Cut off fentanyl supply or reduce demand? President Biden says he’s working to do both

WASHINGTON — So many pills sold online contain potentially fatal amounts of fentanyl that buyers would face better odds playing Russian roulette, National Drug Control Policy Director Dr. Rahul Gupta said during an Aug. 31 White House event with families who have lost loved ones to overdoses.

About 50 family members from all over the country sat at half a dozen tables, framed photos of the people they lost positioned in front of them.

Gupta spoke about watching one of his patients struggle with addiction and die.

“I want you to know that in so many cases, for a lot of you also, it was out of your control,” Gupta told them.

President Joe Biden in February’s State of the Union address bragged about the seizure of 23,000 pounds of fentanyl in the preceding months and called for a “major surge” against fentanyl, with more detection machines at the border and tougher penalties for traffickers.

In addition to disrupting the fentanyl supply chain, he has sought to bolster treatment resources and promote public awareness campaigns to alert young people to the danger lurking in pills not prescribed by a doctor.

He faces criticism from Republicans who say he should do more to secure the entire border to help cut off the flow of drugs, while some policy experts say focusing on supply is misguided.

Capitol Hill lawmakers have authored a laundry list of fentanyl-related proposals but most are sitting in committee.

In the meantime, more people are dying.

Gupta said in an interview to The Dallas Morning News last month that the administration’s efforts have shown progress in the form of massive fentanyl seizures and a “flattening” in the rate of fatal drug overdoses.

Driven by fentanyl, drug overdose deaths have risen dramatically for years.

The most recent Centers for Disease Control and Prevention statistics show nearly 107,000 overdose deaths in 2021, a fivefold increase from 2001. About two-thirds of those were attributed to synthetic opioids such as fentanyl, including 1,858 in Texas.

That trendline has leveled off somewhat according to provisional CDC numbers that predict 110,469 drug overdose deaths between March 2022 and March 2023, but that number remains staggeringly high.

Biden has adopted a “commercial disruption” approach that involves identifying the fentanyl supply chain and targeting choke points, including the supply of precursor chemicals used to produce fentanyl, Gupta said.

Those chemicals typically flow to Mexico from China and have legitimate industrial uses, which complicates efforts to cut them off.

The administration has sanctioned more than 170 individuals involved in fentanyl trafficking since Biden took office, many of them members of the Mexican cartels that supply most of the fentanyl flowing into the United States.

Sanctions are intended to block those on the receiving end from conducting business. Americans face civil or criminal penalties if they engage in any transactions with sanctioned individuals.

About 76% of those sanctions have been placed on members of the Sinaloa Cartel and the Jalisco New Generation Cartel, major fentanyl suppliers, and their global networks, according to the White House.

The administration has expanded the High Intensity Drug Trafficking Area program through which federal, state and local authorities coordinate anti-trafficking efforts that seek to secure large busts.

Government officials say increased use of detection technology at ports of entry has helped enable historic fentanyl seizures at the border.

While headlines on seizures typically cite the amount or how many fatal doses were involved, the dollar value of the product seized is also important.

“We denied $22 billion to traffickers by interdiction,” Gupta said. “So we cannot ignore the fact that when we disrupt their business, it hurts them. It makes it more difficult for them to do their business. So that’s the angle we’re taking. We’re going after not just the pills, the production, the supply chain, but also their profits.”

The White House has organized meetings with foreign leaders to coordinate the international response. It has increased access to nasal sprays that can counteract overdoses and designated fentanyl mixed with Xylazine as a national emerging threat.

Xylazine is a powerful sedative approved for veterinary use. Also known by the name “Tranq,” the DEA has warned it is increasingly being mixed with fentanyl.

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TREATMENT VS. INTERDICTION

Some drug policy experts view publicizing seizures as an important message to drug trafficking organizations. Their profits come at a high price, and authorities are keeping drugs off the street that would otherwise be poisoning Americans.

“Supply matters,” said Uttam Dhillon, who served as acting administrator of the U.S. Drug Enforcement Administration from 2018 to 2020. “Enforcement is a critical part of reducing drug overdose deaths.”

The principle that “supply creates demand” was illustrated when communities flooded with prescription opioids saw more people become addicted and then overdose, he said.

Compared to marijuana or even cocaine, small amounts of fentanyl are so potent it’s far easier to hide and smuggle.

Advances in anti-trafficking technology at ports of entry are encouraging, Dhillon said, but Biden has failed to aggressively deploy technology and physical barriers as a way to secure the rest of the border.

“Can you solve this problem? You can mitigate this problem significantly by increasing border security,” he said.

Dhillon also has criticized Biden’s DEA for not issuing an updated version of its National Drug Threat Assessment since early 2021. Congress should demand real-time tracking and response to an assortment of metrics, he said — the most important of which is how many people are dying.

“You can look at all the performance measures in the world but the only one that matters is drug overdose deaths,” he said. “That number has to go down. It is the only real measure of progress.”

Katharine Harris, a fellow in drug policy at Rice University, also views overdoses as the most important measure of progress. She warned against an overemphasis on interdiction without working to reduce demand.

“They can go ahead and do the large seizures and all of that but we need to recognize that that is never going to be enough … We have a demand for drugs here,” Harris said.

“That is what we need to be addressing and all the supply-side measures you want aren’t going to address that. And we have decades of drug war policies as evidence that that’s the case.”

Tree, the drug policy expert, described Biden as a long-time drug war proponent, citing his support for enhanced drug crime penalties during his time as a senator.

He suggested the rise of highly-potent fentanyl has come in part as a response to the fight against drugs and compared it to the country’s experiment with banning alcohol a century ago. He said prohibition turned a nation of beer and wine drinkers into consumers of hard liquor because that was the most economically efficient way for bootleggers to deliver intoxicants.