Exploring the sources of the decline in US drug overdoses

Strobe Talbott Center for Security, Strategy, and Technology

斯特罗布塔尔博特安全、战略和技术中心

After rising for more than 40 years, the number of U.S. drug overdose deaths began to fall in mid-2023, declining from a 12-month rate of about 110,000 in June 2023 to about 72,000 in August 2025, primarily as a result of a decline in the number of deaths involving fentanyl.

美国药物过量死亡人数在经历了 40 多年的上升之后，于 2023 年中期开始下降，从 2023 年 6 月约 11 万例的 12 个月下降到 2025 年 8 月的约 7.2 万例，这主要是由于涉及芬太尼的死亡人数下降。

Many factors have been suggested to explain that unanticipated decline: some focused on supply and some on people who use illicit drugs, including widespread adoption of several harm reduction measures.

人们提出了许多因素来解释这种意外的下降：一些因素集中在供应方面，一些因素集中在使用非法药物的人身上，包括广泛采用的几项减少伤害措施。

This essay examines five different potential sources of decline.

本文探讨了五种不同的潜在衰退根源。

Two are specific policy interventions aimed at reducing demand or mortality risk; for neither intervention do we assess the effects as likely to be substantial.

二是旨在降低需求或死亡风险的具体政策干预措施；对于这两种干预措施，我们都没有评估其影响可能是重大的。

Two sources are characteristics of the supply that may have changed to reduce mortality; both may have played a role.

有两个来源是可能改变以降低死亡率的供应特征：两者可能都发挥了作用。

The fifth is purely epidemiological, and we are unable to assess its impact.

第五个纯粹是流行病学的，我们无法评估其影响。

The brief concludes with recommendations for strengthening monitoring systems to improve policy.

简报最后提出了加强监测系统以改进政策的建议。

Between late-2021 and June 2023, the United States attained a truly catastrophic peak level of overdose mortality, averaging nearly 10,000 deaths per month.

2021 年底至 2023 年 6 月期间，美国的服药过量死亡率达到了真正灾难性的峰值水平，平均每月有近 10,000 人死亡。

This plateau was six times the figure for 2000 and represented a continuation of a 40-year increase.

这一平稳期是 2000 年数字的六倍，代表着 40 年来增长的延续。

The sudden and substantial downturn that followed was unforeseen and broad-based: It accelerated the declines in states that were hit first by fentanyl and were already past their peaks and flipped the trajectory of states where deaths had still been rising.

随后发生的突然而大幅的经济衰退是不可预见的、基础广泛的：它加速了首先受到芬太尼打击且已经超过峰值的州的经济衰退，并扭转了死亡人数仍在上升的州的轨迹。

The sustained pace of decline was also remarkable.

持续下降的速度也很显着。

Over the next two years, the national number of deaths involving fentanyl was cut in half.

在接下来的两年里，全国因芬太尼而死亡的人数减少了一半。

The figure below highlights key components of that dynamic among fentanyl-linked overdose deaths:

下图突出显示了芬太尼相关过量死亡动态的关键组成部分：

Furthermore, while the decline was not exactly the same size in all states, it was broad and better thought of as a nationwide, not merely a regional, phenomenon.

此外，虽然所有州的下降幅度并不完全相同，但其范围很广，最好将其视为全国性现象，而不仅仅是地区性现象。

These separate trajectories hint at some dynamics that may help explain the overall decline.

这些不同的轨迹暗示了一些可能有助于解释整体下降的动态。

The fact that stimulant without fentanyl overdose deaths have been essentially flat suggests that the forces driving the decline are specific to the fentanyl market—whether those forces act on the supply of fentanyl, on how people use it, or on the likelihood that a given fentanyl exposure becomes fatal.

不含芬太尼的兴奋剂过量死亡人数基本持平的事实表明，推动下降的力量是芬太尼市场特有的——无论这些力量是否影响芬太尼的供应、人们如何使用芬太尼，或者特定芬太尼暴露致死的可能性。

Explaining why this happened is a major challenge.

解释为什么会发生这种情况是一个重大挑战。

Nabarun DasGupta has identified eight possible factors , and it is not difficult to add still others to his list.

Nabarun DasGupta 已经确定了八个可能的因素，并且不难将其他因素添加到他的列表中。

Vanda Felbab-Brown, in another Brookings report , has also considered a variety of sources.

