Fentanyl-related overdoses keep claiming scores of American lives every day, and most efforts so far have failed to counter its spread effectively. The most recent debates focus on the southern border’s security and include initiatives that deploy more National Guard troops to the southern border. Several Republican governors have followed suit and sent reservist troops primarily to the border in Texas. These states maintain that the leadership solutions at the federal level fall short, and states need to send these troops to secure the border, reduce the flow of fentanyl, and combat human trafficking. Nevertheless, it is a question of whether this approach effectively counters ongoing fentanyl trafficking.
The fentanyl epidemic has ramped up in the past couple of years, as seen in Figure 1 below. Opioid overdose deaths rose from 21,089 to 47,600 in 2017 and remained steady through 2019. It was followed by significant increases in the following years, with 80,411 in 2021 and a slight decrease to 79,770 in 2022. The Biden administration has increased funding to disrupt and dismantle drug trafficking operations and reduce the supply of illicit drugs like fentanyl; however, fentanyl-related overdoes still rip through the entire country and hit all societal segments. The younger age groups are more at risk of fentanyl overdoses. Opioid overdoses are incredibly high in the U.S., accounting for a significant portion of deaths worldwide.
Figure 1: National Overdose Deaths Involving Any Opioid Between 2017 and 2022
Fentanyl is an opioid, which is a type of painkiller. Opiates are natural compounds from poppy sap and poppy plant fibers, including morphine and codeine. Opioids is an umbrella term encompassing any compound that binds to and acts on opioid receptors in the body. It includes natural opiates like morphine and codeine, semi-synthetic opioids like heroin, and fully synthetic opioids like fentanyl.
Fentanyl is one of the deadliest drugs in the world. It is highly potent and 50 times stronger than heroin and 100 times more than morphine. There are two types of fentanyl: pharmaceutical fentanyl and illegally made fentanyl. Both are considered synthetic opioids. Doctors prescribe pharmaceutical fentanyl to treat severe pain, especially after surgery or for advanced-stage cancer. Most recent cases of fentanyl-related overdose are linked to illegally made fentanyl, distributed through illegal drug markets for its heroin-like effects. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous. Illegally made fentanyl is available in different forms, including liquid and powder.
Before fentanyl overtook Oxycontin and heroin on the center stage in 2013, its scary journey recorded three waves. The first wave lasted from the early 2000s to 2010 and was dominated by prescription bills. The drug companies aggressively promoted these pills to prescribers, asserting they were not addictive and were effective at treating pain. The first wave made the Oxycodone culprit. As a result, millions of Americans got hooked on these pills while these companies made billions of dollars in revenue. The second wave witnessed the spread of heroin use when these pills became less available. The addicts of the first wave transitioned to using heroin, buying it on the streets. Its relatively lower price attracted more addicts to use heroin in the second wave. Finally, the third wave hosts fentanyl as a mostly consumed supplier due to its availability for users.
Why Is Fentanyl Deadly?
Fentanyl is especially deadly because of its specific chemistry of the compound and the tendency of people who use it illicitly but do not know how much they are taking at once. Some addicts believe that fentanyl takes pain from their body and keep them from getting sick. Knowing that 2 mg is enough to deliver a fatal dose, most addicts do only 0.5 mg shots.
Its broad availability and accessibility by users make fentanyl a mainly used drug type. Users can quickly obtain it with street names such as Apache, Friend, Jackpot, Dance Fever, Murder 8, Tango&Cash, and Goodfellas. Powdered fentanyl looks like many other drugs. It is commonly cut with heroin, cocaine, methamphetamine, or marijuana. They are made into pills that resemble other prescription opioids. Fentanyl-laced drugs are hazardous, and many people are unaware that their drugs are added with fentanyl. When they switch to a different supplier, they may not have the same feeling. Therefore, most overdoses come from people not knowing what the drugs may include. Those who experience an overdose may have decreased breathing, lose consciousness, turn blue or pale within a few minutes and then die.
How Do These Drugs Enter the Country?
Individual networks and criminal networks play vital roles in making fentanyl available to addicts. Individuals create a constellation of micro-networks across the country when they go online to one of the many Internet drug marketplaces and purchase fentanyl. Independent actors also use the dark web, which is only accessible with encrypted browsers like Tor. Fentanyl can be shipped in small quantities and is easily concealed due to its extreme potency. In addition to online orders, individuals use mail systems and commercial carriers.
Fentanyl also comes across the southern border. Heroin seizures at the U.S.-Mexico border plummeted 72 percent since 2018, but seizures of fentanyl jumped by 641 percent during the same period. Like heroin, 90 percent of the fentanyl is seized at official border crossings. China is one of the source countries for the precursors of fentanyl, where the chemical manufacturing laws are not tight, and these chemicals are shipped from China to the ports in Mexico. Then they are processed in the hundreds of primitive labs in the country. One of the regions is Sinaloa state, where it is easy and cheap to cook fentanyl precursors in countless labs. Mexican cartel members have little sympathy for overdose deaths. Their greediness pushes them to increasingly become involved in the production and shipment to the U.S. Some cartel members believe that Americans send a lot of weapons to Mexico, and in return they ship lots of drugs to the U.S.
