Ohio drugs safest in a decade

 Sinaloa Cartel Curtails fentanyl production



Overdose deaths in Ohio have fallen to their lowest level since 2015, continuing a historic drop that began unexpectedly last September.

This significant decline appears linked to a June 2023 decision by a major branch of the Sinaloa Cartel to stop producing and shipping fentanyl or fentanyl analogs. The sharp reduction in fentanyl in Ohio’s drug supply is evident in recent state crime lab tests on illicit drugs seized by law enforcement. Four-fifths of Ohio overdose deaths involve fentanyl.

Harm Reduction Ohio was the first to report the steep decline in both overdose deaths and fentanyl in Ohio. Since then, the trend of reduced deaths and a safer drug supply in Ohio has accelerated.

Harm Reduction Ohio estimates the number of Ohio residents who died from accidental drug overdoses in the first three months of 2024 as follows:

  • January 2024: 270 deaths, down 33.7% from 407 deaths in January 2023.
  • February 2024: 260 deaths, down 34.3% from 396 deaths in February 2023.
  • March 2024: 302 deaths, down 23.6% from 399 deaths in March 2023.

Harm Reduction Ohio has accurately estimated overdose deaths for the last five years by downloading data daily from the Ohio Department of Health’s online mortality database. The state health department and National Center for Health Statistics will report final numbers for 2023 in late 2024 and for 2024 in late 2025. However, trends can be seen by comparing real-time preliminary death counts from the current year to the same time in the previous year. For example, 98% of overdose deaths are already confirmed and reported for January 2024. Based on this preliminary information, Harm Reduction Ohio estimates the death overdose count was about 270 in January 2024 (95% probability of the final count falling within a 265 to 275 range).

Unprecedented decline

The size and swiftness of the drop in overdose deaths are unprecedented. Ohio has gone from suffering 400 overdose deaths per month to fewer than 300 per month. Ohio recorded a record high of 574 overdose deaths in May 2020. The estimated toll in both January and February 2024 is less than half that. The approximately 260 overdose deaths that occurred in February is the lowest number recorded since October 2015 when 250 residents died from drug overdoses.

To account for differences in the number of days in each month, Harm Reduction Ohio measured the average deaths per day from January 2015 through March 2024. January 2024 had the lowest daily overdose death count (8.7 deaths per day) since December 2015 (8.5 deaths per day). Ohio has now experienced five consecutive months of daily death counts averaging in the single digits. Before this change, Ohio hadn’t had any month in single digits since 2018 and no consecutive months of deaths averaging below 10 per day since 2015.

Ohio’s sad overdose history

The favorable trend in overdose deaths is bittersweet. Even with a one-third reduction, Ohio’s overdose death rate remains horrifically high and far above anything experienced before the crackdown on OxyContin access began.

The attack on OxyContin availability pushed opioid users to more dangerous black market drugs—first heroin, then illicitly manufactured fentanyl. That caused overdose deaths to double. Fentanyl then spread from opioids into stimulants and other drugs, doubling deaths again. The closing of borders during the COVID-19 response caused fentanyl, a compact, easy-to-smuggle drug, to displace bulkier, safer drugs like cocaine. That market disruption sent overdose deaths among people who use drugs to record highs in 2020 and 2021. Cocaine and meth users now account for half of fentanyl-related overdose deaths.

Even with that caveat, the decline in overdose deaths is profoundly good news. Ohio’s overdose death rate has fallen to not just pre-COVID levels but to the lowest level seen since before carfentanil drove a massive overdose surge in 2016-17 and before fentanyl infiltrated Ohio’s cocaine and meth supplies starting in 2018.

Why the fentanyl supply changed

Cartel announcement banning fentanyl

What happened to make Ohio’s drug supply safer?

In June 2023, the Sinaloa Cartel branch run by the family of Joaquín Guzmán (“El Chapo”) quit the fentanyl business. The family enforced its prohibition on fentanyl within the region it controlled by announcing the policy on banners hung on bridges and killing more than 50 local cooks and middlemen who failed to comply. Today, compliance around the city of Culiacán, the capital of the state of Sinaloa, is near 100%.

The cartel-imposed prohibition of fentanyl has had a positive effect on Ohio. Drugs in Ohio are purer, less adulterated, and less deadly than they’ve been in many years. Unadulterated cocaine, in particular, is more plentiful in Ohio today than it has been in over a decade. Fentanyl in fake Xanax pills is rarer than at any time since COVID-19 pushed drug markets toward fentanyl.

