Yves here. What is troubling about this article is that it, perhaps unintentionally, depicts the rise of multisubstance, or as they call it, polysubstance abuse as if it were an addiction version of “build it and they will come,” driven mainly by supply, as in availability. However, one has to wonder if there is an observation fallacy working: how much of the freakout over these new drug combos is that they are more often lethal than, say, good old fashioned opioids? In other words, this article does not give a good sense as to whether and how much hard drug use is rising along with the rise in fatalities.
I hate to sound unduly clinical, but dealers offering up these apparently deadlier combos also points to short-term optimization: even less concern that they might wind up killing customers in the supposed interest of giving them some sort of higher high. The flip side is (and I hope readers with some expertise will opine) that inclusion of meth in the mix would to make it harder to kick the habit. Anecdotally from the old NYC club scene, very few meth addicts were able to stay clean on a lasting basis.
The other issue not mentioned is why the apparent rise in abuse of dangerous drugs. One factor not mentioned enough in polite company is the long handover from the opioid crisis, where Purdue Pharma and others set out to create addicts and had a lot of success.
However, this is not an adequate explanation. Deaths of despair, which include suicides and alcohol abuse, have risen in the US among less educated whites since 1999….a distinct American phenomenon among advanced economies, along with our declining life expectancy. We also have astonishing levels of psychiatric drug use among the young. Some of this is lowering the threshold for a clinical diagnosis because MD and Big Pharma profits. But how much of this is due to the fact that our society, as opposed to our kids, are sicker?
By Colleen DeGuzman, KFF Health Care Correspondent and previously, a reporter for the Austin American-Statesma, The Texas Tribune and The Monitor newspaper in McAllen, Texas. Originally published at KFF Health News
The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.
These waves, according to a report out today from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.
The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.
The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.
Its findings offer staggering statistics and insights. Its major finding: how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
The most concerning, she and other addiction experts said, is the dramatic increase in the combination of meth and fentanyl use. Methamphetamine, a highly addictive drug often in powder form that poses several serious cardiovascular and psychiatric risks, was found in 60% of fentanyl-positive tests last year. That is an 875% increase since 2015.
“I never, ever would have thought this,” Volkow said.
Among the report’s other key findings:
- The nationwide spike in methamphetamine use alongside fentanyl marks a change in drug use patterns.
- Polydrug use trends complicate overdose treatments. For instance, though naloxone, an opioid-overdose reversal medication, is widely available, there isn’t an FDA-approved medication for stimulant overdose.
- Both heroin and prescribed opioid use alongside fentanyl have dipped. Heroin detected in fentanyl-positive tests dropped by 75% since peaking in 2016. Prescription opioids were found at historic low rates in fentanyl-positive tests in 2023, down 89% since 2013.
But Jarratt Pytell, an addiction medicine specialist and assistant professor at the University of Colorado’s School of Medicine, warned these declines shouldn’t be interpreted as a silver lining.
A lower level of heroin use “just says that fentanyl is everywhere,” Pytell said, “and that we have officially been pushed by our drug supply to the most dangerous opioids that we have available right now.”
“Whenever a drug network is destabilizing and the product changes, it puts the people who use the drugs at the greatest risk,” he said. “That same bag or pill that they have been buying for the last several months now is coming from a different place, a different supplier, and is possibly a different potency.”
In the illicit drug industry, suppliers are the controllers. It may not be that people are seeking out methamphetamine and fentanyl but rather that they’re what drug suppliers have found to be the easiest and most lucrative product to sell.
“I think drug cartels are kind of realizing that it’s a lot easier to have a 500-square-foot lab than it is to have 500 acres of whatever it takes to grow cocaine,” Pytell said.
Dawson said the report’s drug use data, unlike that of some other studies, is based on sample analysis with a quick turnaround — a day or two.
Sometimes researchers face a months-long wait to receive death reports from coroners. Under those circumstances, you are often “staring at today but relying on data sources that are a year or more in the past,” said Dawson.
Self-reported surveys of drug users, another method often used to track drug use, also have long lag times and “often miss people who are active for substance use disorders,” said Jonathan Caulkins, a professor at Carnegie Mellon University’s Heinz College. Urine tests “are based on a biology standard” and are good at detecting when someone has been using two or more drugs, he said.