Vanda Felbab-Brown 在布鲁金斯学会的另一份报告中也考虑了多种来源。

In a recent Science article , one of us and five other authors presented an analysis that strongly suggested that a supply shock was a major factor.

在最近的一篇《科学》文章中，我们中的一位和其他五位作者提出了一项分析，强烈表明供应冲击是一个主要因素。

It also proposed, less certainly, that Chinese actions against precursor producers were responsible.

它还提出，虽然不太确定，但中国针对前体生产商的行为是负责任的。

That second suggestion has attracted more criticism , including from Felbab-Brown ; critics doubt that China did take effective actions before June 2023.

第二个建议引起了更多批评，其中包括来自 Felbab-Brown 的批评。批评者怀疑中国在2023年6月之前确实采取了有效行动。

However, the U.S. Drug Enforcement Administration (DEA) provides a counterpoint in its annual National Drug Threat Assessment that was released in April 2025: “Fentanyl purity declined throughout 2024, consistent with indicators that many Mexico-based fentanyl cooks are having difficulty obtaining some key precursor chemicals.”

然而，美国缉毒局 (DEA) 在 2025 年 4 月发布的年度国家毒品威胁评估中提出了相反的观点：“芬太尼纯度在 2024 年全年有所下降，这与许多墨西哥芬太尼厨师难以获得某些关键前体化学品的迹象一致。”

In this essay, we focus here on four factors DasGupta names that have received prominent attention in policy discussions.

在本文中，我们重点关注达斯古普塔命名的四个因素，这些因素在政策讨论中受到了广泛关注。

First, we consider interventions focused on consumption that scaled up rapidly around the same time as the downturn: a harm reduction initiative expanding naloxone access and a treatment initiative expanding buprenorphine prescribing.

首先，我们考虑在经济低迷时期左右迅速扩大消费的干预措施：一项扩大纳洛酮使用范围的减少危害举措和一项扩大丁丙诺啡处方的治疗举措。

We also discuss two changes in the characteristics of the drug supply: increasing xylazine adulteration and greater consistency of counterfeit pills.

我们还讨论了药品供应特征的两个变化：甲苯噻嗪掺假增加和假药一致性更高。

These, by contrast, were more gradual but may have independently altered overdose risk at the individual level.

相比之下，这些措施更为渐进，但可能独立改变了个体水平的用药过量风险。

Together, these four factors provide some clues about how much of the decline can be attributed to deliberate public health action versus shifts in market conditions.

这四个因素共同提供了一些线索，说明下降有多少可归因于故意的公共卫生行动与市场条件的变化。

We also consider a purely epidemiological factor that has also been advanced, namely “depletion of the susceptibles,” the hypothesis that overdose deaths so far outpaced fentanyl initiation that the population of people who use fentanyl has substantially declined.

我们还考虑了一个已经提出的纯粹流行病学因素，即“易受影响者的消耗”，即迄今为止过量服用芬太尼导致的死亡人数超过了芬太尼使用的人数，因此使用芬太尼的人数已大幅下降。

Our goal is to identify factors that might explain a sudden and very large decline, as distinct from interventions that may have reduced fatal overdoses somewhat in successive years.

我们的目标是找出可能解释突然且大幅下降的因素，这与连续几年可能有所减少致命过量用药的干预措施不同。

Making naloxone an over-the-counter medication.

使纳洛酮成为非处方药。

Naloxone is a medication that can reverse the effects of an opioid overdose; in March 2023, it became available over the counter.

纳洛酮是一种可以逆转阿片类药物过量影响的药物； 2023 年 3 月，它开始在柜台销售。

Naloxone could have had a major effect on fatal overdoses if used more regularly, but an early study found that only about 9% of pharmacies chose to stock it .

如果更经常使用纳洛酮，可能会对致命的过量用药产生重大影响，但一项早期研究发现，只有约 9% 的药房选择库存它。

Data from the National Emergency Medical Services Information System provided to us by Andrew Thompson offer useful context for evaluating naloxone’s role.

安德鲁·汤普森向我们提供的国家紧急医疗服务信息系统的数据为评估纳洛酮的作用提供了有用的背景。

The total number of naloxone-related emergency medical service (EMS) activations fell substantially over this period, from roughly 32,000-37,000 per month in 2022 to approximately 23,000-26,000 per month by 2025, a decline of around 25% to 30%.

