Financial Times: Fentanyl deaths are falling. What's behind the decline?

[Dennis Donovan]

Financial Times - (archived: https://archive.ph/Tc4vv ) Fentanyl deaths are falling. What’s behind the decline?

The evidence points to changes in the drug supply



John Burn-Murdoch
26 minutes ago

So much has happened in America in recent months that one big positive story has probably got less attention than it deserves. A few weeks ago, the US Centers for Disease Control and Prevention published data showing that fentanyl deaths have been declining for 11 straight months, and now stand 20 per cent below their 2023 peak.

This is a stunning turnaround in the opioid epidemic that has been ravaging the country for more than a decade, killing hundreds of thousands, and has reduced US male life expectancy by a whole year.



But what’s behind the reversal? And what does the answer mean for how confident we can be that the decline will continue?

Some officials say new drug treatment initiatives and products like naloxone deserve the credit. If true, this would be hugely welcome news, and would mean officials now have a proven strategy that can be rolled out more widely until the epidemic is fully in remission.

But there are two problems. The first is that there is very limited evidence that these interventions really do move the needle. And the second is that these explanations don’t fit the data.

One of the striking things about the reversal in fentanyl deaths is that it is spreading smoothly from the east coast of the US to the west. Charles Fain Lehman, a crime researcher with the Manhattan Institute, notes that this is an almost perfect echo of the drug’s initial spread a decade ago.



/snip

[peregrinus]

1. Dilution of fentanyl

The drug dealers realized they were killing off their own customers

[MichMan]

2. Shrinkflation

[Passages]

3. Incredible.

To be clear, these theories remain smoking guns rather than definitive conclusions. A third possibility is the idea put forward by Nabarun Dasgupta and colleagues at the US academic collective Opioid Data Lab, that much like an infectious disease epidemic, fentanyl has now worked its way through its susceptible population. Some died, others figured out ways to use without overdosing, so the remaining fentanyl-naive drug-using population has shrunk. The wave-style dynamics at work here mean it would also theoretically fit the east-west pattern.

In short, we don’t know exactly why deaths are coming down, but on the balance of evidence, policy is probably playing a smaller role than might be assumed.

Tens of thousands of lives saved is a hugely positive development, but the possibility that it’s down to a chance narcotic innovation that on this occasion may have saved lives instead of ending them demonstrates how unpredictable the drug landscape can be.

[GusBob]

5. This was my first thought

The way the tide is turning in a wave across the country the same way it started

It’s working its way thru the users, the susceptible ones

[Dem4life1234]

4. What's good about killing off your customers?

So they dilute the drugs.

[Igel]

8. That would be an easy thing to spot.

But it hasn't been reported, not as just due to simple dilution. I mean, I suspect that if users expect a certain effect and don't get it that they'd just find ways to increase the dose.

From the OP,

there is growing evidence that the supply of fentanyl is down, and when there’s less fentanyl around, fewer people die. ... A branch of Mexico’s Sinaloa cartel thought to have been one of the largest fentanyl suppliers has reportedly banned its production in a bid to ease pressure from law enforcement.

Alt. supply-based theory from the OP,

In recent years, gangs have begun mixing fentanyl with the horse tranquilliser xylazine, whose properties alter the fentanyl high. This is believed to postpone withdrawal symptoms in some cases, meaning users take fewer hits, reducing the risk of a deadly overdose. Xylazine is also thought to be one factor behind the shift among users from injecting to smoking fentanyl, which tends to reduce its lethality.

[Dem4life1234]

9. Great points!

[Clouds Passing]

6. My son

[Dennis Donovan]

11. My condolences

[GusBob]

7. I know from fenty ODs

In one weekend 2 years gone by there were 28 cases of overdoses on the Rez , calls that our clinic EMTs had to handle. 2 deaths among many other at the time

This was on a small Rez, maybe 4500 folks max. Law enforcement was non existent .

What the Tribe and our clinic did

Narcan, narcan, narcan. They handed out like candy
Education and awareness. There was always silence and shame associated with the deaths
Increased the MAT program, it remains the most crowded in my new clinic
Increased the mental health department


Unfortunately meth is still a problem among Native and non native rural folks where I live

[Rebl2]

10. Narcan

I have heard the same thing the last two months and one of the reasons given was Narcan. People have it at home, pretty sure EMT’s and police and firefighters have it. I would guess schools have it available as well.