The annual U.S. death toll from illegal drugs, which has risen nearly every year since the turn of the century, is expected to fall substantially this year. The timing of that turnaround poses a problem for politicians who aim to prevent substance abuse by disrupting the drug supply.
Those politicians include Republican presidential nominee Donald Trump, who promises to deploy the military against drug traffickers, and his Democratic opponent, Vice President Kamala Harris, whose platform is also heavy on supply-side tactics. Neither candidate seems to have absorbed the lessons of the “opioid epidemic,” which showed that drug law enforcement is not just ineffective but counterproductive, magnifying the harms it is supposed to alleviate.
In the first two decades of this century, the annual number of drug-related deaths quintupled, reaching a record of nearly 108,000 in 2022. That year, illicit fentanyl figured in 90% of opioid-related deaths and more than two-thirds of all drug-related deaths.
“We took the drug and fentanyl crisis head on, and we achieved the first reduction in overdose deaths in more than 30 years,” Trump brags, referring to the 4% drop between 2017 and 2018, which in retrospect looks like a blip. The upward trend resumed in 2019, and it included a record 30% jump in 2020, Trump’s final year in office.
Last year, the Centers for Disease Control and Prevention recorded a 3% reduction in fatal overdoses, similar to the 2018 decrease that Trump cites as evidence of his success. But unlike the 2018 drop, this one seems to be continuing: According to preliminary CDC data, the death toll for the year ending in April 2024 was 10% lower than the death toll for the year ending in April 2023.
Nabarun Dasgupta and two other drug researchers at the University of North Carolina found that the downward national trend indicated by the CDC’s provisional counts was consistent with state-level mortality data and with overdose cases reported by hospitals and emergency responders. “Our conclusion is that the dip in overdoses is real,” they write, although “it remains to be seen how long it will be sustained.”
While replacing street drugs with methadone or buprenorphine reduces overdose risk, Dasgupta et al. say, it does not look like expanded access to such “medication-assisted treatment” can account for the recent drop in deaths. But they think it is “plausible” that broader distribution of the opioid antagonist naloxone, which quickly reverses fentanyl and heroin overdoses, has played a role.
By contrast, Dasgupta et al. say it is “unlikely” that antidrug operations along the U.S.-Mexico border have helped reduce overdoses. They note that recent border seizures have mainly involved marijuana and methamphetamine rather than fentanyl, the primary culprit in overdoses, and that retail drug prices have been falling in recent years — the opposite of what you would expect if interdiction were effective.
Supply-side measures, which are doomed by the economics of prohibition, not only have failed to reduce drug-related deaths. They have had the opposite effect.
Prohibition makes drug use much more dangerous by creating a black market in which quality and purity are highly variable and unpredictable, and efforts to enforce prohibition increase those hazards. The crackdown on pain pills, for example, drove non-medical users toward black-market substitutes, replacing legally produced, reliably dosed pharmaceuticals with iffy street drugs, which became even iffier thanks to the prohibition-driven proliferation of illicit fentanyl.
That crackdown succeeded in reducing opioid prescriptions, which fell by more than half from 2010 to 2022. Meanwhile, the opioid-related death rate more than tripled, while the annual number of opioid-related deaths nearly quadrupled.
Trump and Harris seem unfazed by that debacle. Trump imagines “a full naval embargo on the drug cartels,” while Harris aspires to “disrupt the flow of illicit drugs.” They promise to achieve the impossible while glossing over the costs of persisting in a strategy that has failed for more than a century.
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