America has yet to turn a corner on its opioid crisis

WAS IT A mere blip, or a turning point? In 2018 fatal drug overdoses in America fell, year-on-year, for the first time in nearly three decades. The decline was small in percentage terms, at 4%. And the number of overdose deaths was still 67,000—roughly the same as those from murders and suicides combined. But the White House was quick to hail the news as vindication of its efforts to fight the opioid crisis. “We have results that are unbelievable,” President Donald Trump told attendees at a drug-abuse summit in Atlanta, Georgia in April 2019. “We’re making tremendous progress.”

Unfortunately, the celebration may have been premature. Provisional figures from the Centres for Disease Control and Prevention show that drug-overdose deaths increased by 5.6% in 2019 to more than 71,000, an all-time high. Indeed the most recent statistics, far from showing progress in battling America’s drug epidemic, merely confirm just how predictably deadly it has become (see top chart). This decades-long trend has persisted despite significant demographic and generational changes among users.

As for the drop in overdoses in 2018, Hawre Jalal and Donald Burke, two public-health researchers at the University of Pittsburgh, argue in a new paper that an interruption to the supply of carfentanil, a synthetic opioid used for animals rather than humans, caused the decline. The drug, which is 5,000 times more potent than heroin, had been legal to produce in China until March 2017, when it was banned. “We had hyper-exponential growth for one year or two, which was restrained as soon as the carfentanil was withdrawn,” says Mr Burke. States that saw reductions in carfentanil seizures by police—a rough proxy for use—also experienced reductions in deaths (see chart in text). In places without much exposure to the drug, overdoses held steady.

This year the opioid epidemic has been largely overshadowed by covid-19, which has now killed more than 210,000 Americans. Together, the two public-health crises could prove a deadly mix. Social isolation, job loss and depression are known precursors to addiction or relapse. And early data suggest that, despite the difficulties of buying and selling drugs amid social-distancing measures, overdoses are continuing to rise. The American Medical Association recently announced that it was “greatly concerned” by reports of increasing mortality in 40 states.

The public-health policies that will help arrest the epidemic—wide distribution of medically assisted treatment to reduce urges to use, especially—are well-known but insufficiently pursued. Of course, the same is true of coronavirus, and America has failed to flatten that death curve, too.

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