SOME 382,000 Americans have overdosed on opioids—a group of drugs that includes prescription painkillers, heroin and synthetics—since the year 2000. That is greater than the number of American combat deaths in the second world war and the Korean and Vietnam wars combined. Despite this epic toll, there are early signs that at least one battle may be ending.
The Centres for Disease Control and Prevention (CDC) provide the best data for tracking the opioid epidemic. Its latest data, which cover the 12 months to the end of October 2017, show that opioids were responsible for some 46,041 deaths (see chart) in that period. While provisional and subject to revision, that number was at least not dissimilar to the previous month’s figure of 46,202.
The precise workings of the epidemic in recent months are not well understood, but a few elements stand out. The first is that deaths from prescription medication are likely to have been pushed down by lower availability of those drugs. Official data from the CDC show that prescription rates were nearly 20% lower in 2016 than at their 2012 peak. IQVIA, a health consultancy, reckons that prescriptions fell by another 10% in 2017. Donald Burke, dean of the University of Pittsburgh’s graduate school of public health, thinks there is “almost certainly cause and effect” between prescription rates and deaths.
Experts agree that the most effective way to fight addiction is with medication-based treatment, such as methadone. But just one-third of Americans live in counties with treatment centers providing these kinds of drugs. For real progress it is necessary to look north. Vancouver has pioneered the use of safe-injection sites. Seattle and other progressive enclaves of America would like to follow their lead but they face stern opposition. America’s attorney-general, Jeff Sessions, has threatened to prosecute such sites under the “crack house statute”. Such sites, claims the Department of Justice, will only “encourage and normalize heroin use”.