But using data from urine samples also comes with limitations.
For starters, the tests don’t reveal users’ intent.
“You don’t know whether or not there was one bag of powder that had both fentanyl and meth in it, or whether there were two bags of powder, one with fentanyl in it and one with meth and they took both,” Caulkins said. It can also be unclear, he said, if people intentionally combined the two drugs for an extra high or if they thought they were using only one, not knowing it contained the other.
Volkow said she is interested in learning more about the demographics of polysubstance drug users. “Is this pattern the same for men and women, and is this pattern the same for middle-age or younger people? Because again, having a better understanding of the characteristics allows you to tailor and personalize interventions.”
All the while, the nation’s crisis continues. According to the Centers for Disease Control and Prevention, more than 107,000 people died in the U.S. in 2021 from drug overdoses, most because of fentanyl.
Caulkins said he’s hesitant to view drug use patterns as waves because that would imply people are transitioning from one to the next.
“Are we looking at people whose first substance use disorder was an opioid use disorder, who have now gotten to the point where they’re polydrug users?” he said. Or, are people now starting substance use disorders with methamphetamine and fentanyl, he asked.
One point was clear, Dawson said: “We’re just losing too many lives.”
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> But how much of this is due to the fact that our society, as opposed to our kids, are sicker?
1969.
The substances aren’t as new as the despair.
Is there not a link to be explored as to the possible link in the uptick of fentanyl use in the USA and the end of the USA mission to prop up heroin production in Afghanistan? I recall that the first time around, back in 2000, the Taliban were remarkably successful in crashing opium production in the country to record lows (another possible link there to be explored re the opium production crash in 2000 and dot com bubble crash – a reduction in CIA drug slush funds possibly used to inflate the tech stock bubble?). Opium production then exploded exponentially after the USA invasion and stayed at record levels throughout the duration of the occupation. Could the Taliban’s return to power have resulted in a supply shortage in the illegal opiates market, hence the turn to fentanyl as a substitute. The market will get what the market demands, after all. Alternately, has the withdrawal from Afghanistan simply made getting the real stuff into the USA more difficult and costly as less military flights to smuggle it in on, etc. and could that account for the apparent market switch to fentanyl? Just curious, as I’ve not seen any articles making any links between the military withdrawal and the turn to fentanyl, which imo warrants further investigation.
That was my first curiosity as well. A quick search pulls up a UN report citing a 95% reduction in heroin/opium production in Afghanistan between 2022 and 2023. From 6,200 metric tons down to 333 tons.
There have been articles about heroin becoming more expensive…and thus this…… Sorry I don’t have the time. But your overall insinuation that a ‘shortage’ increases substitutes or adding Fent., is true. …
I had thought that fentanyl is an adulterant that none of the opioid-purchaser/users are actively seeking. It is just an increasingly common pollutant in the morphine or heroin or whatever that they hope they are buying.
Am I wrong about that?
I’m sure you’re right about this. Fentanyl might be cheaper and easier to produce as well, and it doesn’t need as big a dose to have the desired affect.
To Yves point about a sick society, Toles had a cartoon many years ago (early’90s?) depicting an Uncle Sam figure beside a plant labeled “Illegal Drug Imports.” Uncle Sam says to two workers, “pull it out — by the roots!” There are several frames showing the workers pulling more and more of the plant out of the ground until the final frame depicts Uncle Sam disappearing into the ground.
I wish I could find it online, because it is evergreen.
How about a new war on drugs? This time it will work… *sigh*
When I was a teenager, all of the cool people did drugs and in some way you wanted to emulate them or so you thought, maybe you had no musical skills aside from being handy on the treble & bass on the stereo, but doing a line of cocaine didn’t require much tuning skills.
And then a funny thing happened over the course of my life, only uncool people did hard drugs-the human debris field, and in some measure you wonder if cities are secretly urging those on to do themselves in, one less burden on a municipality where all they did was take drugs and never gave.
I knew a few people that were meth addicts, and they were truly human wrecking balls, everything they touched turned to shit-not quite Midas in the methodology.
Meth-odd actors tend to flame out-but it takes awhile, combining meth & fentanyl is akin to a daily-double of trouble, adios.
“ knew a few people that were meth addicts, and they were truly human wrecking balls, everything they touched turned to shit”
Yes, and then kids involved and that entire web of social relations falls apart in a generation.