在此期间，与纳洛酮相关的紧急医疗服务 (EMS) 启动总数大幅下降，从 2022 年的每月约 32,000-37,000 例减少到 2025 年的每月约 23,000-26,000 例，下降约 25% 至 30%。

Notably, the share of activations in which naloxone had been administered before EMS arrival rose only modestly, from about 16% in early 2022 to about 20% by early 2025.

值得注意的是，在 EMS 到达之前施用纳洛酮的激活比例仅小幅上升，从 2022 年初的约 16% 上升到 2025 年初的约 20%。

Much of that shift appears to reflect improved documentation rather than a meaningful increase in bystander naloxone use because the share of cases in which naloxone was definitively not administered before EMS arrival remained essentially flat throughout the period.

这种转变在很大程度上似乎反映了记录的改进，而不是旁观者纳洛酮使用量的有意义增加，因为在此期间，在 EMS 到达之前明确未使用纳洛酮的病例比例基本保持不变。

Taken together, these patterns suggest that the decline in EMS overdose activations reflects fewer overdose events occurring overall, rather than a growing share being intercepted upstream by bystanders with naloxone.

总而言之，这些模式表明，EMS 过量激活的下降反映了总体上发生的过量事件较少，而不是越来越多的事件被上游旁观者用纳洛酮拦截。

Further circumstantial evidence comes from Canada, which made the overdose reversal drug available seven years earlier in 2016 yet experienced a parallel decline in opioid overdose deaths at generally the same time.

进一步的间接证据来自加拿大，该国早在 7 年前的 2016 年就推出了这种药物过量，但阿片类药物过量死亡人数总体上同时下降。

Though increased access to naloxone may well have saved lives, it is not clear that it made a large contribution to the observed decline .

尽管增加纳洛酮的获取很可能挽救了生命，但尚不清楚它是否对观察到的下降做出了巨大贡献。

Elimination of the buprenorphine X-waiver.

取消丁丙诺啡 X 豁免。

Buprenorphine has become an important alternative to methadone in recent years, largely because it is less prone to misuse and overdose and generally requires fewer clinic visits.

近年来，丁丙诺啡已成为美沙酮的重要替代品，主要是因为它不易滥用和过量服用，而且通常需要较少的就诊次数。

In 2021, the Department of Health and Human Services removed the eight-hour training requirement for physicians prescribing buprenorphine to up to 30 patients, lifting a significant barrier to access.

2021 年，卫生与公众服务部取消了医生为最多 30 名患者开出丁丙诺啡处方的 8 小时培训要求，消除了使用丁丙诺啡的重大障碍。

Then, in January 2023, the Consolidated Appropriations Act eliminated the so-called “X-waiver” entirely, allowing any DEA-registered provider with Schedule III authority to prescribe buprenorphine without additional registration or patient caps.

然后，在 2023 年 1 月，《综合拨款法》完全取消了所谓的“X 豁免”，允许任何在 DEA 注册且拥有附表 III 授权的提供者开出丁丙诺啡处方，无需额外注册或患者上限。

The question then is whether substantially more patients received buprenorphine after these reforms.

接下来的问题是，在这些改革之后，是否有更多的患者接受丁丙诺啡治疗。

The Centers for Disease Control and Prevention reports that “The overall national buprenorphine dispensing rate remained relatively stable from 2019 to 2024, with the rate in 2024 at 4.5 buprenorphine prescriptions dispensed per 100 persons (a total of more than 15 million buprenorphine prescriptions).”

美国疾病控制与预防中心报告称，“2019 年至 2024 年，全国丁丙诺啡总体配药率保持相对稳定，2024 年配药率为每 100 人 4.5 个丁丙诺啡处方（丁丙诺啡处方总数超过 1500 万张）。”

A study published in the New England Journal of Medicine examining the first year after X-waiver elimination found that the number of buprenorphine prescribers increased substantially—from about 42,000 to nearly 54,000 per month—but the total number of patients receiving buprenorphine changed little.

《新英格兰医学杂志》上发表的一项研究对 X 豁免取消后的第一年进行了调查，发现丁丙诺啡处方者的数量大幅增加——从每月约 42,000 人增加到近 54,000 人——但接受丁丙诺啡的患者总数变化不大。

Initiation of new patients increased only modestly.

