhsa.gov/substance-use/treatment/options/metha...
How does this work? Naively, I'd expect addicts to up the dose of the "other substances" if they can't reach their high. Or does methadone outright "block" the other substances' effects?
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.
There is no human in this world who could say something similar about heroin.
If people were aware in how many ways caffeine messes up a lot of people there would be. Exhaustion, migranes, anxieties, twitching, insomnia, mental issues to name a few. Most never attributed to caffeine but mysteriously going away after a person manges to kick the habit.
The ideal situation is the client leverages methadone into a recovery/remission from addiction - but that can be incredibly hard for them to do.
Isn't it hardship when people with guns come to you and burn your fields?
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.
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.
I think this is a false dichotomy: Either you campaign for $SPECIFIC_SOCIAL_CHANGE or you think that addicts are subhuman? There's no in-between? You don't think that casting the conversation in this light ("Anyone not with us thinks $PEOPLE are subhuman") is a bad faith argument?
The most reasonable explanation I can think of is that people just don't care enough about some $SPECIFIC_SOCIAL_CHANGE.
Someone not interested in voicing their opinion on Palestine/Gaza, BLM or addicts doesn't mean that they think the victims in those circumstances are subhuman.
Well yes and no. Only addicts to opioids go into hibernation and become detached and 'subhuman'
Those who are addicted to uppers (cocaine, nicotine, meth etc) are considered thugs and or violent
I am not convinced we can claim what you think with any level of confidence.
If you walked up to a doctor in BC and said you have a fentanyl drug use disorder and you've hit rock bottom and you're ready for treatment, they can't help you, and you'll be put on a waiting list. I imagine many other jurisdictions across North America are the same.
Of course what happens is that in the days that follow the window of opportunity is missed, the person goes and gets some more street drugs to self medicate their addiction, the only option because there is no prescribed option, and those street drugs are cut with toxic who knows what and the person overdoses and dies (because there is no safe known dosage of street drugs that contain ???).
No real surprise that 6-7 people have been dying a day for years now.
You'd think at some point someone would build some more treatment beds but that costs money and how dare you raise taxes. So the status quo of indifference and death continues.
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.
> 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.
But... this relies on the idea that the purity numbers are based on "time of test" not "date of seizure". This seems like a pretty obvious thing they would have accounted for. Do you have any evidence that the published data for purity levels is delayed by several months?
No, the idea doesn't rely on "time of test" vs "date of seizure". There is no real provenance for any of this. There is no auditable trail for when any given batch of narcotics was manufactured, when it appeared in the US, how long it took to disseminate to domestic dealers, when it may have been further cut by domestic dealers, when it was sold, and when it was actually used. Even the seizure dates are dubious, given haphazard and inconsistent law enforcement handling and record keeping. There are also sampling biases, because some legal jurisdictions and law enforcement organizations are more or less cooperative than others.
All I claimed was that a delay was plausible. I am not obligated to become a narcotics market researcher in defense of my modest claim, and given the nature of all this, no amount of such effort is likely to be sufficient for you in any case.
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.
> Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays, and increasingly pressed into pills made to look like legitimate prescription opioids. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.
From Riley county: https://www.rileycountyks.gov/2050/Fentanyl-and-Opioid-Aware...
> Unlike most opiates, fentanyl can be lethal with the first use. It only takes a two-milligram dose, similar to 5-7 grains of salt, to cause death for an average size adult.
People ODing on Fentanyl often don’t even know whatever they took had it.
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.
Powedered drugs like cocaine mixed with fentanyl are even more horrible, since there is absolutely nothing to keep the concentration of fentanyl homogeneous throughout as it is handled.
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.
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 substance is too potent per physical unit of weight and volume to be conveniently dosed through other means.
But this attitude smells an awful lot like the stupid person's eugenics. Let's not cater to it.
Perhaps there's another place where poverty is a greater curse, though. But I would rather be poor in Burundi or Haiti than Ohio—at least I can sleep outside without dying and my neighbor won't fucking shoot me for existing. But this is what i get for living in the us, the place with the most evil people to have ever lived.
