Progress has been made in the fight against the opioid epidemic, but it could all be lost unless we make a critical pivot in our approach.
The numbers are striking: In 2018, drug overdoses claimed more than 68,500 lives, and 47,600 were the result of opioid overdoses. The upside is that these same figures show that overdose deaths overall dropped about 5% year-over-year, the first decrease since 1990. Yet a deeper dive into these figures reveals where the problem grows more acute.
To this point, most of our efforts to combat this crisis have centered on opioid addiction treatment and over-use in the medical industry, and the numbers do indicate some positive impacts. Between legislation and self-regulation by pharmaceutical companies and doctors, important steps have been taken to reduce over-prescription and the risk of getting people unwittingly addicted in the first place. However, the larger opioid threat comes not from prescription abuse, but from illicit sources such as heroin and fentanyl.
In 2016, for example, around 75% of opioid-related deaths were caused by illicit drugs. When opioid-related deaths increased almost 13% the following year, fatalities from prescription painkillers leveled off— but fatalities from fentanyl and related synthetic opiates rose by nearly 50%.
These statistics demonstrate that while there was indeed initially a need to introduce measures to prevent misuse of opioid-based painkillers, a narrow approach confining our focus to pharmaceutical companies and medical professionals threatens not only to slow down the gains that have been made but actually make the situation worse.
The problem is political as much as anything else.
It is politically easy but intellectually lazy to just go after big businesses or the pharmaceutical industry and focus on the softer side of the equation, such as treatment, education, and so on. It’s also become far less popular to advocate the tougher, law enforcement side of things. This political reality is an over-correction from the much-maligned “War on Drugs,” which aggressively targeted supply but failed to control demand.
The current state of play is simply untenable. The much-needed awareness effort calling attention to over-prescription of opioids has now morphed into a series of politically-expedient measures and frivolous lawsuits aimed at the convenient boogieman of the pharmaceutical industry. Meanwhile, the criminal problem continues to grow. The reality remains that Fentanyl, a synthetic opioid, is the chief culprit.
It is up to 50 times more potent than heroin, so toxic that only a few milligrams of the stuff can kill. Carfentanil, a closely-related fabrication, is even deadlier, requiring only a single grain to result in a lethal overdose. Paradoxically, its potency is what makes it so attractive to addicts, who are continuously chasing an increasingly powerful high — up until the one that kills them.
The dilemma gets even more complicated when tracing the origin of these drugs.
China is one of the largest sources of fentanyl and related substances. The country provides it to criminal enterprises, which then handle the distribution. Enormous quantities of fentanyl and its chemical components are sent from China to Mexico, where they are turned into the final product, sometimes mixed with heroin and other drugs, or pressed into counterfeit pills and then smuggled across the border.
Efforts by Chinese authorities to shut down the thousands of labs capable of producing synthetic opioid compounds have proven frustrating, and one wonders how motivated the Chinese government is to stem the tide of drugs into the U.S. in the first place. American law enforcement agencies, meanwhile, such as Customs and Border Protection, have found themselves woefully under-equipped to stop these substances at the border.
Meanwhile, the increasing restrictions placed on doctors who treat chronic pain have prevented patients from receiving relief in the form of properly prescribed pain medication — another over-correction that may create a whole new class of potential victims for predatory drug dealers.
If we are serious about combating the opioid crisis, we need to acknowledge the limits of our current approach and recognize the problem as one of criminal interdiction. Law enforcement must be provided the resources necessary to fight illegal opioids where they exist, on the streets, and at the borders.
Kelly Sloan is a former employee of the Calgary Police Service and Royal Canadian Mounted Police and graduated from Mount Royal University with a degree in Criminology. He now resides in Denver, CO.
