Last week brought some rare good news on drugs: Overdose deaths declined in 2023. And while the opioid crisis has taken some surprising and terrible twists over the years, it may finally be turning around.

There are two main causes. First, drug epidemics tend to follow a natural course in which the drugs enter a market, spread and then fade away, at least for some time. The opioid epidemic appears to have entered that final phase. Second, policymakers have increased access to both Narcan, a medication that reverses opioid overdoses, and addiction treatment. These changes have saved lives. Today’s newsletter will explain both causes.

Faddish cycle

Drugs are often faddish; epidemics tend to ebb on their own. Why? Users die. People see the damage that a drug does, and they shun it. Surviving users move on to other drugs that they see as better or safer, sometimes incorrectly.

Think of all the drugs that have come and gone over the past several decades, such as crack, meth and synthetic marijuana. (In the case of meth, a comeback is underway. Even the worst fads can return.)

The opioid epidemic is no exception. In fact, it has arguably been a succession of three different fads — first opioid painkillers, then heroin and finally fentanyl — that have felt like one.