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Comment by mythrwy | Hacker News Reader

"Supply shock" might not be the only, or even primary cause. As far as I know fentanyl is still widely available and inexpensive.

My guess is only a subset of the population is willing to both A) Use a substance like street fentanyl with known lethality. and B) Do so in a risky and unsafe manner (alone, no narcan, shooting instead of smoking, etc. etc.).

That subset of the population has already been decimated to the point we are seeing a decrease, and survivors have become more educated on how to use without dying.

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I'm skeptical of that last one.

My dad was a heroin addict, and while he eventually got (mostly) clean, he wryly joked to me once "you know there aren't a ton of old heroin users for a reason"

Using street drugs kills - we can put people on opiates if done in a controlled way, for the rest of their lives, we instead have gone down the road of prohibition, closing off pathways for people to get maintenance dosing of opiates.

A major factor is Narcan being far more available and usable by people who are not trained.

> fentanyl powder and pills were losing potency just as overdose deaths were falling

Combined with the already dead, does this not explain things?

Illegal drug suppliers don't make money by killing their customers. Consequently, they finally got control over the potency throughout their supply chain.

Although, I'm more interested in the standard deviation of the potency than the absolute value of the potency. I suspect that is much more correlated with OD deaths.

Just a different form of supply shock - to the supply of users.

Living in downtown SF for the last two years has made it painfully obvious those using fent on the streets are not long for this world. It'd an inherently self-solving problem, grim but true.

There is also a never ending supply of destitute and destined-to-be-destitute in America. The people may change but the problem persists.

Not all (probably not even most) destitute people become opiate addicts. People become destitute because they are opiate addicts, it's not the other way around.

> to the supply of users

I think there is a word for this...

That seems the most plausible explanation.

The article says something along these lines. Every pandemic has a peak point when people become alarmed, and there is a clear way to avoid contamination.

It happened with AIDS when people began stopping having risky relations. It is only natural that it would also happen in drug addiction when everyone sees its devastating effects.

The same thing might be happening to tobacco and alcohol consumption.

Deaths for lack of vaccines (e.g. measles) will also behave the same way. When people see very explicitly that risky behaviour has consequences, they think twice before doing it.

> When people see very explicitly that risky behaviour has consequences

With much emphasis on the "very explicitly" part.

It seems to only work that way when it is very explicit and rapid consequences. Abstract consequences far in the future are not very effective at deterring [ entertaining | desirable | fashionable | profitable ] behavior.

"The same thing might be happening to tobacco and alcohol consumption."

I believe the data on smoking was the opposite. Showing people the terrible consequences of smoking (including very graphic images) turns out to have minimal or no effect. There was a large randomized trial in the pacific northwest some decades ago. A lot of people now point to taxes as the main driver in the decrease.

Is there a graph of the decline in overdoses with time?

Your explanation suggests an exponential decay (ignoring aggravating conditions, like seasonal temperature, violence, ...)

In the article, yes. https://d9258mdc7ql01n.archive.is/C0Y0G/696eb2f917764f004c5f...

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