Giving Compass' Take:

• Jirka Taylor and Peter Reuter argue that the next stage of the fast-changing opioid crisis may well depend on how the illegal drug markets morph in the years to come.

• What partnership opportunities exist that could maximize philanthropic efforts to address the opioid crisis?

• Here's why this crisis is not a single problem, but rather a string of epidemics. 

Few people had ever heard of fentanyl five years ago. By 2018 this synthetic opioid was implicated in more than 30,000 fatal overdoses in the United States. The next stage of the fast-changing opioid crisis may well depend on how the illegal drug markets morph in the years to come.

In the corners of Europe that have been dealing with fentanyl as long or longer than the United States, each illegal market for opioids took distinct turns. In some, heroin disappeared. In others, opioid nasal sprays arrived. Online sales became the norm. Any of these things could happen here.

It's Estonia where heroin practically disappeared. In the early 2000s, the Taliban's prohibition on growing poppies in Afghanistan had a ripple effect in Europe, constricting the heroin supply. Fentanyl smuggled from or through Russia took its place. Today, tiny Estonia (population about 1.3 million) has the only “mature” fentanyl market in the world.

The replacement of heroin with fentanyl in its drug market was devastating: By 2012, Estonia had one of the highest per capita rates of fatal overdoses in the world. Two other observations, however, offer a bit more reassurance. First, fentanyl does not seem to attract new users:

Read the full article about the future of the opioid crisis by Jirka Taylor and Peter Reuter at RAND Corporation.