新患者的入院人数仅略有增加。

As the study’s authors note, the removal of the X-waiver may simply have been insufficient to overcome other barriers, including cost sharing, stigma, and the unraveling of COVID-era Medicaid coverage.

正如该研究的作者指出的那样，取消 X 豁免可能根本不足以克服其他障碍，包括费用分摊、耻辱以及新冠时代医疗补助覆盖范围的瓦解。

In short, expanded prescribing authority has not yet translated into a meaningful surge in treatment uptake, making it an unlikely driver of the overdose decline.

简而言之，扩大处方权尚未转化为治疗使用率的有意义的激增，这使其不太可能成为药物过量下降的驱动因素。

The minimal impact of removing the X-waiver was correctly predicted by Erin J.

Erin J. 正确预测了取消 X 豁免的最小影响。

Stringfellow and colleagues , who noted that half of doctors with a waiver were not prescribing.

Stringfellow 及其同事指出，一半拥有豁免权的医生没有开处方。

Over time, there have been important changes in the characteristics of the drugs sold as opioids that may affect the associated mortality.

随着时间的推移，作为阿片类药物销售的药物的特性发生了重大变化，可能会影响相关的死亡率。

Introduction of xylazine in the opioid supply.

在阿片类药物供应中引入甲苯噻嗪。

Xylazine is a veterinary tranquilizer, which started to show up in the autopsies of fentanyl overdoses in quantity in 2018.

Xylazine 是一种兽用镇静剂，2018 年开始大量出现在芬太尼过量的尸检中。

If people who use opioids prefer opioids without xylazine, people may adopt safer use practices when xylazine is known to be in what is being sold on the street.

如果使用阿片类药物的人更喜欢不含甲苯噻嗪的阿片类药物，那么当已知街头出售的产品中含有甲苯噻嗪时，人们可能会采取更安全的使用做法。

A recent study interviewing people with recent opioid overdose reversal experience in two Midwestern cities found that 46 of the 52 interviewees reported “ using less, changing route of administration, or abstaining entirely.

最近的一项研究采访了中西部两个城市最近有阿片类药物过量逆转经历的人，发现 52 名受访者中有 46 人报告“减少使用、改变给药途径或完全戒断”。

” Since the share of fentanyl powder showing xylazine has increased sharply from about 20% in the first quarter of 2022 to almost 40% within two years , that might have led to a reduction in overdose deaths.

由于含有甲苯噻嗪的芬太尼粉末的比例在两年内从 2022 年第一季度的约 20% 大幅增加到近 40%，这可能会导致服药过量死亡人数的减少。

Most of the evidence available is qualitative.

大多数现有证据都是定性的。

Participants reported using less opioid in amount or frequency, seeking treatment, switching from injection to smoking, and avoiding dealers known to carry xylazine-adulterated product.

参与者报告称，阿片类药物的使用量或频率减少，寻求治疗，从注射转向吸烟，并避开已知携带赛拉嗪掺假产品的经销商。

Motivations included fear of necrotic skin wounds, loss of functionality, and the failure of xylazine-laced drugs to produce the expected opioid high.

动机包括担心皮肤伤口坏死、功能丧失以及含有甲苯噻嗪的药物无法产生预期的阿片类药物高浓度。

Further, because xylazine is not an opioid, its sedative effects are not reversed by naloxone, adding to user anxiety.

此外，由于赛拉嗪不是阿片类药物，纳洛酮无法逆转其镇静作用，从而增加了使用者的焦虑。

Notably, the geographic spread of xylazine has followed a broadly east-to-west pattern—mirroring the geographic pattern of overdose declines, with eastern states declining earlier than western ones.

值得注意的是，赛拉嗪的地理分布大致遵循从东到西的模式，这反映了药物过量下降的地理模式，东部各州的下降早于西部各州。

This geographic concordance lends additional plausibility to the xylazine hypothesis, though the evidence remains largely qualitative and the causal link is far from proven.

这种地理上的一致性为赛拉嗪假说提供了额外的可信度，尽管证据大部分仍是定性的，而且因果关系还远未得到证实。

Greater consistency in the composition of counterfeit pills.

假药成分的一致性更高。

A major source of risk is that a pill contains more fentanyl than expected.

