A Supply-Side Perspective on the Opioid Crisis

The opioid crisis is a complex, multifaceted, and dynamic problem requiring a comprehensive strategy for dealing not just with the stock of addicted users who are at risk of overdosing, but also considering the flow of new initiates and escalators in abuse. We had a limited understanding of the best approaches for tackling these issues when it was a prescription opioid problem; our understanding of effective levers in the current situation is even more limited. In the past two years, substantial attention and funding has been given to efforts to expand naloxone distribution and access to substance abuse treatment, two very important components of a comprehensive strategy. Prior to this, supply-side interventions dominated the policy landscape. Initial conflicting evidence of the effectiveness of supply-side interventions and the ongoing rise in overdoses despite widespread adoption of such policies, has led to pessimism about the potential of supply-side strategies. Criticisms about these approaches when dealing with black markets further abound. Ignoring the supply side of the equation at this stage, however, particularly the potential reactions and innovation of suppliers in these markets, would be a mistake and could further generate unintended consequences to well-meaning demand reduction strategies just as they did with well-meaning supply-side strategies. We explain below how ignoring the motivation and innovation of suppliers, both in the legal or illicit market, got us to this point in the opioid crisis, and how ignoring their continuing role could be even more devastating.