The state of Tennessee last year put into place regulations limiting and controlling the duration and dosages of opioid painkillers that doctors could legally prescribe, all in the name of fighting addiction.

Yet now the state is seeing a new record in deaths due to overdoses. The latest data from the Tennessee Department of Health shows 1,304 opioid-related overdose deaths in the state for 2018, a 42-death increase over 2017. It is part of a five-year trend in which opioid overdose deaths have increased each year.

Tennessee is one of the top states where residents hunt for painkiller prescriptions. Until last year, there were actually more prescriptions written each year for pain medications than the population of the state (6.7 million). Over the past five years, prescriptions have dropped from 8.2 million each year to 6 million in 2018.

Over the exact same period, deaths continued to rise. And everybody knows why this is happening: Prescribing fewer pills doesn’t stop either people who have legitimate pain from continuing to feel pain, and it doesn’t stop people who are addicted to opioids from seeking out more opioids. Such users simply turn to the black market for opioids, where the drugs are much less safe and often include dangerously high doses of fentanyl precisely because of the lack of quality control. More than 60 percent of the overdose deaths in Tennessee in 2018 were attributed to fentanyl. People are dying in part because the state is stopping them from pursuing safer pills. The Tennessean takes note of the roots of these problems:

Experts say the persistent rise in deaths statewide signals a continued shift of the opioid crisis toward black market drugs. Although the crisis was sparked by prescription painkillers, much of the epidemic is now fueled by street drugs and counterfeit pills that are less predictable, more dangerous and ultimately harder to stop.

Trevor Henderson, Nashville’s opioid response coordinator, said this “second stage” of the opioid crisis is likely to plague the state for years to come.

“Keeping an eye on prescriptions was one problem, but trying to figure out how many fake pills are coming into the neighborhood? That is a whole other thing,” Henderson said. “Once people are buying off the streets, there is no prescribing, there are no records, and it’s hard to know who is doing what, when and where.”

Reason‘s Jacob Sullum has previously noted that the availability of prescribed painkillers did not correlate well with overdose deaths. Even though doctors in Tennessee had been handing them out like candy, the state saw fewer overdose deaths per 100 people than other states where doctors were more stingy. Making the drugs harder to get legally did not improve safety and is not an effective way to fight opioid overdoses.