The U.S. drug overdose crisis continues unabated, driven by the coronavirus pandemic and the powerful synthetic opioid fentanyl.

A new report from the Commission on Combating Synthetic Opioid Trafficking, a bipartisan working group led by Rep. David Trone (D-MD) and Sen. Tom Cotton (R-AK), argued that the U.S. should shift from a War on Drugs-style focus on supply to a treatment-style focus on demand.

“U.S. and Mexican efforts can disrupt the flow of synthetic opioids across U.S. borders, but real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs,” the report stated.

Illegally-trafficked fentanyl — a synthetic opioid similar to the prescription narcotic morphine but 50-100 times more powerful — is now the primary driver of the opioid crisis, accounting for roughly two-thirds of overdose deaths each day.

During his State of the Union address on Tuesday night, President Biden laid out several steps towards addressing both demand and supply: "There is so much we can do: increase funding for prevention, treatment, harm reduction, and recovery," Biden said. "Get rid of outdated rules that stop doctors from prescribing treatments. And stop the flow of illicit drugs by working with state and local law enforcement to go after traffickers. If you’re suffering from addiction, know you are not alone. I believe in recovery, and I celebrate the 23 million Americans in recovery."

The congressional commission's recommendations include expanding access to medication therapies and opioid use disorder (OUD) medication, resources for those in and out of incarceration, fentanyl test strips, and other novel harm reduction methods.

“The commission does take a very strong look at demand reduction in how to go about finding ways to reduce demand,” Bryce Pardo, an associate director of the RAND Corporation's Drug Policy Research Center and the principal investigator of the report, told Yahoo Finance. “There are things the commission recognizes that need to be done beyond just the simple: ‘We need to figure out where this is coming from and stop the flow.’”

Leo Beletsky, a professor who studies the impact of laws and their enforcement on public health at Northeastern University, explained that America's demand for illicitly-manufactured opioids is indicative of a larger issue of a broken health care system, substance use treatment, and social support systems.

“Without addressing these root causes, focus on drug supply doesn’t address the addiction and overdose crisis — it actually makes it worse," Beletsky told Yahoo Finance.

'This is a national emergency'

The government focus on drug supply began with the "War on Drugs," which President Richard Nixon declared in mid-1971.

In the following decades, non-violent drug-related incarcerations increased substantially from 50,000 in 1980 to over 400,000 by 1997.

As the Council on Foreign Relations noted, however, "this approach has been widely criticized for failing to keep people from cycling in and out of prison and for disproportionately targeting Black Americans."

The U.S. opioid crisis was initially driven by prescription opioids in the mid-90s and 2000s, led by the widespread use of Oxycontin, followed by the rise of deadly synthetic opioids in the last decade or so.

Since 1999, nearly 1 million people have fatally overdosed — a number that is “more people than we’ve lost in all the battles in America in our wars, including the Civil War, Korean War, Vietnam War, Iraq, World War I, World War II," Rep. Trone, who lost his 24-year-old nephew to a fentanyl overdose in 2016, told Yahoo Finance. "Unbelievable the number of deaths have happened from overdoses."

For the 12-month period ending September 2021, an estimated 104,000 Americans died from drug overdoses. Roughly 65% of those deaths involved synthetic opioids like fentanyl.

Ways to reduce demand for opioids include expanding access to medication-assisted treatment (MAT) — which uses medications like buprenorphine, methadone, and naltrexone in conjunction with other interventions — as well as increasing the availability of naloxone to reverse overdoses and removing the X waiver, which requires specific training in order to be allowed to prescribe buprenorphine, a medication used to help those with opioid withdrawal symptoms.

Trone stated that the commission is entirely in agreement that MAT is “a winner” and should be expanded further. During the State of the Union, Biden likely was referring to the X waiver when he mentioned "outdated rules."

Trone added that “we’ve got to focus heavily on elevating the director of the Office of National Drug Control Policy to a Cabinet-level position. This is a national emergency and we need one voice at the very top to coordinate everybody, all agencies. That’s really crucial, and we’ve got to work on mental health, because if we don’t tie in mental health to this, we are never, ever going to be successful.”

'Not much we can do in Mexico'

Part of what makes fentanyl — which was initially created as a prescription painkiller — desirable for some is how manufacturers are able to increase its potency.

But that comes at a cost with its effects on the human body.

“With fentanyl in particular, what creates the overdose crisis is the combination of the drug’s potency, which overwhelms the system and then causes respiratory arrest, but also the physiological effects of fentanyl that are specific to that drug causing chest wall rigidity, the ability of which can cross the blood to the brain very, very quickly,” Pardo said. “You have very few minutes to reverse an overdose, whereas with heroin you have a lot more time. These kinds of things are more critical now in today’s day and age.”

Initially, fentanyl was shipped directly to the United States after Chinese producers created the drug in labs. As Chinese authorities became more stringent on fentanyl production, the producers would slightly alter their formulas, creating fentanyl “analogues” that essentially created a game of ‘Whack-a-Mole’ for regulators. In May 2019, however, China began controlling all fentanyl-related substances, which curbed much of the production of fentanyl-like substances.

Unfortunately, this didn’t stop fentanyl manufacturers in China entirely. Instead, they began using non-fentanyl synthetic opioids and turned to Mexico to distribute drugs.

“The Chinese chemical manufacturers are now just offering precursor chemicals to drug trafficking organizations or anybody who is interested in manufacturing fentanyl,” Pardo said. “They’re easy to find on social media platforms or other kinds of [business-to-business] networks. Social media is a platform that is the wild west. People are putting up listings for retail purposes. There are pictures on Snapchat where you can easily obtain drugs on those platforms, as well as other platforms we looked at. Twitter, Pinterest, Linkedin, where you do find these other listings for precursor chemicals and bulk amounts of precursor chemicals that are being sold, with the intention of synthetic opioid manufacturing by some criminal actors in Canada or Mexico or where have you.”

Mexican drug cartels can illegally traffic drug precursor chemicals into the United States through various ways such as passenger boat, cargo ship, train, commercial plane, drone, mail carrier, and vehicle border crossings. These routes have been the primary sources of illicit fentanyl in the U.S. since 2019, according to the report.

??“There’s not much we can do in Mexico,” Trone said. “The Mexican government has a lot of great people that would love to make a difference, but they’ve chosen that it’s not in their best interest given the level of violence the cartels have brought against people in Mexico. The level of corruption has taken many people. They’re now working for the cartels and not for the government. There’s not a lot we could do right now in Mexico, unfortunately, given the position they’ve taken. It kind of comes back down to: What are we going to do to slow the demand down?”

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and reach her at [email protected].

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