“If the scourge slay suddenly, he will laugh at the trial of the innocent.”
Job 9:23 (King James)
Since the last decade of the 20th century, America has been gripped by a tremendous increase in the number of its citizens who are suffering from the overuse and misuse of opioids. The result has been called an epidemic, but another term might be more apt. As one physician described it, “The proliferation of opioid use in the United States is called an epidemic, but it more resembles metastatic cancer.” Cancer could be a more appropriate label, given the number of fatalities that opioids have caused. As U.S. Senator Tom Cotton and U.S. Representative David Trone, co-chairmen of the Commission to Combat Synthetic Opioid Trafficking, explained earlier this year, “The overdose crisis in the United States claims more lives each year than firearms, suicide, homicide, or motor vehicle crashes.” More people than even AIDS killed during its worst years.
This Legal Memorandum is another in a series of Heritage Foundation papers under the overall title “Twenty-First Century Illicit Drugs and Their Discontents.” This one will focus on the synthetic opioid fentanyl. It will explain why fentanyl has become a modern-day Old Testament scourge.
The Dilemma That Opioids Pose
The bulbs of the poppy plant produce a gum that has been known for its analgesic properties for thousands of years. The word opium comes from the Greek word opion, meaning poppy juice. In the 19th century, chemists identified the poppy component responsible for the plant’s analgesic effects and purified that substance into the drug known as morphine, named after Morpheus, the Greek god of sleep. Just before the turn of the 20th century, the Bayer company modified morphine to produce diacetylmorphine, which the company called heroin after the German word heroisch, which means heroic or mighty. Touted as a powerful cough suppressant and a less addictive painkiller than morphine, heroin was seen initially as an invaluable medicament at a time when tuberculosis and pneumonia killed thousands.
Opioids remain the premiere analgesic today. They have that effect by generating a cascade of the naturally produced pleasure-inducing molecule dopamine in the reward center in the brain, the nucleus accumbens. Think of it as “the brain’s Grand Central Station, a junction for addictions and anxieties and obsessions.” Dopamine is exceptionally helpful in some circumstances. To produce it, physicians prescribe opioids to relieve the intense pain and suffering caused by recent surgery or end-stage cancer, which dopamine accomplishes well. Opioids, like antibiotics and vaccines, are a modern-day pharmacological success story.
Yet therein also lies a dilemma: “[O]pioids give pleasure, and pleasure is a trap.” Opioids seduce people into believing that they are the ticket to earthly paradise. A problem is that long-term (and some short-term) users get waylaid into physical dependence or addiction. The former describes the state in which your body needs a certain drug to avoid becoming physically ill; the latter, a state in which using a drug becomes the raison d’étre for your life. Addiction treatment physician Dr. Brodie Ramin has described the problem as follows:
Addiction is about dopamine. Addictive substances push dopamine to high, often massively elevated levels, in the nucleus accumbens, the reward centre of the brain. This is the high of the street vernacular. You get high, then you come down. You get dope, then you get dope sickness. You use. You need a fix, a drink, a toke. Stimulating the opioid receptors leads to a cascade in the brain that ends with increased dopamine…. Floating on a cloud is a common description of the first high.
Dr. Ramin explained the highs and lows of opioids as follows:
Pamela told me that heroin is like an abusive lover; it gets under your skin and into your mind. Opioids make you feel high and then bring you down. They make you feel calm and safe and then smother you in your sleep. All you can think about is your next point of heroin or your next pill of Percocet, but more than anything you want to stop using. You want to get away. You fight, but the opioid fights back. It gives you chills and drenching night sweats; it makes you vomit; it makes you want to jump out of your skin; it makes you crazy with revulsion and desire. It is the perfect biological weapon, designed to target the pleasure centres of the brain.
The process of addiction leads to a rewiring of the brain or “neuroplasticity”—viz., “systematic changes in the synaptic signaling, or communication, between neurons in various reward regions of the brain”:
Opioids affect the brain’s response to stimuli and impair decision-making. We are all creatures of habit, and addiction is a deeply ingrained habit…. When you smell your favorite food, you start salivating before a morsel has passed your lips. So it is with drugs. Entering a room where you have used drugs or taking out the equipment to smoke or inject a drug leads your dopamine-producing cells to start firing in anticipation of the rush to come. Repetition turns opioid use into an automatic and compulsive behavior. These changes in the brain endure; they last for years after drug use stops, which is why addiction is a chronic disease.
