alt Hacker News>> Researchers have pondered what could have caused this sudden turnaround, pointing to the end of the covid-19 pandemic or a rise in drug treatment. A new article, published in Science on January 8th, suggests, instead, that a supply shock drove the decrease.
The supply shock sounds right.
I was volunteering at a state run institution, who had an addiction data science team, at the peak of the opioid crisis. I was developing ml models to predict patient dropout early in a 32 week program. The data and funding for such research was very scarce and it didn't go anywhere.
Treatment for opioid use disorder with medication is highly effective for 50% - 90% who respond well to treatment. The problem with the bottom 50% was early dropout, due to the lack of dissemination of proper treatment protocols and stigma attached to medication for treatment (methadone). I stopped following the work, I became too sensitive, it was pretty depressing.
The pandemic coupled with the increase in illicit fentanyl was just tragic in what it did to people. I remember reading the DEA research, where the precursor for fentanyl came from china and was manufactured and distributed from mexico. Mexico was also manufacturing high quality meth and displaced most of the meth labs in america, coming with increases in meth overdose during the same period. The fentanyl was so cheap compared to traditional heroin manufacturing.
I'm glad the supply seems to have dried up. It was nuts, what was going on a few years ago.
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I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw:
I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid.
Edited slightly for clarity.
Even still today there is no reliable place to source black tar or China White or any of the traditional opium derivatives without having a fentanyl cut.
The initial spike in overdose deaths were largely caused by government crackdowns on pharma drugs.