When Good Intentions Backfire: How Drug Seizures Can Drive Overdose Deaths and What We Can Do Instead

The United States has been in the midst of an overdose crisis for more than a decade, largely due to the proliferation of fentanyl and other potent synthetic opioids. Although fatalities have declined from their 2023 peak of roughly 114,000, drug overdoses still took almost 90,000 lives last year. In an effort to stem the crisis, many U.S. communities from Boston to San Francisco have directed more law-enforcement resources toward breaking up open-air drug markets and deterring public drug use.

However, some research suggests that increased law enforcement activity and the disruption of illicit drug markets caused by drug seizures may have a troubling, yet unintended consequence: more overdose deaths. Rather than relying primarily on crackdowns, cities and states must consider integrated and health-oriented approaches as well.

Findings From Indianapolis and San Francisco

Since 2023, two important studies have been published highlighting a geographic and temporal connection between law-enforcement drug seizures and drug overdoses—one in Indianapolis and the other in San Francisco.

Although these studies were not experimental in nature (and thus cannot conclusively determine causality), they do clearly demonstrate two connections:

• Law-enforcement drug seizures preceded overdose increases by a matter of days.
• Overdose increases occurred within a relatively small radius of the drug seizure.

Furthermore, the fact that the two studies were conducted in two very different U.S. cities—one densely populated, the other sprawling—strengthens the findings and suggests that communities across the country should take note of this issue.

Why Drug Seizures May Drive Overdose Mortality

While the causal relationship between drug seizures and spikes in overdose fatalities is not absolute, several possible explanations help clarify the relationship and provide insights for lawmakers looking to protect both public health and public safety.

One way that drug seizures may lead to increased overdose fatalities is by increasing the visibility of law enforcement, thereby triggering fear of arrest or incarceration among people who use drugs. Decades of research performed in a variety of cultural contexts demonstrates that worries related to negative law-enforcement interactions lead people to engage in riskier drug-taking behaviors. For example, they may inject more quickly, fail to use a fentanyl test strip, avoid carrying the overdose-reversal medication naloxone, or be more likely to use alone. Furthermore, witnesses to an overdose are less likely to call emergency services due to fear of arrest.

Second, people who regularly use opioids are often opioid-tolerant and opioid-dependent. Tolerance causes people to need higher and higher doses of a substance in order to feel the effects, whether that is pain relief, pleasure/euphoria, staving off cravings, or the depressed breathing that causes overdose. When a person stops taking opioids, they can lose tolerance in as little as a few days. Dependence, on the other hand, means that the body requires the substance to function optimally. When an individual who is dependent on a drug suddenly loses access to that drug, they may experience withdrawal symptoms. Characterized by nausea, diarrhea, fever, and chills, opioid withdrawal can be incredibly uncomfortable and even life threatening. People who are dependent on opioids may take much higher risks than usual in an attempt to alleviate their withdrawals, including taking fewer precautions in purchasing and consuming their drugs. Therefore, when drug seizures hinder people’s opioid access—even for just a few days—the combination of decreased tolerance and withdrawal symptoms work together to increase their overdose risk.

Third, in order to cope with the uncertainties of an illicit supply, many people who use drugs attempt to mitigate risk by working with known and trusted sellers. While this strategy is not foolproof, it may help increase transparency (so people know what they have purchased to put in their bodies) and accountability (if sellers work with repeat customers). Drug seizures could disrupt this supply chain in some markets by removing trusted sellers or suppliers and creating an unmet demand channel for other suppliers who are unknown to the buyer. Given fluctuations in the current drug supply and the extreme strength of fentanyl, even relatively minor discrepancies between expected and consumed potency could be life threatening.

Alternative Solutions

It is increasingly clear that law-enforcement drug seizures can inadvertently increase overdose deaths in the area surrounding the events. Furthermore, the modern illicit drug market is more resilient than ever to supply-side interventions, including law-enforcement seizures. Because the market is largely made up of synthetic substances rather than those derived from plants, manufacturers can quickly and cheaply replace confiscated product.

This does not mean law enforcement has no role to play. Given that prohibitionist drug laws create space for criminal enterprises and associated violence, some drug-related interventions—such as large-scale interdictions targeting high-level traffickers or operations that dismantle particularly violent drug networks—may offer public-safety benefits.

But in order to optimize benefit and minimize harm or risk, street-level activity should focus on reducing demand and connecting people who sell and use drugs with social, health, and treatment resources. (Almost half of those who sell drugs have a substance use disorder themselves.)

One way communities can do this is by adopting social and health-oriented programs that complement law-enforcement activity—an approach that is increasingly accepted by law enforcement. For example, coordinating drug seizures with robust harm reduction outreach including naloxone distribution, treatment linkages, and information-sharing partnerships to spread knowledge about supply contents may help mitigate adverse consequences. Absent these supports, seizures alone are unlikely to stem the tide of the overdose crisis, and they may even make things worse. Another approach is to adopt pre-arrest diversion and Law Enforcement Assisted Diversion programs that connect individuals with services rather than criminally charging them.

Communities should also place greater emphasis on health-specific interventions. Scaling up evidence-based prevention efforts including youth programs, trauma-informed care, and early intervention services targeting adverse childhood experiences will help reduce illicit drug use, thereby cutting demand for illicit drugs in the long term. Another effective way to reduce illicit drug use, overdose risk, and criminal activity among people struggling with an opioid use disorder is to expand access to evidence-based medications like methadone and buprenorphine. Finally, communities can address concerns like public drug use and syringe litter via a range of locally relevant and appropriate programs.

Conclusion

The United States has grappled with an unprecedented opioid overdose crisis for more than a decade. As evidence mounts that law-enforcement drug seizures may actually cause surges in overdose deaths, it is increasingly clear that policy solutions cannot neglect public health. Drug-related policies should prioritize a health-centered approach without compromising public safety, and law-enforcement interventions should be paired with robust harm-reduction outreach to minimize unintended consequences.