An Unprecedented 22 Percent Drop in Drug Deaths Does Not Mean Prohibition Is Finally Working
Drug warriors deserve blame rather than credit for their role in recent overdose trends.
During the year ending last August, according to preliminary estimates from the Centers for Disease Control and Prevention (CDC), the number of drug-related deaths in the United States was about 22 percent lower than the total for the previous year. That unprecedented drop is more than twice as big as the already remarkable decrease indicated by earlier estimates last fall, and it should give pause to anyone who thinks interdiction of the drug supply is the key to reducing the annual death toll.
The CDC predicts that drug overdose deaths during the 12 months ending in August 2024, once fully counted, will total around 89,740, down from nearly 115,000 during the prior 12 months. That is by far the largest annual drop ever recorded, and it represents a striking departure from recent trends. Between 2002 and 2022, the CDC reports, the annual number of drug-related deaths almost quintupled, from fewer than 24,000 to nearly 108,000. During that period, the death toll rose every year except for 2018, when it fell by 4 percent.
Deaths rose by a whopping 30 percent in 2020, rose again in 2021 and 2022, then fell by 3 percent in 2023. Although the CDC heralded that small decrease as a hopeful sign, it pales by comparison with the huge expected drop in 2024. While there are several possible explanations for that unanticipated development, one thing is clear: Drug warriors, whose policies contributed to the seemingly inexorable rise in deaths, cannot take credit for it.
Notwithstanding the projected decrease, the 2024 total probably will still exceed the number recorded before the 2020 spike, which is widely viewed as a consequence of the COVID-19 pandemic and the government response to it. Unpacking that connection may help illuminate the factors underlying the subsequent decline.
Beginning in the spring of 2020, millions of Americans were out of work, out of school, cooped up at home, separated from social networks, and deprived of engaging activities. Those conditions, observers surmised, were conducive to substance abuse. (They also seem to have played an important role in the similarly large 2020 homicide surge.) While opioid-related deaths were already rising, The New York Times reported in April 2021, "the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect."
During ordinary times, mainstream news outlets like the Times tend to explain addiction and substance abuse by reference to the inherent powers of certain drugs. But confronted by the pairing of pandemic-related disruption with a record rise in drug deaths, they were compelled to acknowledge the importance of personal, social, and economic circumstances.
The Times cited research that found many drug users had increased their consumption during the pandemic. They also were more likely to take drugs on their own, which increases the risk of a fatal outcome, and most reported consuming mixtures of drugs, "another red flag."
A 2024 study likewise found that "volatile drug use during the COVID-19 pandemic was common, appeared to be driven by structural vulnerability, and was associated with increased overdose risk." Another study published the same year concluded that "policies limiting in-person activities significantly increased" drug death rates. In addition to magnifying problems that make drug use more attractive, a July 2022 article in the CDC's Morbidity and Mortality Weekly Report noted, COVID-19 policies disrupted "access to prevention, treatment, and harm reduction services," which the authors said "likely contributed" to the spike in drug deaths.
If pandemic-inspired restrictions were largely responsible for the surge in drug deaths, it is less clear why deaths declined so precipitously in 2024, which was well after those restrictions were lifted. It could be that habits formed during the pandemic persisted even after most Americans returned to normal life. The lingering economic effects of the pandemic may also help explain why drug deaths continued to rise in 2021 and 2022, when inflation was high and businesses were still recovering, although the unemployment rate had fallen below 4 percent by early 2022.
Writing last September, when it looked like the 2024 drop would be in the neighborhood of 10 percent, Nabarun Dasgupta and two other drug researchers at the University of North Carolina thought it was "plausible" that broader distribution of the opioid antagonist naloxone, which quickly reverses fentanyl and heroin overdoses, had helped reduce drug deaths. But given the practical impact of the relevant policy changes, they said, it did not look like the decrease in deaths could be explained by expanded access to "evidence-based drug treatment," which involves replacing street drugs with buprenorphine or methadone.