The result is like seeing Dante Alighieri’s Divine Comedy played in reverse. Opioid use can take people from the Paradiso or Purgatorio through the Inferno, ultimately entombing them in a far worse form of misery than whatever physical or psychological anguish they had hoped to leave behind.
The tragedy for nearly all people who use drugs is that they never return to that initial state of bliss. With repeated use, smaller and smaller amounts of dopamine are released. People need to increase the quantity and frequency of opioid use. Even worse, they become less sensitive to the stimulation for non-drug-related rewards, and they lose motivation to do quotidian and necessary activities such as show up at work and maintain their relationships. The joys of drug use plateau and then decline, but so do the joys of life. Food doesn’t taste as good, careers become a barrier to using drugs, and love feels less like love.
Sadly, even that absence of ordinary sources of gratification and happiness is not the nadir of an addict’s life:
It gets worse. Not only does the brain’s reward system flatline, but there is a concurrent rise of the brain’s anti-reward system, the network of brain pathways involved in stress and negative emotions. Chronic drug use makes the anti-reward system overactive. That is why people who use opioids chronically are more likely to develop depression and to stop caring about every other aspect of life other than drugs. People who use opioids are pulled to the rewards of drugs while also being pushed to avoid withdrawal, depression, and pain. Over a short period of time, a person transitions from taking drugs in order to get high to using them to get a brief respite from depression. Rather than using to get the feeling of floating on a cloud, people begin to use opioids to make the pain stop.
Far too many Americans fell into that trap over the past century by overusing prescription opioids or illicit substitutes to address physical pain or to avoid psychological distress that can be no less real and disabling. Nonetheless, illicit opioid use can have tragic consequences. Approximately half of the people who use heroin become addicted to it; for every first user, “it is a coin toss” whether addiction will follow. Congress sought to prevent heroin’s use by prohibiting its sale more than a century ago. Nonetheless, just as prohibiting the production and distribution of alcohol did not prevent people from becoming alcoholics, outlawing heroin has not kept heroin from ruining or claiming numerous lives.
The Opioid Epidemic
Traditionally, physicians were reluctant to prescribe opioids except in limited circumstances, given their addictive potential. Several factors coalesced to change that attitude in the 1990s. Prompted by the work of patient advocacy groups, pain—whether caused by disease or by injury and whether acute or chronic—came to be seen as the fifth vital sign (atop temperature, heart rate, respiration rate, and blood pressure). Insurers for managed health care programs demanded that physicians increase the number of their patients and declined to reimburse non-opioid pain treatments. Pharmaceutical companies claimed to have developed forms of opioids that had a very low risk of addiction. Physicians feared patients’ ability to rate the quality of their treatment on social media. As a result, doctors found that they could satisfy all of those groups by regularly prescribing opioids to manage chronic pain. Sadly but perhaps predictably, beginning late in the 1990s, “America has witnessed an increase in drug overdose deaths in numbers partaking of Biblical proportions,” due principally to overuse and misuse of opioids, legal and illegal.
The epidemic hit the nation in three successive “waves” of increasing severity.
- Wave 1 involved the overprescription and overuse of opioids.
- In Wave 2, once the federal and state governments limited opioid prescriptions to address the spreading overdose crisis, opioid users turned to heroin because it was easier to obtain and less expensive.
- Wave 3, the most recent and still-ongoing stage, involves a synthetic analgesic, fentanyl.
Fentanyl made a cameo appearance in the United States late in the 1970s, when it was known as “China White.” Now, however, it has become the principal villain responsible for America’s overdoses and fatalities. Ben Westhoff described the current wave in his book Fentanyl, Inc.:
After the heroin and prescription pill crisis took off in the 1990s and reached epidemic levels in the following decades, heartbreaking reports increasingly appeared about decimated communities, about young victims cut down in their prime.
