Opinion: Understanding how fentanyl 'saturated the U.S. drug supply' could help address the addiction crisis

Naloxone can prevent overdose deaths, but it's expensive.
(Adobe Stock photo)

The current U.S. opioid crisis started with painkiller prescriptions in the early 2000s, but once medical providers started nixing those medicines, heroin's popularity surged, and then fentanyl and its "tsunami" of death entered the market, reports Maia Szalavitz of The New York Times. "Understanding how fentanyl saturated the drug supply, moving from the East Coast of the U.S. to the West, is critical to ending the worst drug crisis in American history."

Drug cartels' greed drove the creation and use of fentanyl. "By 2013, cartels had realized that they could slash their labor, manufacturing and transit costs by replacing heroin derived from farm-grown opium with a powder made in a lab — fentanyl," Szalavitz writes. "Before 2018, 80% of all deaths associated with fentanyl occurred east of the Mississippi. . . . Since 2021, at least two-thirds of America’s 100,000 annual overdose deaths involved a synthetic opioid like fentanyl."

While heroin was considered a more urban drug, "increased opioid prescriptions — followed by sharp reductions — resulted in new heroin users in rural areas," Szalavitz explains. "Illegally manufactured fentanyl began appearing in both urban and rural drug markets. . . . Rural West Virginia and other Appalachian regions were the center of the earliest prescription opioid wave of the crisis, which led to the establishment of new heroin markets in places facing job loss."

Combating opioid addiction and overdose deaths liked to fentanyl is tough because the drug's supply chain and use is now deeply embedded across the country. The drug is cheap to make and buy, and provides an exceedingly potent high for the user. "So, what can be done? The answer is to focus on the drivers of demand, not supply. This means addressing the roots of addiction and treating it compassionately," Szalavitz writes. "We have a great generic opioid overdose antidote, naloxone. . . . And two medications — methadone and buprenorphine — have proved to cut the risk of death among people with opioid addictions by 50% or more when used long-term."

Szalavitz adds that people often start doing drugs because their lives feel hopeless. "Addiction is most often an attempt to escape despair. The condition itself is defined by compulsive drug use despite negative consequences, which is why threats of punishment or even death rarely yield recovery. . . . It’s not coincidental that the exponential rise in overdose deaths has occurred in tandem with a profound increase in income inequality."