…the cause of the overdose epidemic…

…and how to end it


This is an important chart. What does it mean?

The Black line shows the percentage of overdose deaths in Ohio that involved methamphetamine. In 2010, less than 1% of Ohio overdose deaths involved meth. In 2022, an astounding 27.7% of overdose deaths did.

Now look at the Red line. That’s shows the share of overdose deaths that involved both meth AND fentanyl (or a fentanyl analog). Meth-fentanyl overdose deaths have soared from 0.0% in 2010 to 22.3% of all Ohio overdose deaths in 2022.

This may not be a surprise. We know fentanyl in the meth supply increased, as perhaps has use of both drugs together. Fentanyl was involved in 80.8% of all meth overdose deaths in 2022, up from 0.0% in 2010.

Now look at the Blue line. This is the most important line for understanding the cause of the overdose epidemic and how to end it.

The Blue line shows the share of overdose deaths involving meth but NOT fentanyl. You’ll see that’s increased a little…but, relatively speaking, not that much. Meth overdose deaths NOT involving fentanyl have increased from 1.5% in 2010 to 5.3% in 2022. Meth-only overdoses actually fell slightly from 2021 to 2022.

The growing distance between the Red line and the Blue line shows that increased meth adulteration, not an increase in meth use, is the primary driver of the enormous increase in meth-related overdoses deaths.

This distinction has profound meaning. It tells us that meth use is not the primary problem. Meth adulteration (with fentanyl) is the problem. In other words, we can’t “treat our way out of the problem.”The only way to significantly reduce meth-related mortality is to reduce drug adulteration. In other words, a safer drug supply is the solution.

What is the cause of adulterated drugs? The drug war is the case.

Illicit markets have no way for consumers (or suppliers) to possess accurate knowledge of what’s in drugs. Drug prohibition distorts illicit drug markets to produce (and consumers to use) potent, compact drugs that can be produced, smuggled and hidden more easily from law enforcement. The drug war turned fentanyl from a medical product into a consumer product.

Big picture: the drug war is an example of bad regulation and unintended consequences — in this case, catastrophic consequences (mass death of people who use drugs). The intent of the drug war is purportedly to protect health. But it does the opposite. The drug war is regulatory blunder that shows the road to the graveyard may be paved with good intentions.

Overdose death will be hard to reduce and impossible to drop as long as the drug war continues. The drug war is not just a poor solution to the overdose epidemic, it is the cause of the epidemic. As the last 50 years has shown conclusively, as the drug war escalates, so does death (and imprisonment, family destruction, income equality, etc.)

The drug war is the biggest public policy folly of our time. We cannot end the overdose epidemic until we admit the obvious: Prohibition kills. Always has. Always will. Is doing so now.

— By Dennis Cauchon, President, Harm Reduction Ohio

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