The CDC was right; fentanyl is claiming lives at an unprecedented rate. Heroin use “had never been a particularly safe pastime,” but once fentanyl appeared, users “began dropping like flies.” A 2022 study published in the Journal of the American Medical Association found that “[i]n 2021, fentanyls were identified in 77.14% of adolescent overdose deaths, compared with 13.26% for benzodiazepines, 9.77% for methamphetamine, 7.33% for cocaine, 5.76% for prescription opioids, and 2.27% for heroin.” “Overdoses involving illegally manufactured fentanyl are now the leading cause of death for those ages 18 to 45.”
The costs of the opioid epidemic are staggering. “Since 2000, there have been 400,000 opioid-involved deaths in the U.S. contributing to an historic decline in U.S. life expectancy.” According to the most recent annual data, from June 2020 through May 2021, more than 100,000 Americans died from drug overdoses—more than double the number of Americans killed in action during the Vietnam War. Since 1999, drug overdoses have killed approximately one million Americans. Estimates of the national economic cost have ranged from approximately $700 billion to $1 trillion annually. “In terms of loss of life and damage to the economy, illicit synthetic opioids have the effect of a slow-motion weapon of mass destruction in pill form.” For the ones who lose their lives and the people who care about them, the personal cost is incalculable.
Synthesized as a more powerful painkiller than morphine, fentanyl is a powerful anesthetic and analgesic. The Food and Drug Administration approved it in 1972 as a Schedule II controlled substance under the Controlled Substances Act of 1970 (CSA), the classification used for drugs that have legitimate medical uses but also pose a serious risk of abuse and can be distributed only pursuant to a physician’s order. Commercially produced fentanyl is a legitimate product. It is used intravenously during surgery or as a treatment for end-stage cancer pain, often as a transdermal patch. Like other opioids, fentanyl produces effects such as pain relief, sedation, relaxation, euphoria, and respiratory depression.
It is the mass production of illicitly produced and distributed fentanyl, however, that is killing thousands of Americans today. The principal culprits are China and Mexico. Together, they have been responsible for nearly all of the illicit fentanyl that has entered the United States and have caused scores of thousands of overdose deaths.
China. China was not a traditional source of the narcotics that have been smuggled into the United States, such as heroin. Nonetheless, beginning in approximately 2013, China became the principal direct source of the processed illicit fentanyl that arrived in America. China has massive pharmaceutical and chemical sectors that annually contribute trillions of dollars to China’s economy. They synthesized the precursor chemicals for the production of fentanyl as well as the finished product, and China’s regulation of that industry, whether purposeful or not, was, in a word, lax. Perhaps that is because the initial response of the Chinese Communist Party (CCP) to flaws in its Communist paradise is to deny the existence of any problem. Perhaps it is because the economic might of China’s chemical and pharmaceutical industries translates directly into considerable power. Perhaps it is because China has no interest in penalizing companies that employ thousands of workers in the provinces. Perhaps it is China’s way of repaying the West for the Opium Wars and resulting addiction that England forced China to endure in the 19th century. Or perhaps it is a combination of those factors and others as well (such as an unstated desire to weaken the United States). Regardless of the reason why, the CCP has been reluctant to stifle the smuggling of illicit fentanyl into the United States.
Initially, Chinese companies would synthesize fentanyl and traffic the completed product into the United States (or send it to Mexico for one of the cartels to take fentanyl the last mile) by the U.S. Postal Service, private express carriers, passenger boats, commercial freighters, trains, and drones. Given the small size of smuggled fentanyl packages and the overwhelming number of inbound parcels, illegal packages hidden in shipping containers, like particular trees, were hidden in a forest of shipments. To make detection even more difficult, Chinese shippers use false identities, mislabel shipped fentanyl, hide it in legitimate cargos, and transship packages through “scores of middlemen and freight forwarders” to “launder” its origination point.
