From the Left: Fentanyl and the border
By Lance Simmens
This week President Biden visited with Mexican officials at the Southern border. Among other issues, there may be discussion of the growing fentanyl crisis affecting the nation and the flow of illicit drugs fueling drug overdose deaths. Whether or not there is a direct correlation between the surge of immigrants and this growing health-care crisis remains to be seen, but certainly it deserves immediate attention. While many may not be familiar with the fentanyl crisis, I would like to provide a snapshot of statistics of this growing health-care scourge.
The Centers for Disease Control and Prevention (CDC) reports that in 2021 there were some 107,622 overdose deaths in the U.S. and two-thirds were caused by fentanyl, a synthetic opioid.
How did we get here? In 1991 we witnessed a dramatic rise in opioid and opioid-combination medications for the treatment of pain, primarily for cancer patients. Pharmaceutical companies began to promote the use of opioids in non-cancer patients and by 1999, 86 percent of patients using opioids were using them for non-cancer pain, despite data regarding risks and benefits.
By 2010 we witnessed a rapid increase in deaths from heroin abuse, a cheap and widely available and potent illegal opioid. Between 2002 and 2013 deaths due to heroin-related overdoses increased by 286 percent.
By 2013, deaths related to synthetic opioids like fentanyl increased dramatically, and by 2016, 20,000 deaths from fentanyl and related drugs were reported. According to a Feb. 2, 2022, report from the Stanford-Lancet Commission on the North American Opioid Crisis, “Without urgent intervention, 1.2 million people in the U.S. and Canada will die from opioid overdoses by the end of the decade in addition to the more than 600,000 who have died since 1999.”
The report strongly suggests that it is critically important to address the “revolving door” where former government regulatory officials leave public service and find lucrative employment in the very companies they once regulated. It also recommends that efforts to curtail the impact of opioid manufacturers who donate campaign funds to politicians as a strategy to influence policy decisions be aggressively pursued and executed.
According to the Drug Enforcement Administration (DEA) most illicit fentanyl is mass-produced in “secret factories” in Mexico with chemicals obtained from China. But according to Susan Sherman, a health behavior professor at the John Hopkins Bloomberg School of Public Health, “Whether illicit fentanyl is sourced from Mexico or whether it’s sourced from China, the issue is here with consumption, with lack of scaled-up evidence-based medication-assisted drug treatment.”
And while the DEA seized enough fentanyl to kill every American in 2022 (379 million deadly doses), if there was a lack of demand, subsequently there would be a corresponding lack of supply. How serious is the demand?
- The number of Americans killed by the drug has jumped 94 percent since 2019.
- On average, one person dies of a fentanyl overdose in the United States every seven minutes.
- Fentanyl kills more people than automobile accidents.
- One milligram of fentanyl has the same potency as 50 milligrams of heroin; 67 milligrams of oxycodone; and 100 milligrams of morphine.
The answer is not to build a wall. The vast majority of fentanyl seizures occur at the US-Mexico border crossings in California and Arizona. According to a congressional analysis, the damage to U.S. communities cost the economy $1.5 trillion in 2020. Federal agents estimate that they are seizing about 5-10 percent of the drugs coming from Mexico. Using data from 2021, the CDC has recently announced that life expectancy in the U.S. has dropped to its lowest point in two decades, in part because of street drugs. And while Republicans have made fentanyl a major part of their midterm election message, attempting to link drug smuggling to undocumented immigration, the overwhelming majority of opioids being smuggled across the border came through legal points of entry.
The Biden administration has announced new rules that will make it easier for many patients to access methadone and buprenorphine, medications proven to help patients avoid opioid relapses. Dr. Rahul Gupta, head of the White House Office of National Drug Control Policy, maintains that we must “begin to normalize and understand addiction as a disease … and we start to treat people suffering from addiction as human beings and then prescribe them treatments … if it remains easier for people to get illicit drugs than to get treatment, we’re not going to be able to bend the curve.”
While Big Pharma helped to facilitate the opioid crisis and have agreed to pay more than $50 billion in settlements, big increases in state and federal funding for addiction care at least represents a positive path toward addressing the problem. These statistics show an alarming crisis within our midst that will require a solution governed by medical expertise, not political grandstanding.