The U.S. Drug Enforcement Administration (DEA) has reported a decrease in the amount of fentanyl in illicit pills, suggesting that this reduction may be contributing to a decline in overdose deaths. However, experts are cautioning that there are multiple factors at play, and the situation is far more complex than it might appear.
Fentanyl Pills in the U.S. Illicit Market: Decline in Lethal Doses
According to DEA Administrator Anne Milgram, recent tests of fentanyl pills show that only about 5 out of 10 pills contain lethal doses of fentanyl, down from 7 out of 10 last year. This change, she suggests, is a positive sign that could help reduce overdose fatalities. Milgram emphasized the role of DEA operations in pressuring drug cartels to reduce the amount of fentanyl in the illicit drug supply.
Recent federal data also reflects a promising trend: overdose deaths dropped by nearly 15% between June of this year and last, with a significant reduction in deaths linked to synthetic opioids like fentanyl. The CDC estimates that 16,000 fewer people died from overdoses in the most recent 12-month period, with fentanyl being a primary contributor to the previous spike in fatalities.
Cartels and the Fentanyl Supply Chain
The DEA has focused much of its efforts on dismantling the two major Mexican drug cartels – the Sinaloa and Jalisco cartels – which are largely responsible for the influx of fentanyl into the U.S. In its May report, the DEA highlighted that combating these cartels remains its top priority. However, the DEA has not provided specific details on the number of pills tested or their exact origins, making it difficult to fully assess the impact of these findings.
Experts Question the DEA’s Analysis: Fentanyl Powder and Other Factors
While the DEA’s findings are being hailed as a key factor in reducing overdose deaths, experts argue that the analysis oversimplifies the issue. Dr. Alex Krotulski, a toxicology and chemistry expert at the Center for Forensic Science Research and Education, points out that fentanyl is more commonly found in powder form than in pills. Krotulski also emphasizes that the purity of fentanyl in the drug supply can vary significantly, and recent data from his lab shows only a modest decrease in fentanyl powder concentrations—not a drastic drop that could account for thousands of fewer deaths.
Moreover, the DEA defines a “lethal dose” of fentanyl as 2 milligrams, but this threshold can vary greatly depending on an individual’s tolerance, genetics, and other factors. Krotulski argues that this variability makes it difficult to directly link changes in pill contents to fluctuations in overdose deaths.
The Complexity of the Drug Supply and Public Health Efforts
Dr. Krotulski also suggests that while changes in the drug supply may have an immediate impact on fatalities, a significant and abrupt reduction in fentanyl would likely be required to explain a substantial drop in overdose deaths. The variability in the types of drugs consumed, the presence of other contaminants, and different routes of administration complicate efforts to directly connect fentanyl levels to the overall decline in fatalities.
In a statement, Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, acknowledged the multifaceted nature of the overdose crisis. Gupta emphasized that efforts by the Biden administration to expand access to treatment, increase naloxone availability, and invest in law enforcement measures at the border have all contributed to the recent decline in overdose deaths.
Other Factors Contributing to Declining Overdose Deaths
While the DEA’s data may provide some insight, experts like Dr. Daniel Ciccarone from the University of California, San Francisco, argue that a combination of factors is likely behind the recent drop in overdose deaths. Ciccarone points out that the reduction in fentanyl exposure could be one reason, but it is also possible that the at-risk population has shrunk. Younger people who were not exposed to fentanyl in their heroin supply may be less likely to seek out fentanyl, thus decreasing the pool of potential overdose victims.
Ciccarone also suggests that the decline could be a natural return to pre-pandemic levels following the sharp spike in overdose deaths during the height of the COVID-19 pandemic. During the pandemic, many people faced social isolation, economic stress, and disruptions to drug use patterns, which may have contributed to an unusually high number of overdose deaths. As these factors stabilize, the trend may be returning to more typical levels.
The Role of the “Supply Shock” in Fentanyl Availability
Another theory offered by Ciccarone centers around the concept of a “supply shock,” where changes in the availability or price of fentanyl on the street could have immediate effects on overdose rates. He suggests that reports from cities like San Francisco and Ohio indicate that fentanyl is becoming weaker, harder to find, and more expensive, possibly due to shifts in production or enforcement efforts. Such a change could decrease consumption, leading to fewer overdoses.
However, Ciccarone is cautious about attributing the decline in overdose deaths to a single cause, noting that the illicit drug market is highly adaptive and resilient. “The market will adjust,” he said. “I’m not convinced that this phenomenon will last another year. We have to expect the unexpected.”
Looking Forward: A Complex and Evolving Situation
In sum, while the DEA’s findings regarding fentanyl levels in illicit pills may be one contributing factor to the decline in overdose deaths, it is likely not the only explanation. Public health experts stress the need for a holistic approach to tackling the overdose crisis, which includes addressing the underlying drivers of drug use, expanding access to treatment, and continuing enforcement efforts to disrupt the fentanyl supply chain.
Despite the optimistic trend in overdose deaths, experts like Ciccarone caution that the situation is still fluid and that the decline may not be sustained. The illicit drug market is unpredictable, and the factors influencing drug use and overdose rates remain complex and interwoven.