During the Obama and Trump Administrations, the United States urged China to control its production and export of fentanyl and its analogues—drugs that have only minor variations from fentanyl in their chemical structure that leave its effect unchanged but allow manufacturers and shippers to evade the regulatory scheme. Yet fentanyl traffickers could easily evade the Chinese regulations and weak enforcement efforts. In 2019, however, after engagements at multiple levels, including a meeting between President Donald Trump and President Xi Jinping, China changed its fentanyl regulatory scheme. The Chinese government included all fentanyl analogues within its schedule of controlled substances and banned their export without a special government-issued license. The result was to shift the nature of China’s involvement in fentanyl trafficking. Rather than send processed fentanyl directly to the United States by mail or by express carriers, China began to send fentanyl’s precursor chemicals to Mexico, where they have been processed into the final product and smuggled across the border. Whether China will vigorously enforce its scheduling law remains to be seen, but the prognosis is a bleak one.
Yet even if China were to collaborate aggressively with the United States to stem illicit fentanyl manufacturing, China’s efforts might not count for very much. A variety of chemicals can be used in fentanyl synthesis; some precursors have lawful uses in synthesizing legitimate chemicals; the manufacturing technique is not scientifically challenging; and legal controls on the production and export of precursor chemicals vary from country to country. The Mexican drug cartels—also known as Drug Trafficking Organizations (DTOs) or Transnational Criminal Organizations (TCOs)—could turn to countries like India and Myanmar to purchase the same precursor chemicals in the open market, smuggling them in legitimate shipments, or mislabel them to hide their origin and nature. Accordingly, the difficulties posed by dealing with nations like India and Myanmar might be no less challenging than the ones that China presents.
Geopolitics plays an unavoidably large role in the fentanyl problem. Foreign nations often expect or demand some type of quid pro quo to help the United States solve a problem they do not share. Our government must decide whether obtaining the assistance of nations like China, India, and Myanmar is a priority and, if it is, what we are willing to offer to enlist their help. Complicating those negotiations is any tension or enmity between those nations (or their leaders) and ours. For example, China, hypersensitive to criticism, is loath to accept responsibility for any part in America’s fentanyl crisis. The CCP has consistently blamed America for any fentanyl overdose and fatality problem, saying that the United States must reduce its demand for illegal drugs, change its culture of drug use and addiction, and step up its enforcement of our laws. China also has been reluctant to partner aggressively with the Drug Enforcement Administration in the investigation of illicit fentanyl labs and smuggling activities within that country. Finally, China’s recent adventurism in Southeast Asia toward Taiwan makes it unlikely that China would welcome or empower new American law enforcement officers on Chinese soil anytime soon.
Besides, whatever saps this nation’s energies strengthens China’s position relative to ours. Scheduling fentanyl’s analogues in 2019 and now sitting back and doing nothing (or next to nothing) gives China a cost-free way to avoid international criticism while harming its most powerful rival. As Napoleon is reputed to have mused, never interfere with the enemy when he is in the process of destroying himself.
Mexico. Mexico has always played an important role as a transshipment point for the smuggling of China’s fentanyl into this country. Once China revised its fentanyl laws in 2019, however, “supply pivoted to Mexico.” Our southern neighbor is now the principal site for fentanyl’s illicit production and the direct source for the finished product to be smuggled into the United States.
Two of the nine Mexican drug cartels—the Sinaloa Cartel and the Jalisco New Generation Cartel (CJNG)—are principally responsible for manufacturing the finished product from the precursor chemicals imported from China via shell corporations, from whence they smuggle the finished product into this nation. Using both large-scale and small-scale laboratories in Mexico, the cartels are able to churn out massive quantities of fentanyl for smuggling into this country. As The Wall Street Journal recently reported, “In a six-day workweek, the cook said, he can make enough fentanyl for hundreds of thousands of doses.” The Sinaloa and CJNG cartels have established smuggling routes to transport fentanyl across the border and into the United States, including new areas where fentanyl use once was rare. The cartels then use established distribution routes, along with local gangs, to infiltrate fentanyl and other illegal drugs into every corner of this nation, earning them billions of dollars.