风险的一个主要来源是药丸中芬太尼的含量超出预期。

There is some evidence that pills manufactured in Mexico have more consistent composition than those produced locally in the United States from imported fentanyl powder.

有证据表明，墨西哥制造的药丸比美国本地用进口芬太尼粉末生产的药丸的成分更一致。

DasGupta’s Street Drug Analysis Lab at the University of North Carolina at Chapel Hill, which has analyzed over 23,000 samples from 42 states as of early August 2026, emphasizes that it is fluctuation in fentanyl content—not average potency—that drives overdose risk: a user calibrated to weak product who encounters a hot batch is in acute danger.

截至 2026 年 8 月，北卡罗来纳大学教堂山分校的达斯古普塔街头药物分析实验室已分析了来自 42 个州的 23,000 多个样本，该实验室强调，芬太尼含量的波动（而非平均效力）导致了服用过量的风险：使用弱产品的用户在遇到热批次时会面临严重危险。

In that light, greater consistency of Mexican-manufactured pills (even at somewhat lower average potency) could reduce the variance that kills.

有鉴于此，墨西哥制造的药丸的一致性更高（即使平均药效略低）可以减少致命的差异。

Against this, DasGupta has argued that the decline in overdose deaths started well before 2024, when the pill-consistency phenomenon was first widely reported, and that most illicit fentanyl consumed nationally is still in powder form rather than pills.

对此，达斯古普塔认为，服药过量死亡早在 2024 年之前就开始下降，当时药丸一致性现象首次被广泛报道，而且全国消费的大多数非法芬太尼仍然是粉末形式而不是药丸。

Thus, while this factor may have contributed at the margin, it is unlikely to account for a large share of the decline on its own.

因此，虽然这一因素可能略有贡献，但它本身不太可能在下降中占很大份额。

Finally, there is a potentially important epidemiological change.

最后，还有一个潜在的重要流行病学变化。

Depletion of susceptibles.

易感体的耗尽。

This takes two forms.

这有两种形式。

One simply refers to a decline in the number of individuals taking fentanyl.

其中之一只是指服用芬太尼的人数减少。

After all, there were 403,000 deaths from fentanyl related overdoses in the period 2015-2023.

毕竟，2015 年至 2023 年期间，有 403,000 人因芬太尼相关过量死亡。

If one were, naively , to believe the official estimates of the number of opioid users based on the National Survey of Drug Use and Health (NSDUH), the total number of individuals who used fentanyl in the past 12 months in 2023 was only 816,000 .

如果天真地相信根据国家药物使用和健康调查 (NSDUH) 对阿片类药物使用者人数的官方估计，那么在 2023 年过去 12 个月内使用芬太尼的总人数仅为 816,000 人。

The error bands around the NSDUH estimates are so broad that no one-year change is statistically significant.

NSDUH 估计值的误差范围如此之大，以至于一年的变化在统计上都不显着。

However, if something on the order of 70,000 fentanyl-involved overdose deaths in 2022 occurred among less than a million estimated people at risk, it is not a leap to reason that the number of people at risk of fatal overdose is declining.

然而，如果 2022 年，估计有不到 100 万的危险人群中发生了约 7 万人因芬太尼过量死亡的事件，那么就可以推断，面临致命过量服药风险的人数正在下降。

We think that the NSDUH estimate is a vast underestimate, as it is for heroin .

我们认为 NSDUH 的估计被大大低估了，就像海洛因一样。

One reason for that is that even in 2023, many of those using fentanyl were unaware.

原因之一是，即使在 2023 年，许多使用芬太尼的人也不知道。

Most fentanyl overdoses in recent years have been associated with stimulant use.

近年来，大多数芬太尼过量服用都与兴奋剂的使用有关。

Many of those who purchase methamphetamine that has been adulterated with fentanyl do not know that .

许多购买掺有芬太尼的甲基苯丙胺的人并不知道这一点。

Hence, if they do participate in the survey, they provide honest but inaccurate negative responses to the question of whether they have used fentanyl.

因此，如果他们确实参加了调查，他们会对是否使用芬太尼的问题提供诚实但不准确的负面回答。

The second form of “depletion of susceptibles” is more subtle.

