Some good news on street drug deaths

The fact that there were over 100,000 drug overdose deaths in the United States last year should sadden, and appall, all Americans.

But, all things being relative, and because humans need hope in order to make progress, the oddly good news is that there was actually significant progress on the 2023 numbers versus the overdose deaths of 2022.

Last month, the National Center for Health Statistics announced: “Provisional data from CDC’s National Center for Health Statistics indicate there were an estimated 107,543 drug overdose deaths in the United States during 2023 — a decrease of 3% from the 111,029 deaths estimated in 2022. This is the first annual decrease in drug overdose deaths since 2018.”

Best news in five years — that’s the good news.

The reasons are complicated. The progress, and some lack of it, is spread unevenly across the states. It can be hard to say what is random and what is the result of ongoing education about the danger of overdoses, the growing availability of naloxone and other such overdose-reversal drugs in public places such as bars and drug-testing kits that reveal the presence of the most dangerous drug in circulation these days, fentanyl, in other street drugs.

“The new data show overdose deaths involving opioids decreased from an estimated 84,181 in 2022 to 81,083 in 2023. While overdose deaths from synthetic opioids (primarily fentanyl) decreased in 2023 compared to 2022, cocaine and psychostimulants (like methamphetamine) increased,” the CDC reports.

“Several states across the nation saw decreases; Nebraska, Kansas, Indiana, and Maine experienced declines of 15% or more.”

But the bad news can’t be ignored, either: “Still, some states saw increases. Alaska, Washington, and Oregon stood out with notable increases of at least 27% compared to the same period in 2022.”

That the overdose crisis has remained persistent over time and across states with different political and legal approaches toward drugs underscores the difficulty at hand.

Drug prohibitionists, for example, will point to the spike in overdose deaths in Oregon as evidence that tough-on-crime approaches are necessary. In November 2020, Oregon voters approved Measure 110, which decriminalized possession of drugs. Earlier this year, the Oregon Legislature panicked and decided to recriminalize possession due to a perception that it was decriminalization specifically which drove overdose deaths.

This is not so, according to research published by JAMA Psychiatry in 2023, which “found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates.”

The problem in states like Oregon and Washington is the surge of fentanyl and fentanyl-laced drugs, which in turn is a consequence of drug prohibition. As explained by Reason Magazine’s Jacob Sullum, “The government’s crackdown on pain pills pushed nonmedical users toward more dangerous substitutes, replacing legally produced, reliably dosed pharmaceuticals with products of uncertain provenance and composition.”

There is little sign politicians have the will to face this fact.

Evidence from around the globe shows that effective public health programs coupled with decriminalization works. Portugal saw a 75% decline in drug deaths from 2001 through 2022 after it decriminalized possession of small amounts of drugs.

Portugal’s success took years to successfully implement, but it ultimately has. The country found the right mix of counseling, medical care and enforcement. “Above all, you have to be consistent in your approach and give it time to provide results,” the country’s health minister said, as quoted by Carmen Paun and Aitor Hernandez-Morales in a piece for Politico. “When you’re taking on something as complex as the opioid crisis, you can’t really expect to see dramatic changes from one day to the next.

We know for certain that drug prohibition doesn’t work. It didn’t work for alcohol, it didn’t work for marijuana, and it doesn’t work now. But we also know that drug addiction and overdose deaths are problems that demand multi-layered responses. Harm reduction and education are key, as are accessibility to addiction services and holding accountable those who infringe on the well-being of others.