HN

Comments (150)

• marojejian
  archive: https://archive.is/C0Y0G#selection-1303.143-1303.175this is my best guess for the research cited (paywalled): https://www.science.org/doi/10.1126/science.aea6130If true, the next question is what caused the supply shock?
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  lazarus01
  >> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new article, published in Science on January 8th, suggests, instead, that a supply shock drove the decrease.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.
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  greygoo222
  The claim that fentanyl death rates are decreasing because fentanyl products are less pure does not make much sense. Even on their provided charts, deaths dropped months before purity did.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.
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  Tiktaalik
  British Columbia declared the toxic drug crisis an epidemic in 2016, with the amount of deaths amounting to 6-7 a day through this period until now.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.
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  jimnotgym
  Could this effect actually be more of a customer service effect?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 ways1) they could have saved money by using less fentanyl2) 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 activitiesTherefore 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.
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  awakeasleep
  What happened to the theory that the deaths were decreasing because we burned through our buffer of people susceptible to deaths of despair? That always seemed reasonable to me.
• bdauvergne
  Maybe they completely reversed the causality, it's a demand shock not a supply shock. There are less users because they died, and they died pretty fast compared to previous opioid users. As demand diminished there was over supply and to maintain their margins provider had to lower the supply. QED.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.
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  dopa42365
  If the cost didn't go up, it can't have been a supply shortage. Even at its US peak, there wasn't much of a "fentanyl epidemic" in Mexico either.The overprescription of opioids in the US (especially in the past) is hardly a secret.
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  phtrivier
  How good is overdose _deaths_ as an indicator of the epidemic of drug consumption ?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 ?
• hwguy45
  The kneejerk explanation would be the more strict border and law enforcement under the current administration. But the chart peaks in Dec 2023 and drops in 2024, so it cannot be that.Perhaps, then, it was Kamala Harris' success as border czar under Biden.
• jimnotgym
  This suggests to me that the government could reduce this even further by simply outcompeting with illegal sources.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.
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  AngryData
  I would postulate that people learning how to more safely handle and dose fentanyl would be the biggest reason for ODs to drop.
• topranks
  I wonder if the eradication of the heroin supply from Afghanistan following the Taliban takeover has had an effect?Possibly re-directed some of the fentanyl to other markets where addicts could no longer get heroin? Thus reducing supply elsewhere?
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  idoubtit
  The reporter rightly queried other researchers about this article, and all of them were skeptical that a "supply shock" could be the cause, or even the main cause. My own skepticism is because the death rate went down many months before any sign of shortage appeared.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.htmWhy did the death rate slow down for one year, then go down many months before any sign of supply changes?
• saidnooneever
  maybe all the addicts are running out? know it sounds like a troll but with very high death rates on newer drugs... is it really a crazy idea?
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  Analemma_
  I thought this was already well-established public information? That fentanyl came mostly from China was never in doubt, what people were arguing about was whether this was happening with the tacit approval of the Chinese government. Then in 2023 China cracked down on it, and supplies dried up. Whether that was because it was a big enough issue to get their attention, or it was on purpose and they decided it was no longer serving their interests I suspect we'll never know, but I definitely read multiple articles in 2023 about the fentanyl crackdown in China.
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  newsclues
  It’s nice when the government has a leader committed to keeping drugs out of the country
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  simianparrot
  Gee I wonder why. Maybe controlling your borders actually helps prevent illicit goods from entering your country? Crazy take I know, can’t be true because it’s the T man that’s behind it
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  mythrwy
  "Supply shock" might not be the only, or even primary cause. As far as I know fentanyl is still widely available and inexpensive.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.
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  lazyeye
  Perhaps the closure of the southern border a year ago might have played some role in this.
• diogenescynic
  And when supply catches up, overdoses will spike because addicts tolerance will have decreased.
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  wtcactus
  So, statistics clearly show that limiting drugs supply actually works, unlike what the hard left has been saying to us (backed by social “sciences”) since the 2000s?If we just listened to common sense instead of these people, society would be saved from a lot of pain.
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  broochcoach
  [flagged]
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  cramcgrab
  Stop taking drugs, get out and enjoy life. It’s really pretty simple. Most of society works that way.