第二种形式的“易受影响者的耗竭”更为微妙。

Increasing potency in the opioid being consumed can lead to a rise in the number of fatal overdoses, as users are slow to adjust to the new situation.

由于使用者适应新情况的速度较慢，所消耗的阿片类药物效力的增加可能会导致致命过量用药的数量增加。

Over time, if potency stabilizes, the users become less “susceptible” to an overdose .

随着时间的推移，如果药效稳定，使用者就不太“容易”服用过量。

The apparent shift from powder to pills also leads to fewer instances of doses larger than anticipated.

从粉末剂到丸剂的明显转变也导致剂量大于预期的情况减少。

Fentanyl has spread slowly across the states, from east to west.

芬太尼已从东到西缓慢地在各州蔓延。

States such as Washington saw major increases in fentanyl mortality between 2019 and 2021, as fentanyl entered the stimulant supply and displaced heroin.

随着芬太尼进入兴奋剂供应并取代海洛因，华盛顿等州的芬太尼死亡率在 2019 年至 2021 年间大幅增加。

Perhaps by mid-2023, West Coast users had adjusted to the new reality of a much more potent opioid supply.

也许到 2023 年中期，西海岸使用者已经适应了更有效的阿片类药物供应的新现实。

However, the experience of eastern states that were hit by fentanyl early on provides a source of skepticism.

然而，早期遭受芬太尼打击的东部各州的经历令人怀疑。

New York City, already badly hit in 2019 with 1,497 drug deaths, saw a doubling over the next three years; of its 3,026 fatal overdoses in 2022, 81% involved fentanyl .

纽约市在 2019 年已经遭受严重打击，共有 1,497 人因毒品死亡，在接下来的三年里这一数字翻了一番； 2022 年发生的 3,026 起致命用药过量事件中，81% 涉及芬太尼。

This short brief leaves much unexplained.

这篇简短的摘要留下了很多未解释的内容。

Treatment expansion other than the buprenorphine X-waiver has not been discussed as a factor, simply because there was no increase in the number of persons admitted for treatment with opioids as the principal problem.

除丁丙诺啡 X 豁免之外的治疗扩展并未作为一个因素进行讨论，这仅仅是因为入院接受阿片类药物治疗的人数没有增加，这是主要问题。

There is insufficient evidence to explain contributions to the decline from among the remaining plausible candidates.

没有足够的证据来解释其余看似合理的候选人人数下降的原因。

The factors examined here are not mutually exclusive, and the true explanation is almost certainly some combination of supply-side changes, demand-side adaptation, and the hard-to-quantify effects of community organizations doing the daily work of harm reduction.

这里考察的因素并不是相互排斥的，真正的解释几乎可以肯定是供给方变化、需求方适应以及社区组织进行日常减少危害工作的难以量化的影响的某种组合。

For example, the one modeling effort that did predict a decline in fatal opioid overdoses forecasted a decline from 80,000 in 2022 to 60,000 in 2032 through harm reduction strategies, naloxone distribution, and recovery support; the actual 2024 figure was already below 60,000, throwing the modeling parameters into question .

例如，一项确实预测致命阿片类药物过量服用减少的建模工作预测，通过减少伤害策略、纳洛酮分配和康复支持，致命阿片类药物过量服用的人数将从 2022 年的 80,000 人减少到 2032 年的 60,000 人； 2024 年的实际数字已经低于 60,000，这使建模参数受到质疑。

The sharp decline remains, in that sense, largely a puzzle, and one whose solution has serious implications for how we allocate scarce public health resources going forward.

从这个意义上说，急剧下降在很大程度上仍然是一个谜题，其解决方案对我们未来如何分配稀缺的公共卫生资源具有严重影响。

Neither expanded naloxone access nor the elimination of the X-waiver for buprenorphine prescribing produced changes of the magnitude needed to explain an approximately 50% reduction in fentanyl-involved deaths.

纳洛酮使用范围的扩大和丁丙诺啡处方 X 豁免的取消都没有产生足以解释芬太尼相关死亡人数减少约 50% 所需的幅度变化。

Both policies deserve continued support—they almost certainly saved individual lives.

这两项政策都值得继续支持——它们几乎肯定挽救了个人的生命。

But overall, there is little evidence that active demand-side interventions alone can explain a major downturn in opioid overdoses.