To be sure, Mexico has taken some steps ostensibly to limit fentanyl trafficking. For example, President Andres Manuel López Obrador has placed Mexico’s ports and largest Mexico City airport under the control of the Mexican navy, which has seized approximately 320 tons of illicit precursor chemicals this year. Mexican authorities also claim to have destroyed roughly 1,000 labs and fentanyl production sites. But the truth is that the current Mexican president has no stomach for fighting the cartels. His stated policy of “abrazos no balazos” (hugs not bullets)—attacking poverty rather than the cartels—has not merely failed to stem Mexico’s violence. It has emboldened the cartels, allowing them to grow in strength, bravado, and influence by proving that the Mexican government is not a threat.
Consider what happened in October 2019 in Culiacán, capital of the Mexican State of Sinaloa and home of the Sinaloa Cartel. Mexican law enforcement authorities arrested Ovidio Guzmán, the son of the infamous Sinaloa Cartel leader Joaquín “El Chapo” Guzmán, who had been convicted of drug trafficking in the United States and sentenced to life imprisonment. In response, cartel sicarios engaged in more than 70 firefights in that city and forced President Obrador to order the city of Culiacán to release Ovidio. That would be the equivalent of the Gambino Crime Family “going to the mattresses” against the federal government when the latter arrested and prosecuted John Gotti, with the federal government giving in to the Gambino Family’s demand that Gotti be freed. The teaching that any such dereliction of duty sends is that there is no rule of law and no consequence for the cartels’ illegal activities.
Why Fentanyl Is a New Scourge
Fentanyl differs from well-known “hard” drugs, such as heroin, in three ways. Each one is relevant to the problem we face today.
Difference No. 1: Fentanyl is extremely potent. The first difference is that fentanyl is extraordinarily powerful because it binds more efficiently to neuroreceptors than plant-based analgesics like heroin do. Fentanyl is 50–100 times more powerful than morphine, the drug that serves as the baseline for measuring analgesic effectiveness. (For perspective, heroin is five times as powerful as morphine.) And some analogues of fentanyl, such as carfentanil, which is used to tranquilize elephants, are ten thousand times as powerful as morphine. Only a few grains—grains, not grams—of carfentanil are fatal to humans. Only a miniscule amount of fentanyl is necessary for it to have its anaesthetic or analgesic effect. A smidgeon more and death follows like the Ghost of Christmas Yet to Come. “It takes only 2 milligrams to be lethal. That’s not even enough to cover the year on the front of the penny in your pocket.”
Difference No. 2: Fentanyl can kill instantly. The second difference is that because of its potency, fentanyl can kill instantly. There is very little room between the curves defining the maximum recommended therapeutic dose of fentanyl needed to achieve its analgesic effect and the minimum fatal dose. Put differently, there is little margin for error. A person who, wittingly or not, uses more than the small amount of fentanyl to achieve the sought-after blissful euphoric state might not have any such margin. As Illinois’ Madison County Coroner Stephen Nonn put it, “‘When we go to a death scene and you still see the needle in the arm, we know it was fentanyl because it works that quick[ly].’”
That feature alone explains why fentanyl is a far bigger threat than heroin. Heroin turns people into “addicts”—viz., individuals who were more than physically dependent on a drug and would start “jonesing” for it if its use were discontinued. Addicts—a term that is no longer widely used but that still accurately summarizes a relevant concept—are individuals whose drug use dominates their lives so completely and deeply that they compulsively use a drug and do whatever is necessary to obtain it, despite the damage it does to their professional, family, and personal lives, because their brains have become rewired and demand it. Yet, unlike fentanyl, drugs like heroin offer what is called the “gift of desperation”—that is, the opportunity to seek treatment after hitting “rock bottom” and realizing that death is “just a shot away.” Heroin addicts can enter treatment for their substance use disorder, and though escaping an addiction is quite difficult, some are able to do so successfully. Fentanyl doesn’t give people that chance. It is merciless.
Difference No. 3: Fentanyl is easier and cheaper to produce, smuggle, and distribute than heroin. The third difference is in the production processes for poppy-based opioids like heroin and synthetic drugs like fentanyl. Synthetic opioids—and other Novel Psychoactive Substances (NPS)—have several cost advantages for suppliers over plant-based opioids. Those factors encourage TCOs to shift to production of synthetic opioids.
