Sam Quinones, a journalist, is the author of five books, including “Dreamland: The True Tale of America’s Opiate Epidemic” and “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth.” His latest, “The Perfect Tuba,” is a sequel to those books.
Last spring, I interviewed a Salt Lake City woman addicted to fentanyl, which came in illicit pills from Mexico. For a long time, she told me, the high levels of the drug in those pills kept her tolerance quite high, making any sort of treatment — and the withdrawal that would come with it — out of the question.
But in early 2024, a year before our conversation, the fentanyl supply started to change. The pills she purchased gradually weakened, until finally they no longer contained enough fentanyl to staunch her withdrawals. Eventually, she sought treatment.
I was reminded of that conversation last month when the Centers for Disease Control and Prevention released its latest provisional numbers for overdose deaths nationwide. It projected 71,542 deaths in the 12-month period ending in October 2025, a 17 percent drop compared with the previous 12-month period. Even more encouraging, the full year of 2025 is expected to mark a 35 percent drop from the peak number of deaths in 2023.
Many factors contributed to this trend, but I think the most important reason is clear: Fentanyl supplies have dropped thanks to collaborative and wide-ranging counternarcotics strategies. Nothing else explains the timing and abruptness of the decline.
Drug seizures tested by the Drug Enforcement Administration illustrate this well. In August 2023, the agency reported that the purity of seized fentanyl powder products peaked at more than 20 percent; by the end of 2024, it dropped to just above 10 percent. The purity of fentanyl in pills dropped as well, though with some fits and starts likely due to Mexican producers “having difficulty obtaining some key precursor chemicals,” the DEA reported.
Not coincidentally, in my view, this began shortly after federal agents from across the U.S. government implemented a collaborative strategy to disrupt fentanyl supplies. Mexican government agents were also part of the mix.
It was a strategy rooted in the counterterrorism approach used to combat al-Qaeda yet applied to Mexican fentanyl traffickers and Chinese chemical companies. The disruption involved attacking cartel finances, imposing sanctions on Chinese chemical companies, arresting money launderers, tracing pill presses, going after border couriers and, above all, sharing information quickly among agencies. The collaboration provided a template for how to fight drug supplies in the era of synthetic drugs.
Jake Braun, former homeland security adviser during the Biden administration, recounts this story in his book “Fentanyl: Fighting the Mass Poisoning of America and the Cartel Behind It.” This strategy continued during the Trump administration.
That shifts in the supply could have produced such a massive turn in fortune doesn’t surprise me. I wrote a book about the epidemic of addiction to prescription opioid painkillers and another book about Mexican traffickers’ switch to synthetic drugs, namely fentanyl and methamphetamine. My reporting gradually convinced me that these supplies were creating demand, not the other way around, as I once believed.
Street opioids have always been about supply creating demand. They tend to create physical dependency in ways other drugs do not, particularly when they are highly potent and widely available.
The first modern example of this was the opioid epidemic itself, which began in the late 1990s when drug companies pushed doctors to prescribe opioid painkillers, assuring them that pain patients could not become addicted to them. As prescriptions of those pills rose, so too did overdose deaths and requests for addiction treatment. In other words, those relentless supplies created a population of opioid-addicted Americans that had not existed before.
By 2016, chastened doctors were cutting back on prescriptions, resulting in a drop in the supply of pills. Theoretically, deaths should have dropped as well; instead, they rose because Mexican traffickers discovered fentanyl and spread it as abundantly across the country as those doctor-prescribed painkillers.
Fentanyl was the drug dealer’s perfect product. Massive fentanyl supplies meant the tolerances soon soared — at least among those users who didn’t die. The drug’s quick half-life in the brain meant those who survived it had to buy it regularly, and its high potency made it difficult to opt for, and stay in, treatment.
Meanwhile, customers who did die were quickly replaced by new addicts. Most heroin addicts, in fact, did notopt for fentanyl. They were transitioned to fentanyl because dealers mixed it into heroin, cocaine or pills they thought were something else.
Plus, because fentanyl was chemically made, traffickers could produce it year-round, as opposed to drugs that come from seasonal crops such as heroin. All they needed was a steady flow of ingredients from chemical markets, principally those in China, which they achieved using their control of Mexico’s shipping ports. That is what has been disrupted in the past two years, as the DEA purity figures show.
At its core, fentanyl is a supply-driven problem. Problem is, local efforts have relied on demand-reduction strategies, believing they alone will address the problem. For example, we offer treatment to people addicted to towering levels of fentanyl, only to be surprised when they refuse. Declining fentanyl supplies offers a chance for demand-reduction strategies to work, as they apparently did for that woman in Salt Lake City.
It is true that now-plentiful Narcan — the brand name for naloxone, the opioid-overdose antidote — also played a role in falling death numbers. Narcan is a beautiful tool. I carry it in my car, my toiletries and my backpack, though I’ve never had to use it. But in a time of rising fentanyl supplies, naloxone has offered only a temporary reprieve. Many addicts who died of fentanyl overdoses had been revived with Narcan repeatedly.
In fact, the lower supplies of fentanyl seem to be making Narcan’s job easier. Last year, I spoke with a woman who was addicted to the drug in Tucson, two hours from Mexico and a major drug through-point. Supplies of fentanyl had dropped mightily since a peak in 2023, she said, when pills cost between 50 cents and a dollar. Those pills now went for $5.
In 2022 and 2023, she overdosed 26 times in 15 months, revived each time with Narcan. But during her latest episode of drug use, she said, she hasn’t overdosed once.
The lesson here is clear: Public health officials who want to give their demand-reduction strategies a chance to work need to think of this as a supply-driven crisis. The United States has already made great progress in stemming overdose deaths; it should continue with what’s working.
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