What is Fentanyl?
Fentanyl is a synthetic opioid created in the 1960s by Belgian physician, Paul Janssen. It is normally reserved for medical use to treat pain after surgery and in cancer patients. Fentanyl is upwards of 100 times more powerful than morphine, and 50 times more powerful than heroin. Fentanyl has many different street names such as China White, China Girl, Apache, Dance Fever, Goodfella, Murder 8 or Tango & Cash. Fentanyl is one of America’s most deadly drugs and quickly became the leading cause of overdoses. Even though this epidemic was rapidly growing, the federal government gave very little attention to fentanyl, often times simply lumping it in with the already large opioid crisis, despite it being a completely separate issue.
How is Fentanyl Getting into the U.S. and Out Onto the Streets?
Fentanyl mainly makes its way into America from both China and Mexico. American drug traffickers order this drug from China off of the internet. It enters mainly through the U.S. Postal Service by package. USPS previously did not require electronic monitoring of international packages, so it was very difficult to detect packages that contain fentanyl. Fentanyl also enters the U.S. from Mexico disguised within vehicles that come through customs legally.
Between 2005 and 2007 nearly 1,000 people died from fentanyl. The DEA was able to track this outbreak to a lab in Toluca, Mexico and immediately shut it down. However, after that, fentanyl deaths spread across the nation, with a nearly 800 percent increase in Maryland from 2013 to 2015. It was discovered that drug traffickers were buying pill presses from China and then placing fentanyl into counterfeit pills like Vicodin, Xanax, and Oxycodone. This allowed for easy transport and distribution out onto the streets.
The Obama Administration
The Obama Administration was made aware of the fentanyl crisis in May of 2016 by means of letter by national health experts, after the epidemic had already been escalating for three years. The letter called for the administration to declare this drug a public health emergency. However, the federal government was very slow in addressing this issue, which resulted in the loss of many lives over time. In many of the reports and annual presentations about combating drug use in the U.S., fentanyl was either not mentioned at all or merely briefly mentioned in only a sentence or two. The administration was not seeing this as a serious and separate issue from the overall opioid crisis. A former U.S. attorney reported that at least $1 billion was needed for law enforcement and treatment programs for this epidemic. But, the federal government did not provide even a small portion of this deeply needed money and as a result numerous lives continued to be lost.
Many health professionals and local government leaders coming from states such as Maryland, Pennsylvania, and Delaware, called for the White house to simply announce the danger of fentanyl to the American people, but Obama failed to do so. More money and awareness was given to the Zika virus—which resulted in the death of fewer than 5 people in the U.S.—than was appropriated to the fentanyl crisis. Shortly after, the DEA warned the public about the counterfeit pills and declared them a global threat. That fall, the White House finally shed light on the fentanyl epidemic, 3 years after the CDC issued their first warning. The administration announced several initiatives to combat fentanyl, including continuing to work with China and Mexico to stop the flow of the drug into the U.S., making naloxone more widely available, and allocating more funds to drug task forces. It also gave additional money to speed up the process of data collection on overdoses, in order to get a more clear idea of how threatening this epidemic is and where to go from here. The administration even agreed to hold a meeting with grieving parents of those who lost their lives as a result of this issue. At the end of the 2016 election, Obama finally managed to urge congress to approve $1 billion for opioid treatment programs.
On January 11th 2017, in the very last days of Obama’s presidency, the White House declared fentanyl a national crisis. This was four years after the epidemic began in Rhode Island. However, no reports were released and congress did not issue any public statements or calls to action. A little over a week later, Trump was inaugurated and this national crisis was left up to him and his administration.
The Trump Administration
Left with this increasing and deadly epidemic Trump was forced to act but in a much different manner than the previous administration. In Trump’s first year of presidency, 28,869 people died from synthetic-opioid overdoses (mostly fentanyl), a 46 percent increase from the year before. It became apparent that the funding for treatment was not nearly enough and a drug czar was still not appointed. This problem remained and the administration did not have an adequate strategy to adequately combat the issue.
In a move that could endanger Medicaid patients’ access to free insurance and hence their ability to pay for treatment, the Trump administration aims to reverse the Affordable Care Act and cut $1.5 trillion over the course of 10 years from Medicaid. This means that over half a million people currently addicted to opioids could lose coverage for their treatment and support programs. Furthermore, Jeff Sessions aimed to reverse the “Holder Memo” that was created by the Obama administration, which directed federal prosecutors to stop pursing low-level, nonviolent drug charges that would require mandatory prison sentences at the minimum. Holder’s ambitions were to stop the prison system from incarcerating low level crimes for overly long periods of time. Holder witnessed this injustice and aimed to focus on treatment instead of jail time. However, it was Session’s belief that enforcing jail time is the best option to decrease this epidemic, even though many of these people are in desperate need of treatment.
Another difference from the Obama administration is Trump’s public presence in addressing fentanyl. The administration launched a campaign of opioid prevention ads to increase public awareness of the opioid crisis. Since then, tremendous strides have been made in combating the fentanyl crisis. As far as security goes, police dogs are being trained to detect fentanyl in vehicles at ports of entry. Congress also directed the U.S. Postal Service to start electronically track the packages coming in from foreign countries, especially China and Mexico. Additionally, Trump reached out to Chinese President Xi Jinping and asked him to ban all types of fentanyl in hopes of them following through on that promise. In terms of collecting data, the CDC has continued to improve the data collection process, so that the government can have a more comprehensive understanding of the epidemic. The Trump administration even created an opioid cabinet that included representatives from different government agencies. Most importantly, this cabinet secured an additional $6 billion in funds to fight this crisis.
Overall, it seems like this fentanyl epidemic is finally beginning to receive some of the attention it desperately needs. Looking forward, we can only hope these new initiatives continue to be utilized and treatment becomes increasingly accessible.
Sources:
https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-trump-administration/?utm_term=.e5aff3887fb2
https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-obama-administration/?utm_term=.44b4b85a26e6