[Steve_Seattle]

"I wonder how much of the increase is related to the legalization/decriminalization of drug use? How much is fentanyl and opioids?"

You call these "contradictory statements." Not necessarily. Many opioids are prescription - "Doc, my back hurts and I can't sleep." I know people (not personal friends) who make extra cash by selling their prescription drugs to other people. I've seen it in the bar, and this is a middle-class area.

And then there is the psychology of it - when pot is legalized, or when government sets up needle-exchange centers, much of the stigma of drug use is weakened, luring more people into it.

[anton]

This is very true. The spectrum of people who will use drugs illegally is broad and varies. Some need no license of coaxing from anyone. Others need an opening that does not conflict with their sense of themselves. Some will only jump in when there is a perception of approval as you stated.

[BipolarBob]

The scenarios can be worlds apart. Some people just want to get high regardless of the consequences. They are almost hopeless and helpless. I discount then immediately. I have no solution that would be acceptable to the authorities. Meth, heroin, fentanyl has taken over their bodies and soul.
I am more concerned about people with chronic pain who have no choice because the government continually restricts and barricades their means of compassionate relief. They need some medical relief without federal interference.
The legalization of pot doesn't matter to me, one way or the other. The criminal element my follow it because of the opportunity to make money. That's capitalism.