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Overall, doctors , but escalating addiction and tightening supply has led some people to seek cheaper illegal opioids, which now often means fentanyl. 鈥淲hen the illegal opioid markets switched from heroin to fentanyl, you got a huge bump up in deaths,鈥� Caulkins said.

Illegal suppliers are now pressing fentanyl into pills, making the drug more accessible to people who are uncomfortable taking drugs by injection. On top of that, suppliers are adding fentanyl to cocaine and methamphetamine, a practice that could endanger people who have not built up a tolerance for opioids.

Caulkins believes that policies can mitigate, but not eradicate, the overdose crisis.

He noted that the Mental Health Parity and Addiction Equity Act of 2008, along with improved health insurance availability, have expanded treatment access. The U.S. Food and Drug Administration has approved , and the Naloxone has saved lives. The Federal Bureau of Investigation and Drug Enforcement Administration have also broken up some online drug markets, Caulkins said.

Going forward, he鈥檇 like the country to , improve access to Naloxone and offer . He鈥檇 also like cities to better protect communities impacted by the overdose crisis and for law enforcement to better control, without resorting to long prison terms, the disorder associated with street markets.听

鈥淚f you construe it only as an overdose death crisis, you forget there's a broader set of people who are harmed,鈥� Caulkins said. 鈥淔or example, the children 鈥� and parents 鈥� of the person who is struggling with addiction can be harmed. Neighbors living in places where folks congregate to sell and use drugs are also stakeholders, as are people living in countries where drug traffickers undermine democratic institutions.鈥�

Among the approaches he outlined , Caulkins said he would prefer that drug law enforcement focus on constraining drug suppliers鈥� behavior instead of just trying to limit the drug supply. This could reduce 鈥渢he violence, corruption, disorder, and other harmful externalities they impose on society,鈥� and could be combined with other policy responses, he wrote.

Given the severity of the crisis, Caulkins said politicians may be tempted to propose policies that appear strict but are 鈥渨orse than useless.鈥� Some lawmakers have supported the idea that people who supply drugs that kill someone , but Caulkins said it is often impossible to verify chains of custody back to a higher-level dealer, so those long sentences fall primarily on easily replaced retail sellers. 听

Cannabis legalization has been 'dysfunctional'

In the U.S., , according to recent research from Caulkins. But while in 24 states and the District of Columbia, the federal government has not yet legalized the drug. 鈥淭hat's a fundamental inconsistency, whether you want it to be legal, or whether you want it to be illegal,鈥� Caulkins said.听

The federal prohibition has hamstrung cannabis companies in several ways, even if they鈥檙e legal at the state level, he said. They have to pay income taxes on their gross receipts, not their profits, substantially increasing their business costs. They can鈥檛 use credit card payment processing systems or receive services from traditional banks. States can constrain their marketing efforts, as First Amendment commercial free speech protections don鈥檛 extend to illegal activity.听

The quality control of cannabis products is also insufficient, as state regulators can鈥檛 ask their employees to break federal law to conduct independent tests.听

鈥淭here are a lot of efficiencies that would be realized with national legalization,鈥� Caulkins said. 鈥淭he greater efficiencies translate into more marketing, lower prices and so on, but also greater use, which could also produce greater dependence.鈥�

Legalization could take many forms. Caulkins would prefer that the federal government allow only nonprofits to manufacture and distribute cannabis, and require their articles of incorporation to confine their mission to meeting existing demand 鈥� and thereby undercut illegal markets 鈥� without promoting greater use the way for-profit cannabis corporations do.听

鈥淭he mission of a for-profit company is to make money. The way they make money is promoting greater consumption of their product,鈥� he said. 鈥淔or blood products, we don't have Microsoft and Exxon harvesting blood and selling it. The American Red Cross is an organization we trust to put public interest and public health at the forefront for that unusual and sensitive product.鈥�

鈥淲e should likewise recognize that cannabis is 鈥� in the jargon of the field 鈥� 鈥榥o ordinary commodity鈥� and afford it 鈥榞rudging toleration,鈥� not an enthusiastic embrace,鈥� he continued.

Both Vice President Kamala Harris and President-elect Donald Trump that they would be open to legalization.