但总体而言，几乎没有证据表明仅靠积极的需求方干预就能解释阿片类药物过量的大幅下降。

On the contrary, the findings from one major effort, the HEALing Communities Study , fly in the face of many theories to explain the ongoing decline.

相反，一项重大工作——治愈社区研究——的发现与许多解释持续下降的理论背道而驰。

That massive investment in a coordinated treatment, education, and harm reduction strategy suggests we still have much to learn about harm reduction service delivery.

对协调治疗、教育和减少伤害战略的大量投资表明，我们在提供减少伤害服务方面仍有很多东西需要学习。

The two forms of “depletion of susceptibles,” purely epidemiologic explanations, also lack supporting evidence.

这两种形式的“易感者枯竭”纯粹是流行病学的解释，也缺乏支持证据。

However, changes in the characteristics of the supply (more xylazine, more consistent composition of pills) may have been important contributing factors.

然而，供应特性的变化（更多的甲苯噻嗪，更一致的药丸成分）可能是重要的影响因素。

The supply-side story is more intriguing.

供应方的故事更有趣。

The proliferation of xylazine may have paradoxically induced safer behaviors among people who use opioids, while greater consistency in counterfeit pill composition may have reduced the variance in fentanyl dosing that is especially lethal.

矛盾的是，赛拉嗪的扩散可能会在使用阿片类药物的人中诱导更安全的行为，而假药成分的一致性可能会减少芬太尼剂量的差异，而芬太尼剂量的差异尤其致命。

These supply-side changes are also consistent with the aforementioned finding published in a Science article that a supply shock—possibly linked to Chinese precursor chemical regulation—played a central role.

这些供应方面的变化也与《科学》杂志文章中发表的上述发现一致，即供应冲击（可能与中国前体化学品监管有关）发挥了核心作用。

Whatever the precise mechanism, the pattern in the data is clear: the decline has been concentrated almost entirely in fentanyl-involved deaths, while stimulant-only overdose mortality has been remarkably stable.

无论确切的机制是什么，数据中的模式很明显：下降几乎完全集中在与芬太尼相关的死亡中，而仅使用兴奋剂的过量死亡率却非常稳定。

The systems for monitoring the nation’s drug problems are totally inadequate to the task.

监测国家毒品问题的系统完全不足以胜任这项任务。

Moreover, during a period in which those problems have become very much worse , the monitoring systems have actually become weaker.

此外，在这些问题变得更加严重的时期，监控系统实际上变得更加薄弱。

We identify three systems whose restoration, in an improved version, would significantly strengthen the government’s ability to respond effectively and in a timely fashion to changing drug problems.

我们确定了三个系统，其修复后的改进版本将显着增强政府有效、及时应对不断变化的毒品问题的能力。

STRIDE.

迈步。

From about 1981 to 2017, the DEA provided data on the price and purity of drugs seized or purchased undercover; the system was called System to Retrieve Information from Drug Evidence.

大约从 1981 年到 2017 年，DEA 提供了有关缉获或秘密购买的毒品的价格和纯度的数据；该系统被称为从药物证据检索信息系统。

These data were regularly used by researchers and the Office of National Drug Control Policy (ONDCP) to monitor changes in the purity and prices of the major drugs.

研究人员和国家药物管制政策办公室 (ONDCP) 定期使用这些数据来监测主要药物的纯度和价格变化。

In 2017, the DEA stopped providing detailed data to outside analysts, and the analytic value of its simplified replacement that is now publicly available is limited.

2017年，DEA停止向外部分析师提供详细数据，现在公开的简化替代数据的分析价值有限。

STRIDE had well-known limitations but still provided essential insights into markets.

STRIDE 具有众所周知的局限性，但仍然提供了对市场的重要见解。

ADAM.

亚当。

Starting in the 1990s, the National Institute of Justice operated a program that collected data about drug markets from interviews with arrestees in a sample of local jails.

从 20 世纪 90 年代开始，国家司法研究所开展了一项计划，通过对当地监狱样本中的被捕者进行访谈来收集有关毒品市场的数据。

The system was called Arrestee Drug Abuse Monitoring.

该系统被称为被捕者药物滥用监测。

Arrestees include many individuals with extensive drug purchase experiences.

被捕者中包括许多具有丰富毒品购买经验的人。

ADAM allowed researchers to estimate expenditures and drug use prevalence among a segment of the population that is not covered well by other sources but who account for a large share of the demand, thus providing important insights about the market not captured in just purity and price.

