New research shows the historic 2018 downturn actually was caused by China’s regulations on carfentanil
By Jason LangendorfOctober 6, 2020
The recent historic decline in drug overdose deaths in the United States was not, as had been speculated by some, the result of federal legislation, according to researchers at the University of Pittsburgh.
Hawre Jalal, M.D., assistant professor at the University of Pittsburgh’s Department of Health Policy Management, co-authored an examination of preliminary federal data for domestic overdose deaths that appeared in Addiction journal in September. The study’s findings indicate the 2018 decline—the first downturn in the trend of U.S. overdose deaths since 1990—was attributable to China’s crackdown on the drug carfentanil rather than American public health interventions.
“We can’t just look at the single-year drop,” Jalal says. “We have to look into the long–term trajectory and, really, be very careful in assessing short–term increases or declines. And if we have a simple drop in one of the years, we can’t just say we curbed the epidemic. Curbing an epidemic requires a lot more trajectory analysis, and it also requires understanding, Why did we curb the epidemic?”
Jalal and co-author Donald S. Burke, M.D., distinguished university professor of health science and policy, epidemiology, at the University of Pittsburgh, compared trends in overdose deaths and mortality rates by state. They discovered that five states (Ohio, Florida, Pennsylvania, Kentucky and Michigan) accounted almost entirely for the 2018 decline. Those states had also accounted for a drastic spike in overdose deaths in 2016 and 2017, and the subsequent decline coincided with China’s adding carfentanil (a drug that is 10,000 times more powerful than morphine) to its list of controlled substances and a sharp decline in seizure exhibits in the five affected states. The data suggests it was the Chinese policy of shutting off the carfentanil supply rather than American policy that directly affected overdose deaths.
“The first downturn in the trend of U.S. overdose deaths since 1990 was attributable to China’s crackdown on the drug carfentanil rather than American public health interventions.”
Although Jalal says it’s difficult to explain the prevalence of carfentanil in a handful of states as compared to others—in part, he says, because the Drug Enforcement Administration (DEA) limits certain data availability—he emphasizes the importance of viewing the exponential curve of the U.S. overdose problem from a wider lens.
“The main point we’re trying to make in the paper is that it’s a complex dynamic,” Jalal says. “You target a certain drug—for example, carfentanil—through international policy and national policies, and we try to bust some drug dealers. But the epidemic has been growing exponentially for a very long time.”
Jalal notes that cocaine and meth are currently making a comeback, and that synthetic opioids are increasingly being produced more cheaply are more widely available. He says he has struggled to find anything like the exponential trajectory of the overdose death curve elsewhere in nature or public health, and he warns that the dearth of research in the field and any “premature celebration” of a brief overdose decline threatens progress in drug policy and treatment.
“The problem with it is the funding,” Jalal says. “There was a lot of national effort, a lot of funding dedicated when the epidemic was declared a public health emergency. But those funds are going to drain pretty soon. When that happens, there will be a lot of programs, a lot of national efforts, that have not been given enough time to show efficacy and effectiveness. And if the decline has been attributed to domestic intervention, but that’s not what’s happening, then you can imagine how that could negatively impact those programs.”
Photo: Brendan Church