Yves often makes a point about the knock-on effects for higher earners with precarious work; loss of work is not just lost income, but often leaving the neighborhood and breaking of social connections. Maybe an even larger loss than the work.
Similar dynamic can play out with meth and opiate addiction. Whats considered normal and taken for granted starts to change quite a bit.
As a middle millennial, and someone that’s made a lot of younger millennial and gen Z acquaintances, I think this is just part of a bigger process I’ve seen in my lifetime. It’s like even as American culture has adopted more of a “you do you” attitude individually, it’s self-sorting into hedonist and straight-edge subcultures with very solid boundaries between them.
Drugs, sexual promiscuity, partying, and drinking too much are all sort of associated with a personality type now, and especially a lot of GenZers see it as hella cringe. I think there’s even a partial push-back against too much weed. After some bad experiences with friends / partners that smoked a lot, I’ve been surprised to find a lot more people than I expected expressing the same feelings.
I wonder if there’s a political element to it too: the old idea that hedonists always become reactionaries in the end, and the contrapositive that people with committed revolutionary tendencies often become monk-like.
In my “six degrees of separation”, there are three young people who have died from overdoses in the past three years: my great-niece, who died last April, my cousin’s grandson and my hair stylist’s nephew. Great-niece was in and out of treatment several times and in the mean time was kicked out of her house by her parents. I am not privy to the particulars except the losses ripple through family and community.
Oh, how very sad.
A couple of months ago I saw my friend walking down the street in tears. I stopped the car and embraced him. His nephew had just died of an unintentional fentanyl overdose — it was apparently laced in some fake “herbal” medicine that he had obtained.
Fentanyl is appearing everywhere. It’s being pressed into fake pills of all kinds, even laced into cannabis. People don’t even know that they’re ingesting it.
Street fentanyl all starts out in Chinese chemical factories and is processed for distribution in Mexico. All of it, according to the DEA. The borders of the U.S. are necessarily porous to goods due to the off-shoring that also created the precarity that leads to the hopelessness and insecurity that drives Americans to self-medicate.
Fentanyl is China’s asymmetric revenge for the Opium Wars. The disrespect shown by people like Trump and Blinken to the Chinese leadership is only making the problem worse.
Fentanyl is China’s asymmetric revenge…
[ This is wildly incorrect, and especially prejudiced and offensive.
A repeated prejudiced aspersion on a country and a people that have for years worked just as asked with US authorities. We have come to the point where China is formally attacked in the US on a daily basis.
This is entirely distressing, but continually encouraged. ]
Many would disagree with you, comrade:
https://pubmed.ncbi.nlm.nih.gov/37490112/
An editorial in a surgical journal is hardly evidence.
Most of the fentanyl in the US is manufactured in Mexico or in the US. Yes, China ships precursor chemicals but those are used to manufacture many types of medications and not just elicit drugs. You can’t expect China to keep track of every shipment of salt or potassium or some pill mold. And how would they know if it is going to a legitimate company or being resold to some cartel. Mexico manufactures a lot of medical supplies and medications.
Fact is Americans refuse to take on any personal responsibility and just blame China, Mexico, minorities, Jews etc. Americans are taking drugs that are imported by other Americans from across the border. American agencies like the FDA continue to have poor oversight of controlled substances and have even approved drugs 10 times more powerful then fentanyl.
But yeah keep blaming everyone else.
https://www.globaltimes.cn/page/202307/1293865.shtml
https://www.cato.org/blog/fentanyl-smuggled-us-citizens-us-citizens-not-asylum-seekers
https://www.scientificamerican.com/article/fda-approves-controversial-new-opioid-10-times-more-powerful-than-fentanyl/
I agree with you. China is a convenient scapegoat and has been for a long time. Once a tool as our off shore factory – now as a competitor it is an enemy.
It’s an official view:
https://www.bloomberg.com/opinion/articles/2023-10-26/china-sees-fentanyl-as-war-with-us-by-other-means
The same article points out:
So it is not a given that the kid was a user. One plot device in crime shows is the detective who does a bust, finds drugs, gets an itty bitty bitty bit of fentanyl on their hands, either due to not wearing gloves or not removing them carefully enough, and then has to be rushed to the ER because getting on hands will often result in ingestion.