Heroin is the product of the opium poppy. Because heroin is a Schedule I controlled substance, it cannot be lawfully cultivated within, imported into, or manufactured in the United States. It must be produced elsewhere and then smuggled into this country. Those multiple steps between a poppy field and an end-user add time and expense, upping the cost at each stage of the cultivation, processing, smuggling, transportation, and distribution steps that are necessary to get heroin to street-level dealers and users. By contrast, fentanyl is created entirely in a lab from lawfully obtained, inexpensive precursor chemicals. The result is that a far smaller geographic area is necessary to produce fentanyl. In theory, it could be produced in remote labs in the United States, particularly in the vast unsettled areas in Rocky Mountain states.
Transportation costs are also lower. Mexico, the primary source of the illicit fentanyl smuggled into this nation, has a 2,000-mile border with four adjacent American states, eliminating the need for the trans-oceanic shipping that is necessary to bring opium from Afghanistan or Southeast Asia into this country. Moreover, fentanyl’s greater potency makes transportation easier and more cost-effective because small quantities of the drug are easier to conceal in vehicles and can also be sent by parcel post, private express carriers, drones, or some other mode of transportation. The cost of synthesizing, smuggling, and distributing fentanyl is only 1 percent of the cost of trafficking in an equally potent amount of heroin, making fentanyl trafficking preferable from a dose-equivalent or efficiency perspective. Accordingly, because fentanyl and other synthetic opioids “offer economic and tactical advantages that allow criminals to vastly outpace enforcement efforts,” fentanyl is replacing heroin as the principal opioid sold in areas of the nation.
Collateral developments also worsen our predicament. Evolutions in communications, cryptography, and transportation media have made the creation, smuggling, and distribution of fentanyl far easier today than had historically been the case for drugs like heroin. Sellers and buyers of processed fentanyl or its precursor chemicals can meet in cyberspace and communicate via social media or in private over the Dark Web, “a sort of eBay of illicit drugs.” Sellers can deliver purchased goods via a host of private express carriers. The result is to make drugs like fentanyl available to an entirely new range of customers. “The people consuming many of these bastardized novel psychotic substances are not traditional hard-drug users.” Some are “high school kids, college students, and recreational enthusiasts best described as drug nerds,” while others are “psychonauts, thrill seekers who try brand-new drugs that have never been taken before.”
Yet fentanyl is similar to heroin and cocaine in one important—and dangerous—respect: It is a white powder. Drug dealers can intentionally “step on” drugs like heroin or cocaine by diluting it with less expensive fentanyl to reduce their costs or to give their product an extra “kick” as a means of soliciting repeat business. Of course, a result is that there is no uniformity in how much fentanyl can be found in any package or pill. Fentanyl can also wind up unintentionally mixed into heroin and cocaine by dealers who are less than fastidious about how they package their wares.
Many juvenile or young heroin or cocaine users purchase illegal drugs over social media, but they “have no idea just how potent and dangerous these new drugs can be.” That ignorance can be costly; in fact, it already has been. Because one never knows how much fentanyl is in heroin or cocaine powder, or in counterfeit pills, using them is like playing Russian Roulette with more than one round in the chamber. Want proof? Fentanyl was present in the system of 40 percent of the people who overdosed and died from cocaine in 2016.
There is an additional, more ominous aspect of illicit fentanyl sales. Americans are accustomed to and prefer taking drugs by swallowing pills rather than receiving or self-administering injections, so the cartels use commercial-grade presses to manufacture counterfeit pills containing fentanyl, either in part or entirely, creating look-alikes for legitimate prescription drugs such as OxyContin or Adderall. The machines allow the cartels to manufacture millions of pills. The goal is to attract new customers. To entice juveniles, the cartels also manufacture pills in various colors to make them look like candy. Even more horrifying, shortly before Halloween in 2022, law enforcement authorities at the Los Angeles International Airport seized thousands of suspected fentanyl pills disguised in popular candy packages. It is not difficult to imagine the reaction of thousands of parents whose children overdosed and died from ingesting those candies had they reached their destinations.
