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Colorado continues to face an increase in overdose deaths while other states have seen a downturn.
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states → log → downturn
Illicitly manufactured fentanyl, a potent opioid, emerged in the Colorado drug market around 2018.
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fentanyl → manufacture → 2018
That was nearly five years after it began tormenting people who use street drugs in Northeastern states.
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who → begin → states
By 2019, fentanyl replaced other drugs as the driving force behind opioid overdoses in Colorado, and it has held its grip ever since.
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it → replace → grip
But while overdose deaths in the U.S. are currently experiencing a historic decline of almost 14%, Colorado is one of eight states where rates are not dropping.
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rates → experience → states
In fact, Colorado has had an increase of nearly 12% in overdose deaths since April 2025.
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Colorado → have → April
Overdoses are top of mind for many everyday Coloradans, healthcare professionals, elected officials and public health experts like me.
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Overdoses → elect → me
Proposition 132 attempts to address these concerns by stiffening legal penalties.
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Proposition → attempt → penalties
A conservative policy organization called Advance Colorado collected the signatures to get the initiative on the November ballot.
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organization → call → ballot
The proposed change to Colorado law would make possession of any amount of fentanyl a felony, require a mandatory minimum eight-year prison sentence for distribution of any quantity of fentanyl, and eliminate some existing opportunities for reduced penalties.
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possession → propose → penalties
Before Coloradans head to the polls, it is worth examining the state’s overdose trends and considering whether Proposition 132 is likely to solve the problem.
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Proposition → head → problem
A 2022 law already increased penalties
Let’s start by looking at Colorado’s past attempts to stop drug overdoses through legislation.
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law → increase → legislation
In recent years, the state has pursued some public health interventions but has leaned heavily on increasing criminal penalties for using and possessing fentanyl.
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state → pursue → fentanyl
The 2022 Fentanyl Accountability and Prevention Act (HB22-1326), for instance, represented a major expansion of criminal penalties.
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Act → represent → penalties
This law rolled back a 2019 law that had decriminalized small amounts of drugs.
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that → roll → drugs
Specifically, HB22-1326 made the knowing possession of more than 1 gram and up to 4 grams of a substance containing fentanyl a Level 4 drug felony punishable by up to 180 days in jail and two years of probation.
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possession → make → probation
Unlike Proposition 132, the 2022 fentanyl act directed funding for the distribution of naloxone, an overdose reversal medication, and fentanyl test strips that help people identify fentanyl in their drugs before using them.
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people → direct → them
Both naloxone and fentanyl test strips decrease the risk of fatal overdose.
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naloxone → decrease → overdose
The law did not direct funding toward evidence-based treatments such as methadone or buprenorphine for opioid use disorder.
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law → direct → disorder
Supporters argued that the legislation was necessary to prevent overdose deaths and get people treatment.
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legislation → argue → treatment
I led a research team that included addiction treatment providers and substance use–focused epidemiologists to study the effects of HB22-1326.
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that → lead → HB22
Although more people were arrested and faced the tougher penalties, we found no increase in people beginning or staying on buprenorphine.
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we → arrest → buprenorphine
We also found that fewer people were starting and staying on methadone following the implementation of the law.
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people → find → law
Importantly, we found that the law did not change the trajectory of overdose deaths compared to what was expected.
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what → find → deaths
Taken together, we found no substantial evidence that increasing criminal penalties, even with some increased funding for naloxone and overdose prevention, “saved lives” as proponents had hoped.
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proponents → take → lives
Colorado is already uniquely punitive toward people who use illicit drugs, with some of the harshest penalties for drug possession and distribution in the U.S.
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who → use → U.S.
Colorado’s public health response has developed alongside, not in place of, a substantial criminal-legal response.
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response → develop → response
What decreases overdose deaths?
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What → decrease → deaths
Even with efforts to provide additional access to harm-reduction protections, escalating criminal penalties have not produced the treatment gains or decreases in overdose deaths in Colorado that proponents promised.
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proponents → provide → that
So, let’s look at a place in the state where overdose deaths are actually falling to see what is being done differently there.
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what → let → state
Larimer County, home of Colorado State University and part of Rocky Mountain National Park, offers the clearest contrast to the rest of the state.
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County → offer → state
Accidental overdose deaths have declined year after year since 2022, down nearly 42% from 2021.
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deaths → decline → 2022
What’s going on in Larimer County?
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What → go → County
For one, the Larimer County Jail is one of less than half of the Colorado county jails that offers a comprehensive treatment program that includes medications for opioid use disorder.
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that → offer → disorder
The sheriff’s office, in collaboration with several community-based organizations, has also flooded the community with naloxone through the Reversal Project.
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office → base → Project
Furthermore, using opioid abatement funds, the county has expanded youth and family support services, co-responder units and other harm-reduction services.
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county → use → services
The county has also steadily increased the number of people on buprenorphine.
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county → increase → buprenorphine
No single intervention can be credited with Larimer County’s decline in accidental overdoes deaths.
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intervention → credit → deaths
Criminal enforcement remains one component of the county’s response.
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enforcement → remain → response
Yet, what stands out is its emphasis on evidence-based interventions with an emphasis on expanding treatment access and harm-reduction services that save lives and give people the stability and opportunity to build healthier lives.
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that → stand → lives
…and 11 more, not listed.
The Aporia
