OPINION:
On my very first day working at the Office of National Drug Control Policy, an opioid summit was held in the famous East Room of the White House. The setting was awe-inspiring; however, the mood was somber. That contrast was summed up at the end of the day when one father stood up to tell his story: “I never imagined I’d be here at the White House,” he said, “but I’d give [up] all this for just another moment with my son.”
Beginning in the 1990s, opioid abuse and overdose death rates in the United States steadily increased. By October 2017, the Trump administration declared a national health emergency in response to the widespread deaths. With concerted attention and a whole-of-government approach attacking the opioid crisis, we saw the numbers start coming down. In 2018, according to the Centers for Disease Control and Prevention, drug overdose deaths declined 4.1% to just over 67,000 drug overdose deaths in the United States.
Then the COVID-19 pandemic hit. And the opioid deaths started climbing again.
What this tells us is that by taking action and bringing a public policy focus on the problem, we can make a difference. But trends right now are headed in the wrong direction. Drug overdose deaths in general — and opioid deaths in particular — are both increasing. Our policy response is not targeted at the right threat.
Deaths from drug overdoses reached a record of more than 93,000 in 2020, a nearly 30% increase from 2019. Opioids accounted for about 70% of these deaths. That same data shows trends continuing to head in the wrong direction, with preliminary data for the 12-month period ending in November 2021 finding almost 107,000 people died from drug overdoses in the United States.
Public awareness of the challenges associated with prescription opioids led to significant changes and the decline in deaths that we saw pre-pandemic. Prescription opioids, when the use is supervised by a doctor, are an important tool in the arsenal against chronic pain and misuse is on the decline. Aggressive action has been taken to end doctor shopping and shut down pill mills and updated prescribing practices have led to fewer opioids being dispensed. In fact, in 2019 they were dispensed at the lowest rate in 14 years. But while overdose deaths from prescription opioids alone have significantly decreased, the fatality rate from illegal opioids like illicit fentanyl has skyrocketed.
Available 2020 data shows a 63% growth in fentanyl-related deaths compared to 2019. One reason is its insidious proliferation: A national analysis by the Drug Enforcement Administration has found that 4 of every 10 counterfeit prescription pills contained lethal doses of fentanyl. We have a new fight on our hands, facing the increased spread of the synthetic opioid fentanyl in the illegal narcotic supply with catastrophic effects.
Illicit fentanyl has near-immediate effects and is 50-100 times more potent than morphine and many types of heroin. It is so deadly that, according to a leaked internal Department of Homeland Security memo, top military and Homeland Security officials were considering classifying illicit fentanyl as a weapon of mass destruction just prior to the pandemic.
This idea has been resurrected by the group Families Against Fentanyl, founded by James Rauh, who lost his son Tommy to fentanyl poisoning. This past July the group released a letter calling for the WMD designation and it included bipartisan signatories like former CIA Director and Democrat, John Brennan and former Secretary of Homeland Security, and Republican, Tom Ridge.
This renewed focus on the danger of fentanyl reflects the rising crisis: For the first time ever in 2021, more fentanyl was seized at the border than heroin. In fact, the Customs and Border Patrol seized over 11,200 pounds of fentanyl in 2021 — a stunning increase from the 2,633 pounds seized in 2019. Public awareness that the border crisis is a drug crisis is also critical.
The tragic rise in deaths has undoubtedly been boosted by the pandemic and turning the tide will be difficult and require multifaceted efforts that include more investment in treatment and recovery support. However, with the proliferation of a drug as lethal as fentanyl, there is no margin for error. We must move aggressively on the supply side. When 2 mg of illicit fentanyl can kill someone — the size of two grains of salt — there may be no opportunity for treatment or recovery.
A recently released report from the Commission on Combating Synthetic Opioid Trafficking found that the trafficking of synthetic drugs into the U.S. is “not just a public health emergency but a national emergency that threatens both the national security and economic wellbeing of the country.” This escalation of the opioid crisis in our country needs attention and the political will to address it.
• Charmaine Yoest, Ph.D., is a former assistant secretary of health and human services and a former associate director of the Office of National Drug Control Policy.
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