Across the nation, law enforcement has seized millions of counterfeit pills containing fentanyl and have witnessed unprecedented numbers of fatal fentanyl-induced overdoses. However that happens, the presence of fentanyl in an illicit drug can wind up causing someone to die from its use, whether that someone is a celebrity or an average everyday American. As author Ben Westhoff has written, “Until recently young people could often take drugs at parties without risking much more than a bad hangover. Now, however, any black market pill or powder could contain a lethal dose of fentanyl.”
Unfortunately, this problem will only worsen over time. Fentanyl shows that enterprising chemists are able to create new synthetic opioids, and the Mexican cartels are willing to expand their operations to create new drugs for both existing and new markets. Given Mexico’s economic problems, Mexican TCOs also have no shortage of young men willing to join their ranks for the money and prestige that comes with cartel membership. Stopping the smuggling of fentanyl into the United States is a matter of life and death. The question is not whether but how many Americans will die from fentanyl smuggling and distribution.
The Bottom Line
Fentanyl is the Black Mamba of illicit drugs. Its fangs contain a quick-acting, extremely aggressive, highly potent, merciless, and remorseless venom that kills in the blink of an eye. “Never…has an opiate—or any other drug, for that matter—killed so many annually as the fentanyl epidemic.” Illicit fentanyl use is a public health problem of historic proportions. As a 2018 Brookings Institution report noted, “Replacing drugs derived from plants (e.g., heroin, cannabis) with synthetic analogues (e.g., fentanyl, Spice/K2) could be the most disruptive innovation in the history of the international drug trade.” The recent federal Commission to Combat Synthetic Opioid Trafficking concluded that “the trafficking of synthetic drugs into the United States [is] not just a public health emergency but a national emergency that threatens both the national security and economic well-being of the country.” Medical and law enforcement professionals agree on the nature of the problem and the need to stop its murderous assault on the nation.
A joint federal–state response is necessary because this threat will not pass into the night and the states cannot handle it alone. As the Commission to Combat Synthetic Opioid Trafficking concluded earlier this year, given all the features that make fentanyl dangerous—its relatively greater potency than plant-based opioids, its relatively simple and inexpensive production and distribution process, the vast areas in Mexico where the drug can be synthesized, the cartels’ demonstrated willingness to exploit every advantage that the United States offers for drug trafficking, and the refusal of Presidents López Obrador and Joe Biden to stop fentanyl smuggling from Mexico into the United States—“a transition from heroin or diverted prescription opioids to more-potent synthetic opioids is here to stay.”
According to Jim Crotty, Deputy Chief of Staff at the Drug Enforcement Administration from 2019 to 2021, fentanyl “is in fact the most pernicious, the most devastating drug that we have ever seen.” Adding a little bit of black humor, Crotty said that if fentanyl “were an athlete, people would call it ‘The G.O.A.T.’”
All jokes aside, the facts show that Crotty is right. We have long known that while opioids can relieve pain, they also can destroy life. Generally, they work slowly by reducing users to the ever-hungry souls in a Buddhist afterlife. Sometimes, though, they act more quickly, leaving no opportunity for the inexperienced user or for someone who succumbs to reuse after becoming “clean.” Fentanyl, however, does not give many users the opportunity for redemption; it can kill in the blink of an eye. Worse still, fentanyl can kill unwitting or novice users. Opioid users once had the chance to survive a poor choice—to walk away after youthful experimentation or to hit rock bottom after being hooked but then realizing that they needed to turn their lives around. Now users frequently do not get that second chance.
We need to educate people about fentanyl’s danger, persuade them not to run the risks it poses, and stop the sale of poison to our fellow citizens. Andrew Olivastro, a colleague of mine at The Heritage Foundation, once wrote, “In this war, the drugs are winning. The battle must be joined.” Fentanyl proves that he is right.
Paul J. Larkin is the John, Barbara, and Victoria Rumpel Senior Legal Research Fellow in the Edwin Meese III Center for Legal and Judicial Studies at The Heritage Foundation.