Recent trends in overdoses underscore the folly of the war on drugs

The annual U.S. death toll from illegal drugs, which has risen nearly every year since the turn of the century, is expected to fall significantly this year. The timing of that turnaround 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 has promised to use the military to crack down on drug traffickers, and his Democratic opponent, Vice President Kamala Harris, whose platform also relies heavily on supply-side tactics. Neither candidate appears to have learned the lessons of the “opioid epidemic,” which has shown that drug laws are not only ineffective but counterproductive, compounding the harms they are 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 accounted for 90 percent of opioid-related deaths and more than two-thirds of all drug-related deaths.

“We took a head-on approach to the drug and fentanyl crisis and achieved the first decline in overdose deaths in over 30 years,” Trump boasted, citing a 4 percent drop between 2017 and 2018 that in retrospect seems like a blip. The upward trend continued into 2019 and included a record 30 percent jump in 2020, Trump’s final year in office.

Last year, the Centers for Disease Control and Prevention (CDC) recorded a 3 percent drop in fatal overdoses, similar to the 2018 decline that Trump cites as evidence of his success. But unlike the 2018 decline, the one that appears to be continuing: According to preliminary CDC data, the death toll for the year ending April 2024 was 10 percent lower than the death toll for the year ending April 2023.

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

While replacing street drugs with methadone or buprenorphine reduces the risk of overdose, Dasgupta et al. say it does not appear that expanded access to such “medication-assisted treatment” 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, has played a role.

In contrast, Dasgupta et al. say it’s “unlikely” that anti-drug operations along the U.S.-Mexico border have helped reduce overdoses. They note that recent border seizures have primarily involved marijuana and methamphetamine rather than fentanyl, the main culprit in overdoses, and that retail drug prices have fallen in recent years — the opposite of what you might expect if interdiction were effective.

Supply-side measures, doomed 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 only exacerbate those dangers. The crackdown on painkillers, for example, drove nonmedical users to black market substitutes, replacing legally produced, reliably dosed pharmaceuticals with questionable street drugs made even more questionable by the prohibition-driven proliferation of illicit fentanyl.

Thanks to that approach, the number of opioid prescriptions has declined, more than halving between 2010 and 2022. Meanwhile, the number of opioid-related deaths has more than tripled, while the annual number of opioid-related deaths has nearly quadrupled.

Trump and Harris seem unfazed by that debacle. Trump envisions “a full naval embargo on the drug cartels,” while Harris aims to “disrupt the flow of illegal drugs.” They promise to do the impossible while glossing over the costs of maintaining a strategy that has failed for more than a century.

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