Overdose deaths are falling, but the ‘war on drugs’ is still a failure

The annual U.S. death toll from illegal drugs, which has risen almost every year since the turn of the century, is expected to drop significantly this year. The timing of that reversal poses a problem for politicians who want to prevent substance abuse by disrupting the drug supply.

Those politicians include Republican presidential candidate Donald Trump, who is promising to use the military against drug traffickers, and his Democratic opponent, Vice President Kamala Harris, whose platform also focuses heavily on supply-side tactics. Neither candidate appears to have absorbed the lessons of the “opioid epidemic,” which showed that drug law enforcement is not only ineffective but also counterproductive, exacerbating the harm it is supposed to alleviate.

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

“We tackled the drug and fentanyl crisis head-on and achieved the first reduction in overdose deaths in more than 30 years,” Trump boasts, referring to the 4% decline from 2017 to 2018, which in retrospect is a blip seems. The upward trend resumed in 2019 and included a record 30% jump in 2020, Trump’s final year as president.

Last year, the U.S. Centers for Disease Control and Prevention recorded a 3% drop in fatal overdoses, similar to the 2018 drop that Trump cites as evidence of his success. But unlike 2018’s decline, it appears to be continuing: The death toll for the year ending in April 2024 was 10% lower than the death toll for the year ending in April 2023, according to preliminary CDC data.

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

For example, while replacing street drugs with methadone or buprenorphine reduces the risk of overdoses, Dasgupta et al. conclude, it does not appear that expanded access to such “medication-assisted treatments” can explain the recent decline in deaths. But they think it is “plausible” that wider distribution of the opioid antagonist naloxone, which quickly reverses fentanyl and heroin overdoses, may have played a role.

Instead, they say it is “unlikely” that anti-drug operations along the U.S.-Mexico border have helped reduce overdoses. They note that recent seizures at the border mainly involve marijuana and methamphetamine, not fentanyl, the leading culprit of overdoses, and that retail drug prices have fallen in recent years — the opposite of what you’d expect if the ban would be effective.

Supply-side measures, doomed to failure by the economics of prohibition, have not only failed to reduce drug-related deaths. They have had the opposite effect.

Prohibition makes drug use far more dangerous by creating a black market in which quality and purity are highly variable and unpredictable, and efforts to enforce prohibition increase these dangers. For example, the crackdown on painkillers drove non-medical users to black market substitutes, replacing legally produced, reliably dosed drugs with dubious street drugs, made even more dubious thanks to the ban-induced proliferation of illicit fentanyl.

That crackdown succeeded in reducing opioid prescriptions, which fell by more than half between 2010 and 2022. Meanwhile, the opioid-related death rate has more than tripled, while the annual number of opioid-related deaths nearly quadrupled.

Trump and Harris seem unfazed by that debacle. Trump envisions “a complete naval embargo on the drug cartels,” while Harris aims to “disrupt the flow of illegal drugs.” They promise to achieve the impossible while obscuring the costs of persisting with a strategy that has failed for more than a century.

Jacob Sullum is editor-in-chief at Reason magazine.

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