The US urgently needs a smarter, multi-pronged strategy and cabinet-level leadership to tackle an escalating overdose epidemic which poses an unacceptable threat to national security and the economy, a bipartisan congressional commission has found.
The long-awaited report by the Commission on Combating Synthetic Opioid Trafficking calls for a major shift in policy to combat rising fatal overdoses, with much greater focus on reducing demand through public health measures and better treatment options.
About a million Americans have died from drug overdoses since 1999, with around 100,000 deaths in the past year. About two-thirds of the recent fatalities – about 170 a day, mostly working-age Americans – have involved synthetic or human-made opioids like fentanyl, which is 50 times more potent than heroin.
The pandemic has contributed to a surge in substance misuse including fatal overdoses. At least one in 10 Americans initiated or increased drug use amid rising anxiety, depression and trauma, and reduced access to services.
The social and psychological impact has been devastating, but economic costs are also high: drug overdoses cost the US economy about $1tn annually, the commission estimated.
“In terms of loss of life and damage to the economy, illicit synthetic opioids have the effect of a slow-motion weapon of mass destruction in pill form,” the 70-page report to Congress said.
The commission’s findings echo Joe Biden’s declaration last December that the trafficking of fentanyl and other synthetic opioids constitutes a national emergency.
The report acknowledges that the crisis has its roots in an FDA decision to approve the highly addictive painkiller Oxycontin in 1995, fueling a rise in opioid addiction exploited by criminal gangs, at first with heroin but since 2014 with more profitable and deadly synthetics like fentanyl.
Amid inadequate prevention and drug treatment services, gangs have adapted fentanyl to American tastes by creating pills which for many are less stigmatised than snorting, injecting and smoking. It is of the “highest concern”, according to the commission, that most users are not at least initially seeking fentanyl, rather that it is laced into heroin and brand-name pills like Vicodin and Oxycontin, driving overdoses.
Synthetic opioids are highly potent, far easier and cheaper to produce and transport than heroin – which requires poppies grown in mountainous regions – and much harder to detect as the supply chain is simpler. Law enforcement has been outpaced and outmanoeuvred by criminal networks.
At first, synthetic opioids were mostly trafficked into the US from China. But since 2019, Mexico has become the dominant source, drugs manufactured in labs using easy to purchase precursors from China. The vast majority of the drugs enter the US across the southern border, after which powder and pills are increasingly moved by regular postal and courier services.
Many vendors use online platforms including social media to connect with buyers including Mexican traffickers, then use encrypted telecoms systems.
The commission concludes that it is “impossible” to combat the flow of synthetics and reduce fatal overdoses by focusing efforts only on supply, thus challenging the mainstay principle of America’s ill-fated 50-year “war on drugs”.
In order to save American lives, the report says, the government must increase public awareness of the dangers and pervasiveness of synthetic opioids and improve and expand access to treatment options including outpatient care, harm reduction interventions and rehab.
“Failure to intervene in ways that appropriately reduce demand and decrease the risk of fatal overdose will almost certainly result in the death of hundreds of thousands of more Americans and will imperil the country’s economic and social wellbeing,” the report says.
A recent Lancet study warned that without radical change, the US synthetic opioid death toll could rise to 1.2 million by 2029.
The report, which makes 76 recommendations, concludes that serious geopolitical issues are impeding disruption of the drug trade. It is particularly critical of the Mexican president, Andrés Manuel López Obrador, who began his term in 2018 promising “hugs not bullets” for the cartels. Since then, the murder rate has increased and the country has been militarized, while the production and trafficking of illicit drugs like fentanyl has increased.
President López Obrador “must do more in the coming months and years to more directly address the threat cartels pose to the health and safety of both the people in Mexico and the United States”, the report said.