Cocaine death decreases is the hard thing to explain with either theory, supply or naloxone. Fentanyl supply doesn't affect cocaine in any way and naloxone doesn't work on a cocaine OD.

Maybe some percentage of cocaine deaths are misattributed fentanyl deaths?

I also wonder if there's any link to the Oxycontin reforms. Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.

Or maybe it's actually that the drug dealers have gotten more careful. Drug dealers don't want to kill their clients, so maybe they've been purposefully diluting to make sure they get repeat customers.

> Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.

This is definitely part of the story. When your primary source of new addicts is prescription opioids and you cut down on the prescriptions then over time, as people die off from OD, then the OD rate is bound to drop.

The most tragic part of it, to me, is that it's usually the people who got clean who eventually OD. Once they've been clean for a short time then their tolerance for the drug drops drastically, then if they break down and do "just one dose" they make the fatal mistake of thinking they can still handle the same amount they were used to doing before. This exact scenario happened to multiple more or less close acquaintances of mine, even people who were aware of tolerance and should have known better. I'm fairly sure that it's extremely common.

I believe they're using CDC data, which states:

"Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs." https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Someone who overdosed after taking cocaine contaminated with fentanyl would be counted as a cocaine ODD.

The Oxycontin "reforms" caused the fentanyl crisis to begin with. People often moved onto heroin and fentanyl because pharmaceuticals were no longer accessible. The massive spike in overdose deaths begun after the decline in opioid prescriptions. See the Opioid Prescriptions & Opioid Overdose Deaths graph here https://drugabusestatistics.org/opioid-epidemic/

In Europe the per kg price of cocaine has apparently halved.

If that's the case in the US as well, it could be that as a result there's more cocaine in the cocaine and fewer adulterants.

Pure cocaine overdose deaths are relatively rare. Only around 5% of cocaine deaths involved pure cocaine, it's almost always mixed with something else.

> I also wonder if there's any link to the Oxycontin reforms. Perhaps now that prescription is reigned in, we are seeing a lot fewer oxy->fent cases which has cut back on the deaths.

Prescription pills have been a non-issue for a decade by now.

> Or maybe it's actually that the drug dealers have gotten more careful. Drug dealers don't want to kill their clients, so maybe they've been purposefully diluting to make sure they get repeat customers.

Yup. I think that's exactly it.

The major reason for fentanyl deaths was not unintentional overdose because of poor pill quality. It was way too easy to end up with 1mg instead of 500mcg during pill mixture preparation. So _reducing_ the amount of fentanyl per pill results in a better safety margin. And users can just smoke another pill if one pill was not enough to get high, after all.

And yeah, it's just possible that the more reckless drug users are just dead by now. But to be clear, it's still absolutely horrible. We're still above the 2021 level.