Part of the problem of black markets, particularly for drugs (but not just for drugs) is that customers are dealing with criminals who are neither as honest nor as skilled as pharmacists. This means that drug buyers don't know what they are getting, and can overdose, sometimes fatally, when the mixture they have purchased contains drugs or quantities of drugs that they don't know about. As fentanyl has started to show up mixed into heroin, and to replace it, this seems to have been one of the big causes of inadvertent overdoses.
In Vancouver, an experiment is underway to make drugs safer by having pharmacists dispense them, in prescribed dosages. (Not everyone thinks this is a good idea.)
The NYT has the story:
Fentanyl From the Government? A Vancouver Experiment Aims to Stop Overdoses. A city on the forefront of harm reduction has taken the concept to a new level in an effort to address the growing toxicity of street drugs. By Stephanie Nolen
"the breadth of Vancouver’s services and interventions is almost unimaginable in the United States, less than an hour’s drive to the south. Supervised injection sites and biometric machines that dispense prescription hydromorphone dot the city center; naloxone kits, which reverse overdoses, are available free in every pharmacy; last year, a big downtown hospital opened a safer-use site next to the cafeteria, to keep patients who are drug users from leaving in order to stave off withdrawal.
"And since April, Chris... has received pharmaceutical-grade fentanyl through the dispensary, which sells to those who can pay and provides free drugs through the program’s operational budget to those who cannot.
"The new program aims to provide a safer alternative to the fentanyl available on the streets, where the supply is increasingly lethal and is responsible for most of the overdose epidemic that was declared a public health emergency here six years ago.
"Dr. Christy Sutherland, a board-certified addiction medicine specialist who set up the program, said its goal was, first, to keep people from dying, and, second, to help bring stability to their lives so that they may think about what they might want to change."