Despite the Mexican cartels’ active role in shipping fentanyl to the U.S., the fentanyl seizures in Mexico are minimal. The Mexican government denies that Mexico is a source county, blaming the American culture for the crisis, such as the disintegration of families, individualism, and lack of love and brotherhood in American society. It should be noted the current Mexican administration campaigned on demilitarizing Mexico but has vastly increased the military budget and power. More Mexicans have died during the ruling of the current government.
Southern Border and Policy Implications
Some Republican governors decided to send their reservist troops to preferably to the border in Texas. Traffickers use the southern border to ship fentanyl to the U.S.; therefore, it is a decent approach to reduce the flow of fentanyl. However, it may make a temporary impact in the short term. The analogies of the balloon and cockroach effects powerfully convey the implications of preventing fentanyl trafficking. According to the balloon effect, when you push down drug trafficking in one region, it may cause it to bulge somewhere else. Similarly, the cockroach effect maintains that the cockroaches escape to darker areas when you turn on the lights. The border areas with newly deployed troops are expected to deter the traffickers but push them to use alternative routes.
So far almost every country has failed to develop an effective policy model to prevent illegal drug use and trafficking. UNODC reports an increasing number of drug addicts every year. Fentanyl-related overdoses are one of the top agenda issues in the U.S., but unpreventable overdose deaths worsen the situation. Not even a week or month goes by in which addicts use a new type of fentanyl. For example, it is frightening to see Xylazine, an animal tranquilizer also known as tranq, laced with fentanyl and used by addicts. Carfentanyl is another increasingly used type that is more potent than fentanyl since its 0.5 mg dose is fatal.
While some approaches are supply-side oriented, including policies to target criminal organizations, secure the borders, and scapegoat immigrants, others are inadequately demand-side oriented, aiming to reduce the number of drug addicts. Both approaches conclude that a more balanced approach should be given to the supply-and-demand side of the fentanyl epidemic.
In 2022, the administration allocated $11.5 billion to fight the opioid endemic, a 54 percent increase from the previous year. However, the critiques in the U.S. underline the importance of more government initiatives to turn the tide, saying that they are pretty slow and reactive, but they should also be proactive.
Short-term strategies should aim to decrease the number of fentanyl overdoses. There is a need for pilot studies that incorporate proactive and reactive approaches and address the demand-and-supply side of the problem. In the hotspots of fentanyl use, families, bars, and restaurants must be provided Narcan, a medicine that rapidly reverses an opioid overdose. Access to testing centers would significantly reduce the number of overdose killings since most addicts do not know how much of their drugs may include fentanyl.
Long-term strategies should start with understanding well the fentanyl market. Giovanni Falcone, the judge murdered by a mafia group in Italy, said, “You have to understand the business of it, and if you don’t understand the business, you cannot target it.” It is a priority to understand well the fentanyl overdoses in the context of how fentanyl is shipped to the U.S., how it crosses the border, how addicts reach out to these drugs, and why counternarcotics policies do not effectively mitigate the issue.
There is an urgent need to reduce the user population’s size through prevention, harm reduction, treatment, and recovery support services. The limited capacity of halfway houses and rehab centers insufficiently address the effectiveness of demand-oriented approaches. Most addicts complain about expensive treatment plans in these centers.
It is necessary to incorporate the private sector to develop a public and private partnership to understand the issue better since financial institutions, shipping, logistics, and express consignment operators take active roles in this partnership. Law enforcement is limited in being able to look at the packages that come through the U.S. mail, as opposed to the delivery services. Moreover, due to its skyrocketing numbers, law enforcement cannot individually respond to every case. New studies are urgently needed to promote law enforcement innovation. Law enforcement needs to utilize comprehensive methods of criminal activities analysis, including network analysis and geospatial analysis.
In addition to taking a holistic approach that incorporates the perspectives of law enforcement, academia, government agencies, the healthcare sector, and schools, there should be a specific focus on following drug money, strengthening international cooperation with source and distribution countries, and addressing corrupt pharmaceutical companies, healthcare providers, and government entities that facilitate overprescribing of fentanyl.
To conclude, the ongoing smuggling of human beings and shipping of drugs from the southern border constantly raises questions about its security. Politicians also exploit the security issues at the border and use them to show their rivalries’ weaknesses. It has been a reality to know that most drugs are shipped through the southern border. Yet, an effective policy model requires approaches beyond political interests. A more balanced approach must be given to the various dimensions of fentanyl-related overdoses, as the high number of overdose deaths makes it crucial to take necessary measures. It is as easy as providing medicines that reverse the impacts of fentanyl in the hot-spot regions where most deaths are recorded. Still, the most effective results will be obtained with successfully applied long-term strategies.