It does not matter to me if Elon Musk makes another billion dollars if I am making more as well. That does not cause "despair" to a well adjusted person.
Extreme poverty on the other hand (which has been decreasing) does cause these deaths. When people have nowhere left to go and no hope, they to turn to drugs.
Mental illness is another cause. I wonder if we should have gotten rid of asylums.
Yes, you can buy a smartphone. But most of what makes us care for each other has died. Why not kill yourself today, Sisyphus? There are fewer reasons than ever.
As long as conditions are materially improving, we are doing well. It is up to people to maintain a psychological outlook commensurate with their incredible quality of life gains. If they don't manage to do that, that is a personal failure caused by envy, not an inherent structural problem with wealth inequality.
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.
Problem solving itself by killing the users is also not palatable because the conclusion is that the users are expendable in pursuit of solving the problem.
Since neither conclusion is going to be politically acceptable, why is your default hypothesis that the paper must be wrong because your political conclusion is better than the paper's political conclusion?
How would one test it?
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.
China probably just wants to be a neutral supplier and stay out of it.
Despite the difficulty the former US administration was able to diplomatically achieve cooperation from China on this matter which bore fruit and gained traction until a seris of wild accusations and tariffs from a later administration killed a number of US / China working arrangements.
See, for example, 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.
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.
> 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.
"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.
https://www.dropsitenews.com/p/trump-maduro-venezuela-darfur...
Is it just another Epstein diversion maybe?
Oil story doesn't stack up though:
- it's heavy sour oil, the tar like substance isn't economically extractable without an almost doubling in barrel price
- cheaper (existing infra) sour supply chain with Canada already meets US shale light sweet oil blending needs for a long time
- decided on maintaining stability of existing Venezuelan regime over supporting regime change
The overprescription of opioids in the US (especially in the past) is hardly a secret.
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.
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.
Your explanation suggests an exponential decay (ignoring aggravating conditions, like seasonal temperature, violence, ...)
Original: https://x.com/KeithNHumphreys/status/2009340857909170395
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.
I’m an EMT-B. I’ve had narcan in my personal kits for years.
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 ?
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.
echo "
foreground=no
[ economist ]
accept=127.0.0.127:80
client=yes
options=NO_TICKET
options=NO_RENEGOTIATION
renegotiation=no
sslVersion=TLSv1.3
sni=www.economist.com
connect=172.64.145.237:443
"|stunnel -fd 0 -- 50b76b93
x=https://www.economist.com/united-states/2026/01/08/why-overdose-deaths-are-falling-in-america
(
echo GET /${x#*//*/} HTTP/1.0 @
echo host: www.economist.com @
echo user-agent: "Mozilla/5.0 (Linux; Android 14) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/127.0.6533.103 Mobile Safari/537.36 Lamarr" @
echo @
)|tr @ '\r'|nc -vvn 127.127 80 > 1.htm
kill $(busybox pgrep -f 50b76b93)
firefox ./1.htmPossibly re-directed some of the fentanyl to other markets where addicts could no longer get heroin? Thus reducing supply elsewhere?
The opioid epidemic was caused by COVID pandemic and its devastating economic effects and also by cheapness of the fentanyl pills which were going as low as $1 a pop on the streets.
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.
Are you sure about what you are seeing, is it possible this is just for a few US imports and maybe you aren't looking at the shelf sticker? Or maybe it's a province-specific thing?
Edit: Found the regulation. In general,
> On consumer prepackaged foods, the net quantity must be declared on the principal display panel in metric units [221, 232, SFCR]. However, consumer prepackaged foods that are packaged from bulk at retail, other than individually measured foods, can declare the net quantity on the principal display panel in Canadian units [241.4(2)(b), SFCR].
https://inspection.canada.ca/en/food-labels/labelling/indust...
Perhaps, then, it was Kamala Harris' success as border czar under Biden.
https://cdn.jamanetwork.com/ama/content_public/journal/jaman...
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.
But yes today the questions are about how we treat politically-connected smugglers. What are the odds on a Justin Salsburey pardon?
If we just listened to common sense instead of these people, society would be saved from a lot of pain.
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.