Dasgupta also deemed it "unlikely" that antidrug operations along the U.S.-Mexico border had played a significant role in reducing fatal or nonfatal overdoses. They noted that recent border seizures had mainly involved marijuana and methamphetamine rather than illicit fentanyl, the primary culprit in overdoses, and that retail drug prices had been falling in recent years—the opposite of what you would expect if interdiction were effective.
During his 2024 campaign and after the election, President Donald Trump argued that the Biden administration had been lax in prosecuting the war on drugs. "Drugs are pouring in at levels never seen before, 10 times what we had," he said on Meet the Press last month, explaining the rationale for imposing punitive tariffs on Mexico and Canada. "They're just pouring in. We can't have open borders."
The reasoning behind that complaint is revealing. Trump presumably was referring to drug seizures, which rose dramatically after he left office. Fentanyl seizures by U.S. Customs and Border Protection (CBP), for example, rose from 7,330 pounds in 2020 to more than 25,000 pounds in 2023. If the government got serious about stopping drugs from "coming in," as Trump vainly promised to do when he ran for president in 2016, you would expect seizures to go up by a lot. But Trump takes it for granted that CBP manages to intercept just a small percentage of drug shipments, meaning that increased seizures are a sign of failure (indicating an increased supply) rather than a sign of success.
At the same time, Trump absurdly exaggerates the federal government's power to reduce drug consumption. "We took the drug and fentanyl crisis head on, and we achieved the first reduction in overdose deaths in more than 30 years," he bragged during his 2024 campaign, referring to the 4 percent drop between 2017 and 2018, which in retrospect looks like a blip. By this logic, Joe Biden did an amazing job of tackling "the drug and fentanyl crisis," reducing overdose deaths by about the same amount in 2023 and by more than five times as much in 2024.
Assuming that the 2024 death toll is in the same neighborhood as the estimate for the year ending last August, it will be around 16 percent lower than the number recorded during Biden's first year in office. By comparison, drug deaths rose by more than 30 percent under Trump.
Biden's seemingly remarkable performance looks less impressive when you take a longer view. It seems likely that the 2024 death toll will still be nearly four times as large as the number recorded in 2002. That upward trend was exacerbated by the crackdown on pain medication that began during the Obama administration and continued under Trump and Biden.
That strategy hurt bona fide patients while pushing nonmedical users toward black-market alternatives that are much more dangerous because their composition is highly variable and unpredictable. The concomitant rise of illicit fentanyl, a development that also was driven by enforcement of drug prohibition, magnified that danger. The perverse but predictable effects of the war on drugs help explain why the upward trend in overdose deaths accelerated even as opioid prescriptions fell dramatically. Drug warriors, in short, deserve blame rather than praise for their role in recent overdose trends.
If a suddenly successful war on drugs cannot explain last year's dramatic drop in overdose, what does? In addition to public policy changes, Dasgupta considered factors that do not involve deliberate interventions.
If opioid users by 2024 tended to be more experienced than they were when fentanyl began proliferating as a heroin booster and substitute, they might be less likely to overdose thanks to increased tolerance and/or greater caution. And if the introduction of the animal tranquilizer xylazine as a fentanyl adulterant decreased the typical number of doses per day, which Dasgupta et al. thought was plausible given the former drug's pharmacological effects, that could have reduced the risk of overdosing. They added that a shift from injection to smoking, which has been noted by researchers, would have had a similar effect, a point that Cato's Jeff Singer also has made.
Counterintuitively, Dasgupta et al. also suggested that lower retail prices might have helped reduce drug-related harm. Although falling prices are the opposite of what drug warriors are trying to achieve, they mean that people are less likely to oscillate between using drugs when they can afford them and abstaining when they come up short. That pattern increases the risk of an overdose because tolerance declines during periods of abstinence, whether they result from arrest and jail, disruption of the local drug supply, or financial factors like high prices.
Although these hypotheses seem plausible, the truth is that no one really knows why drug deaths fell sharply in 2024. Still, we can be confident that it happened not because of but despite the doomed efforts of politicians who have been promising to "stop the flow" of disfavored drugs for more than a century.