Why did El Chapo’s family abandon fentanyl?

Joaquín “El Chapo” Guzmán

The reasons behind the El Chapo family’s decision to quit the fentanyl business are not well understood. Cartel watchers speculate that the move was made to reduce law enforcement pressure and support negotiations with the Mexican and possibly the U.S. governments. El Chapo, the patriarch, is now held in a supermax federal prison, and one of the four sons who now control the family business was extradited to the United States last year.

Cartel experts also note that fentanyl is not as profitable as it once was. Extortion and immigrant smuggling are more lucrative for crime families today than fentanyl.

Regardless of motivation, the family’s decision to stop shipping fentanyl has dramatically reduced the volume of fentanyl found in Ohio. Many other Sinaloa Cartel branches continue to produce and export fentanyl, but El Chapo’s organization was the most significant fentanyl producer. It is believed to have been the first big entrant into the fentanyl business a decade ago and the biggest producer and exporter until its sudden market exit.

Fentanyl’s presence in Ohio

Harm Reduction Ohio measures fentanyl’s presence in Ohio by analyzing state crime lab data. Since 2008, the Ohio Bureau of Criminal Investigation crime labs have conducted more than 500,000 gas chromatography–mass spectrometry tests on drug samples seized by law enforcement statewide.

The BCI crime lab provides this data (with defendant and case information removed) to Harm Reduction Ohio under Ohio’s Open Records Act. Harm Reduction Ohio then analyzes the data to understand the changes in Ohio’s illicit drug supply.

Academic researchers have shown that frequency of fentanyl in BCI crime lab data is highly correlated with overdose deaths reported in Ohio Department of Health mortality data.

To increase the reliability and robustness of the analysis presented below, we use three-month trailing data. This approach involves averaging data over the previous three months to help smooth out short-term fluctuations and provide a more stable and accurate picture of drug supply trends.

Key Findings from crime lab data:

  • Fentanyl: Found in just 20.2% of all drugs in the three months ending in June 2024, down from 26.6% in the three months ending in June 2023 and a peak of 29.1% in the three months ending in July 2020.
  • Only Fentanyl: Drugs containing only fentanyl (and no other controlled substances) fell to 5.8% in the three months ending in June 2024, down from 10.5% in the three months ending in June 2023 and a peak of 14.1% in the three months ending in July 2020.
  • Cocaine Adulterated with Fentanyl: The share of cocaine mixed with fentanyl fell to 11.5% in the three months ending in June 2024, down from 19.5% in the three months ending in June 2023.
  • Cocaine Unadulterated: Pure cocaine (mixed with no other controlled substances) made up 23.8% of Ohio’s drug supply in the three months ending in June 2024,. That was a significant increase from unadulterated cocaine making up 14.7% of the drug supply in the three months ending in June 2023 and just 7.4% in the three months ending in September 2020. Not since 2011 has cocaine been as plentiful and pure in Ohio as in recent months.
  • Methamphetamine: Meth’s presence in Ohio’s drug supply has remained stable (a little over 40%) over the last year. The share of meth containing fentanyl has also remained stable (about 5%).
  • Xanax: Only 2% of seized alprazolam (Xanax) contained fentanyl in the three months ending in June 2024, down from 10% in the three months ending in June 2023 and more than 40% in the three months ending in 2021.

It’s unclear why unadulterated cocaine has become more common but unadulterated meth has not. A likely cause is different supply routes and country of origins for the two drugs.

What it means

Ohio residents are consuming safer, purer, less fentanyl-adulterated drugs than at any time in nearly a decade. The result has been about 100 to 125 fewer Ohio residents dying from overdoses every month.

Is this change sustainable? Will the decline in overdose deaths increase or decrease in the rest of 2024? Will other cartel branches replace the diminished fentanyl supply? Will El Chapo’s cartel branch resume fentanyl production as quickly as it stopped?

The overdose epidemic is out of our hands and in the hands of organized crime families in Mexico. Crime families control criminalized markets. That’s how market economies work. Today, the lives of thousands of Ohioans and tens of thousands of Americans depend on behind-the-scenes management decisions made by a couple dozen cartel organizations in Mexico. The drug war is a catastrophic multi-generational policy blunder. The consequences of this policy mistake, however unintended, are on full display right now in Ohio. What happens next? It’s out of our control. We can only watch and count the bodies.

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