Everyone’s familiar with this graph:

Scary, although it was actually down slightly in 2018. Looking at this, one would assume that huge numbers of Americans are now addicted to opioids. However, although the numbers are annoyingly tricky to find, this doesn’t seem to be the case.

  1. 2 million Americans had an opioid use disorder in 2018, about 0.8% of the adult population. (A much larger number “misused prescription opioids”, but this is defined extremely broadly.) The average American high school has 750 students; in a group this size, on average, six would be opioid addicts.
  2. 800,000 Americans used heroin, about 0.3% of adults. In the 750-person high school, between two and three people would use heroin. This is the lowest figure since 2013.
  3. About 5 million Americans have ever used heroin during their lives. This is about 2% of adults, or 15 people in a high school.

Opioid prescriptions per capita peaked in 2010, and have since been going down:

The dramatic spike in overdose deaths, therefore, seems to mainly come from drugs getting much more dangerous, rather than more people using them. Fentanyl and other synthetic opioids, which have dangerously unknown doses and potencies, were initially used to make heroin stronger; they were then found in counterfeit prescription pills; and recently, they have appeared even in non-opioid drugs, like meth and cocaine. This suggests that one way to reduce the number of deaths would be distributing fentanyl test strips, which are widely available online.