>>>Fentanyl is China’s asymmetric revenge for the Opium Wars. The disrespect shown by people like Trump and Blinken to the Chinese leadership is only making the problem worse.
That was then, this is now. To me, they are all the same.
I do not care what people like Trump, Blinken, Xi, or all of their supporters who have shipped the factories out of the country, think or want. What they have done is for their own personal satisfaction and benefit, which have hurt the innocent, the vulnerable, not the wealthy and the powerful, the results of which I can see on the streets. They are all on my little list.
Fake herbal medicine, puhlease. Parents are ashamed to say their precious child OD’ed. Let me ask, are the evil Chinese mixing fentanyl on lollipops and infant formulas too?
I would be surprised if there was fentanyl in the tea, but Chinese food and medicine have had serious problems for decades. Baby formula and pet food involved a lot of dying of babies, dogs, and cats. Plus, poor quality control can also cause contamination. Just incompetence or an honest mistake as well.
Infant formula? Like the Sanlu melamine scandal? A Freudian slip, Comrade Troll?
Fentanyl exported as a raw chemical from China is compounded by the Mexican drug cartels into many forms. The cartels have become quite adept at understanding the American market for self-medicating the despair and precarity created by the greed of U.S. elites — who have willfully undermined the common prosperity of all of the world’s people.
What’s with the “Comrade Troll” ad hominem?
You think you’re being clever, or cute?
It may or may not be a strategy of the Chinese but i doubt it’s actively targeted if a strategy at all. Unfortunately I have had the opportunity to observe the social ripple effects of drug abuse myself time and again. Some much too close. I.e. the daughter of an acquaintance has 4 children from 4 different fathers, all of whom live in foster families now or have been adopted by her mother who has a troubled son herself at home. She’s been in prison for drug-related crimes and has not come to terms that she is not fit to take care of her kids until she’s changed etc.
But I believe the only viable counter strategy would have to begin in wider society, especially in the USA. On the individual level there is an element of luck involved and if bad luck hits, it’s down to dealing with the consequences. On a societal level atomisation of society will only lead to more vulnerable people that get trapped.
I don’t believe much in the effect of supply/demand and consider Portugals strategy of legalisation and care as, well, better than many. It’s a reasonably wealthy society but economic life is tough there but legalisation has not resulted in skyrocketing numbers of abuse. It hasn’t done much to reduce the numbers of addicts either, apparently.
I am so sorry.
Check out Channel 5’s Streets of Philly video expose of a hideous new street drug concoction “Tranq”.
You will need a strong stomach.
https://www.youtube.com/watch?v=925wmb-4Yr4&t=117s
I wonder if the current problem of “polydrug” abuse is related to the popularity of Ecstasy in the early 90’s.
When Ecstasy first hit the rave scene, it was pharmaceutical grade. Originally a prescription diet drug, it provided a euphoria enhanced by the rhythm of EDM with the energy to dance twelve hours straight. On its own, Ecstasy was relatively harmless from a medical point of view. Ecstasy overdoses were almost unheard of, mostly limited to heat stroke and dehydration from day long dancing. But it had two fatal problems.
First, the high diminished each time you used it. The first experience was sometimes life changing. So many users started chasing that original high by experimenting with different combinations of street drugs.
Second, real Ecstasy was in limited supply. So dealers started mixing various euphoriants and stimulants and selling it as the real thing. Plus, chemists developed “designer drugs” that were similar to, but not exactly, Ecstasy.
Thus the birth of mystery “party drugs.” I find it strange that the same generation that shuns chemical fertilizers, pesticides and GMO crops in their food is willing to use mystery drugs to get high.
The majority of Yves’ add on comments are really true.Here in SF (NOT the overdose capital ‘per capita’….not even in top 15, it’s just more visible, being a dense city….). when responsible journalists, often writing for local blogs, look into data, the majority of OD’s are a mixture..and very often people just wanting heroin or other opiates, get fentanyl mixed in. But all THOSE OD’s are specifically called FENT only! Yes some are asking for Fent. straight up….that’s true, it’s more hyper and wears off sooner…horrible. ………..But also, yes it’s a way to deflect away from our sick society, our lack of mental health care and housing, and decent jobs..deaths of despair…….to just blame ONE ‘foreign produced’ drug as the problem that can be stamped out. Now you have Tranq also. Young people and my older acquaintances from the music scene since the 80’s, wouldn’t be knocking themself dead, if life was not so hard, and filled with evictions, job changes, unaffordable health care…etc…. and a society that prescribes punishment……not community….
