Parents were understandably rattled when seven youth at one Washington DC high school suffered fentanyl overdoses within a three-week span. Yet that’s just the latest of myriad such tragedies in a nation where more than 100,000 die from fatal overdoses every year. The deadly drugs are (mostly) produced by organized crime groups overseas, so it is natural that a group of U.S. Senators are calling for improved border security and the Secretary of State has formed a Global Coalition to Address Synthetic Drug Threats. But precisely because the main problem is synthetic drugs like fentanyl and methamphetamine, the most effective responses actually lie closer to home.
Illicit drug use, markets, and policy are truly being upended by potent synthetic drugs [link] that can be rapidly produced without reliance on agriculture. Overdose statistics show clearly that these drugs present greater risks for users than do traditional plant-based drugs like heroin and cocaine. What is less widely appreciated is the challenges they pose for traditional approaches to drug control policy.
Fentanyl is extraordinarily compact. Total annual illicit consumption is less than 10 metric tons, meaning it could fit in any one of the millions of tractor-trailers that cross the US-Mexico border each year. That makes border interdiction much harder than with cocaine, let alone a bulky drug like marijuana. Border interdiction could become better if vehicle-scanning technology improves, but to what end? At those market levels, fentanyl can be up to 100 times cheaper than heroin per dose, so it is easy for traffickers to replace lost loads. And unlike with agricultural drugs, they don’t need to wait through another growing season: their labs can more or less synthesize as much as they want, whenever they want.
However, one should not leap from an inability to seal the border to mistaken calls for legalization, or denial that law enforcement is vital. Rather, law enforcement should be focused on minimizing market-related harms, like violence and corruption, not the impossible task of creating a drug free nation. Closing open-air drug markets that blight many U.S. cities is a valuable and attainable goal, particularly if police, health professionals, and communities are willing to collaborate using low-incarceration strategies that have proved successful in the U.S. and abroad. Law enforcement can never eliminate drug dealing, but some dealers and markets are more destructive than others, and prioritizing them – not just those caught with the largest quantities – would help.
For those with opioid use disorder, treatment can reduce use and restore their health and function. Great strides have been made in the past 15 years towards including evidence-based addiction treatment in all public and private health insurance plans, but more needs to be done to make access universal, including during and immediately after jail stays. That said, treatment has limits and no epidemic ends by focusing all attention on those who are already ill.
Prevention initiatives must therefore be re-invigorated. Mocking programs from the era when the DEC Rainbow, Apple Lisa, and ACT Apricot were cutting edge computers gets easy laughs, but it is outdated and intellectually lazy. We have come a long way since notions of prevention revolved around police officers in classrooms trying to scare kids. Evidence-based programs like Communities that Care, which make significant investments in kids over several years, not only reduce their alcohol, tobacco, and drug use, but also their involvement in crime and likelihood of dropping out of school. Prevention’s benefits take years to accrue, but the alternative to not investing in it is being in the same or an even worse place with drugs a decade from now.
Sadly, no matter what policies the U.S. implements, millions will remain dependent on synthetic drugs in the coming decade. So we need to do more than just offer treatment or drug harm reduction. We also need to become more forgiving and generous in supporting all people who struggle, regardless of the reason. Stronger policies on affordable housing, mental health, child neglect, and returning to employment those with criminal records will improve outcomes for individuals and families recovering from addiction even if those efforts do not have the word “drug” in their title.
There is a lot to be done, and it won’t be cheap, but the necessary hard work begins at home. Pointing fingers at enemies abroad is not the best way to help our neighbors here at home.
Jon Caulkins is the Stever University Professor at Carnegie Mellon’s Heinz College and Keith Humphreys is the Esther Ting Memorial Professor at Stanford University.
