Speculation about overdose decline – Streetwatch: notes from a paramedic

Is the decline in drug overdose deaths more related to increased availability of naloxone, improved treatment for people who use drugs, or changes in the supply of drugs on the street, which, while still quite toxic, perhaps less so due to adulteration with other chemicals?

A recent article in NPR, The pipeline of deadly fentanyl into the US may be drying up, experts say, speculates that the recent decline in overdose deaths seen in many parts of the country may be due to fewer fentanyl on the street. Although they see numerous experts, there does not seem to be a clear consensus.

Deaths in Connecticut decreased by 13.7% from 2021 to 2023, but the percentage of deaths involving fentanyl was essentially the same: 86% in 2021 and 2022 and 85% in 2023. However, it is possible that although fentanyl was still present in 85% of cases, The deaths could have meant the amount of fentanyl in any container was less now that it was 2021. For example, if you added the cheaper xylazine to a batch and subtracted some of the much more expensive and deadly fentanyl, the percentage would still continue to test positive. fentanyl the same. It could lead to fewer deaths because the batch would be less potent, and the addition of xylazine, which due to its sedative effects, can prolong someone’s high and thus mean you don’t have to use it as often.

Are dealers using less fentanyl because it is cheaper to use additives or are they using less fentanyl because there is a shortage of supply? Or perhaps the drug cartels have realized that it is in their best interest to sell a less toxic mix? Fewer deaths mean less pressure on their organizations. In 2023, the Sinola organization reportedly ordered its members to stop trafficking fentanyl or risk death. This appears to have been just a publicity stunt, as the DEA has continued to report record seizures.

Is Fentanyl Supply Low Due to Increased Attacks? Some experts in the NPR article claim this is so, but I find this hard to believe given the ease with which fentanyl can be manufactured and smuggled into the country.

If I had to guess, I’d say deaths have fallen due to both the increased availability of naloxone (along with the hard work of harm reduction experts across the country) and changes in the drug supply that could potentially make it safer (although still quite poisonous). . In any case, we will need a longer term to assess whether this is just a temporary decline or a real turning point in the crisis.

There is no time to rest. If fentanyl is in the mix, the supply of drugs will continue to be extremely lethal and as long as people die from overdoses, more naloxone needs to be distributed.

Keep up the good work, damage control soldiers.