Because they are fentanyl overdoses, whether intentional or not. It’s quite hard to overdose on just meth. It’s true a lot of people aren’t intentionally doing fentanyl blues; more are intending to just do meth (heroin and cocaine largely don’t exist on the street anymore, they’re exclusively rich people drugs now). But fentanyl is now mixed into basically everything, whether by design or not (some of it is simply becauseof quality control of homemade drugs being nonexistent and cross-contamination happening). No one intentionally uses tranq, so far as I know. It’s a literal horse tranquilizer that gets mixed into the supply, presumably as filler, that increases fentanyl overdoses because it counteracts the narcan that might otherwise save someone.
‘Community’ is not highly regarded by the capitalist system – in fact it’s an obstruction to the unfettered spread of self-oriented consumerism and unquestioning submission to the ‘rules’.
The issue here is not what mixture of drugs is around on the “street” but why people want and need to get high in the case of fentanyl and meth why do they want to go so far away such that they become radically irrational dysfunctional. I had a meth problem when I was 18-19 and got out of it through becoming psychotic and recovering once I had a month off of the drug–never touched it again.
The problem we have in our society is that we try to suppress the problem through coercive methods not because there is evidence that it works (it obviously does not work) but because we like to coerce others because that is our culture. The real cause of this problem which will only get worse as our life-expectancy continues to drop with no end in sight is because the authorities don’t care about those who are not at or near the top of the economic system. Because we believe in “competition” as almost an end in itself so that those who lose (which will always be a majority) are, in terms of American society, heretics who should always be treated without compassion. I think this will change when more people begin to see that pain is not remedied by punishment of indifference (at best).
Through many of the issues we face seem beyond being solved since we believe that the authorities have “expertise” in those areas they rule over whether it is foreign policy, child services, health-care, labor policies, the mainstream media, or Silicon Valley our emphasis on aggression, competition, and, above all, money just continues our spiritual emptiness which those most sensitive among us cannot handle. Often drug addicts possess what we lack as a society, i.e, compassion and emotional sensitivity–it’s a shame they are let to escape into an artificial world. At the same time, many of us are addicted to bursts of dopamine as we search for little thrills to fill up the emptiness that comes from moral confusion, too much information and utterly inadequate education for our current world that gets worse every year.
Thank you for your comments and congratulations on your recovery. That must have been a very tough time. You have made some important points about the reasons why some feel the need to escape from society’s spiritual emptiness.
My experience also lines up with Yves. The club scenes I was part of took a dark turn once meth started showing up in them; it was community-destroying, and it seemed really hard to stay clean once you were went a ways down the road.
On a lighter note, what I always thought was funny was that the people who gravitated toward speed were already the speediest naturally. They were the last I would have ever wanted sped up more…
A friend of mine said that about 30-40% of his small Appalachian high school graduating class has died by middle age, mostly fent, and both fent and meth certainly wreaked havoc in the rural south, where much of my extended family is. We hear about the cities, of course, but the rural experience is close to unbelievable.
>>>The club scenes I was part of took a dark turn once meth started showing up in them; it was community-destroying, and it seemed really hard to stay clean once you were went a ways down the road.
In reference to what Albe Vado said about heroin and cocaine being rich folk drugs, I am thinking that only having them around would be an improvement. The halcyon days of my youth where we just had the the weed smugglers, the gangs’ crack wars, and the coke and heroin of the narco lords. When having a speedball of coke and heroin was a deliberate act, not an accident. I’m a hermit now, but it just looks like every decade means new horrible ways of chemical exploitation by both the dealers and the government. The thought of what all this would have done to my classmates, friends, and coworkers makes me ill.
But I guess some form of neoliberalism would hit the drug scene as well. I guess I can look at the past few decades as the crapification of the drug scene. Or would that be the enshittification? Cheaper, more potent, worse quality product, like our “food,” being manufactured and sold for the quick buck. And like our “food” creating the conditions that encourage the use of the junk narcotics.