ADAM 使研究人员能够估计其他来源没有很好覆盖但占需求很大份额的部分人群的支出和吸毒流行率，从而提供有关市场的重要见解，而不仅仅是纯度和价格。

The program gradually declined in scope starting around 2005 and ended in 2013.

该计划的范围从 2005 年左右开始逐渐缩小，并于 2013 年结束。

A version of this needs to be restarted .

需要重新启动此版本。

DAWN.

黎明。

The Drug Abuse Warning Network collected data from emergency departments in a large sample of hospitals from 1980 to 2010.

药物滥用预警网络收集了 1980 年至 2010 年期间大量医院样本急诊科的数据。

DAWN provided important data on new drugs that were showing up on entry to emergency departments and on the characteristics of those who were suffering adverse consequences.

DAWN 提供了有关进入急诊科的新药物以及遭受不良后果的患者特征的重要数据。

It was paused for a few years and then returned in a much-shrunken form.

它被暂停了几年，然后以大幅萎缩的形式回归。

It needs to be resuscitated in a robust manner that provides useful information at both the national and regional levels.

需要以强有力的方式复兴它，在国家和区域层面提供有用的信息。

In addition to restoring these programs, the federal government should invest in new monitoring systems.

除了恢复这些项目之外，联邦政府还应该投资新的监控系统。

Wastewater testing.

废水测试。

Drug use is reflected in wastewater systems.

药物的使用反映在废水系统中。

Many European countries have developed sampling programs that provide estimates of quantities consumed in individual cities or metropolitan areas on an almost real-time basis and at very modest cost.

许多欧洲国家制定了抽样计划，以几乎实时的方式且成本非常低的方式提供各个城市或大都市区消费量的估算。

The United States has lagged in developing such programs.

美国在开发此类项目方面已经落后。

However, ONDCP recently moved to close that gap by funding a six-site study along the southwest border and lists a national wastewater monitoring system among its priorities in the 2026 National Drug Control Strategy .

然而，ONDCP 最近采取行动，通过资助西南边境的六个地点研究来缩小这一差距，并将国家废水监测系统列为 2026 年国家药物管制战略的优先事项之一。

Social media.

社交媒体。

In the Science article pointing to a supply shock as a major source of the downturn in deaths, analysis of Reddit comments and questions about the state of the fentanyl market played an important role.

《科学》杂志的文章指出供应冲击是死亡人数下降的主要原因，对 Reddit 评论和有关芬太尼市场状况的问题的分析发挥了重要作用。

As social media becomes an increasingly important mode of communication and expression, systematic analysis can serve to provide important information about changes in use patterns and risk factors.

随着社交媒体成为越来越重要的沟通和表达方式，系统分析可以提供有关使用模式和风险因素变化的重要信息。

The overdose crisis, which has claimed hundreds of thousands of American lives over the past decade, is a public health catastrophe with few modern parallels.

过去十年中，药物过量危机夺走了数十万美国人的生命，这是一场现代罕见的公共卫生灾难。

Understanding what finally bent the curve is not merely an academic exercise: getting the answer wrong risks repeating the mistakes that caused it.

了解最终导致曲线弯曲的原因不仅仅是一项学术练习：如果答案错误，就有可能重复导致错误的错误。

The authors would like to thank Jonathan Caulkins and Beau Kilmer for their helpful comments.

作者要感谢 Jonathan Caulkins 和 Beau Kilmer 的有益评论。

This work was supported by a National Science Foundation grant (2146230) to Peter Reuter and the University of Maryland, and by the Brookings Institution.

这项工作得到了 Peter Reuter 和马里兰大学的国家科学基金会拨款 (2146230) 以及布鲁金斯学会的支持。

The Brookings Institution is committed to quality, independence, and impact.

布鲁金斯学会致力于质量、独立性和影响力。

We are supported by a diverse array of funders .

我们得到了众多资助者的支持。

In line with our values and policies , each Brookings publication represents the sole views of its author(s).

根据我们的价值观和政策，布鲁金斯学会的每份出版物均代表其作者的唯一观点。

Strobe Talbott Center for Security, Strategy, and Technology

斯特罗布塔尔博特安全、战略和技术中心