Feel bad? Have a serving of the latest, greatest hit of pseudo-food or the hit new drug sensation Fukitall while sitting on the pile of dung that is your life. American in the 21st century. Happy, happy, joy, joy.
Enshittification of the drug scene is a good way of putting it.
Tangential here is Mark Fisher’s writings on the path of the British club scene going from favoring uppers to downers in the 2000’s and what that might say about the culture. There’s an interesting next chapter left unwritten after his death about the transition from downers to disassociatives like ketamine.
More loosely:
I don’t want to feel pain, and I want to feel great –> dim everything around me, it’s too much –> I don’t want to experience or remember anything.
>>>I don’t want to feel pain, and I want to feel great –> dim everything around me, it’s too much –> I don’t want to experience or remember anything.
Living suicide is what people are doing.
I think the only way to stop these deaths is to legalize all drugs and nationalize production so cartels don’t get hands on it. This would destroy nearly all drug market in USA. To make sure people buy only from government control shop is to give high fines to those people
The government would have to ensure the availability and quality of the drug, and a price that would undercut the dealers, which is the only practical way of cutting them off.
And price it so low that the cartels could not possibly underprice it. Because if they could, they would.
Some much smaller nations tried that and it didn’t work. It’s a very bad idea.
>>>Some much smaller nations tried that and it didn’t work. It’s a very bad idea.
So does having the largest incarcerated on Earth, which to United States has, and has done so for several generations. I am not sure of what should be done, but what we are doing now are making the government, politicians, police, prison guards, and the narcotraficantes job security and wealth.
This seems the anthesis of any business model. Why sell drugs that are killing your customers?
Two brothers in their 40’s, friends of mine, walked into a bar where one of their girlfriends worked. She gave them what she thought was cocaine. They went to the bathroom to injest it, one brother died on the spot, the other was in a hospital for 6 weeks. I had no clue they did drugs, and maybe they were just occasional users.
This fentanyl is a pure killer. When people are high they make real stupid decisions; did I mix four bags of cocaine with one bag of fentanyl or was it the opposite?
Fentanyl and its even stronger analogs can kill a person with low/no tolerance so very easily. A tiny bit the size of a dimple is all it takes.
They add meth to fentanyl because it keeps you awake and so you take more. Otherwise most people will nod off with a tiny bit off fentanyl and that’ll be it for the evening. They add fentanyl to cocaine because its an order of magnitude cheaper, gives a euphoric feeling and the coke keeps the customer awake for more.
A little bit of sloppiness in measuring or mixing and you get a lot of dead people with fent. That’s it.
A couple of years ago at Burning Man, a campmate broke his ankle falling off a bar stool (we were all in agreement that the tale needed to be gussied up big time) and there is actually a hospital in Black Rock City, and our fellow burner had been given fentanyl when they did an operation on him.
…he went to Burning Man to do fentanyl~
Because you expect to get new customers to replace the old ones? That was the tobacco industry’s strategy.
Also because “I’ll be gone, you’ll be gone”
The street level dealers are a dime a dozen. If they don’t sell, they are replaced.
The street price of an eight ball is constant but the price of pure cocaine has skyrocketed. It’s not a case of mixing incorrectly but not having enough cocaine to make eight ball pricing work. Dealers need something else to produce a high before their customers disappear through peddling a product that doesn’t even get one high.
There is a scene in The Wire where the dealers plan to sell watered down product because of their whole sale price as a new product with a different price point.
Drug dealers are always a phone call away from being arrested at every level. The dealers may not have product tomorrow due to a bust, so who cares about repeat customers?
I had jury duty last year (it was nearly worth the five days), but the defendant was robbed and shot by an unknown attacker and had nearly 100k worth of cocaine in his apartment among other sundries including drug cutting supplies and guns which is a problem for violent felons. The basic gist is his dealer saw he was not keeping a low profile and cut decided to cut him off. The whale in the area had been busted, so the defendant became the only game in the area really quickly. He just started to become an obvious liability.
My solution to the drug crisis starts with universal healthcare and a massive build-up of the Public Health Service. This could all be funded by reprogramming the trillions wasted on foreign wars and 800 overseas military bases.
If our ruling class were truly interested in defending Americans it would start at home. This seems to be a no-brainer to me.