President Donald Trump and the Opioid Crisis Paper Example

Last night, President Donald Trump told Congress that by building a big wall along the Mexican border and deporting illegal immigrants, he'll improve America's economy and keep illegal drugs off the streets. "We will stop the drugs from pouring into our country and poisoning our youth," Trump said. "And we will expand treatment for those who have become so badly addicted."

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Trump isn't the only one waking up to the drug crisis-more precisely, the opioid crisis. These drugs, whether in the form of heroin or prescription painkillers, are crippling communities in the United States, and one is causing more devastation than others: fentanyl, a synthetic opioid that is far more likely to result in overdose deaths. Because it's a challenge to produce, the labs producing fentanyl should be a reasonably easy target in the battle against opioid addiction. But rooting out these drugs is a game of whack-a-mole; once the DEA targets a specific chemical composition, a new one pops up. Ending the opioid crisis will take more cunning than a wall.

Unlike heroin (derived from poppies), cocaine (processed from coca leaves), or methamphetamine (cooked in garage-sized labs), producing fentanyl and its deadlier analogs pretty much requires a graduate degree in illicit chemistry. "They are fairly sophisticated clandestine laboratory processes, more complicated than methamphetamine, and require some degree of chemistry knowledge," says Russ Baer, a spokesman for the Drug Enforcement Agency. "It's not a do-it-yourself or look it up on the internet and I can produce it tomorrow process."

You can, however, order it up on the internet. Right now, most of the drug sneaks into the illicit drug marketplace from Chinese online pharmacies. "A lot of fentanyl comes through the US mail and mailing services down to 100 or 200 grams," says Baer. "They are able to cut out the middleman, order from the internet from the vendor and two or three days later have those deadly substances on the front door."Fentanyl got popular about two or three years ago, around the same time tougher rules on prescription pain-killers like oxycodone, Percocet, and oxycontin kicked in. That slowed the flow of "pill mills" that dispensed legal painkillers out the back door of clinics, many in rural America. "If you clamp down on prescription opioids, you will balloon the demand for heroin," says Alex Walley, director of the Addiction Medicine Fellowship Program and a physician at Boston Medical Center. But drug dealers soon found that adding a few grams of fentanyl could boost the euphoric effects at a cheaper cost-leaving oblivious users at a much higher risk of overdose.

Chinese officials began to crack down on fentanyl production in 2015. But that just spawned a new class of drugs: chemical analogs that were just different enough to avoid legal prosecution, but still pack a potent high. While fentanyl can be 50 times stronger than heroin, analogs like carfentanyl, an animal tranquilizer, are even worse. "Carfentanyl is in a class by itself," says Baer. "It's the most powerful, the most deadly synthetic opioid that we are aware of. Up to 100 times more potent than fentanyl itself." The powdered drug is so nasty that DEA agents are warned to protect themselves from exposure to minute airborne particles.

Beginning March 1, China agreed to stop the sale and manufacture of carfentanyl and three less-powerful analogs: furanyl fentanyl, acrylfentanyl, and valeryl fentanyl. That, DEA officials say, could have a big impact on illegal imports to the United States.

But medical professionals and drug treatment experts say it probably won't make a huge difference. Once China is cut off, supply lines will likely just switch to places like Mexico. "Some chemists may pop up and start to produce these things," says Baer. The DEA is already aware of illicit labs in Mexico producing fentanyl from precursors manufactured in China.1 "We are working with Mexican counterparts in targeting them," he says.

"It's a game of how quickly can domestic and international regulatory bodies control substances, versus the chemists modifying them so they are not illegal," says Christopher Jones, acting associate deputy assistant director at the Department of Health and Human Services. "To reduce available supply stands to be impactful, but it doesn't solve the problem."

Mexico's legal drug industry is much smaller than China's. But that doesn't mean the cartels can't recruit the scientific talent needed to make the latest fentanyl analog, officials say. Just like Heisenberg, a good chemist can command a high value whether he's running a drug lab in Shanghai, Juarez, or Albuquerque. So far, however, DEA agents haven't found any fentanyl labs operating here in the United States.

Jones has been spending much of his days recently on the road to places like West Virginia, Ohio, and bordering states that have been hard-hit by fentanyl. He's been meeting with state officials and local clinic directors to figure out how to get more federal resources into drug addiction treatment. The White House's budget for the kind of treatment that Trump mentioned Tuesday night hasn't been released yet, but it will likely face scrutiny from a Republican-controlled Congress that has put cutting domestic programs at the top of its agenda.

Conclusion

The good news is that fentanyl does respond to existing treatments, such as naloxone, which kicks the drug off the brain's opiate receptors and prevents the victim's lungs from failing. The bad news: Many of these emerging fentanyl analogs can't be detected with existing toxicological screening tests, making it harder to know how victims are dying.

"All the data we have likely underestimates the problem," says Jones. Meanwhile, fentanyl continues to wreak havoc. Cincinnati's coroner is renting space from local funeral homes to store the bodies of fentanyl victims, while four people in Seattle died in one day last month from fentanyl-laced heroin. Building a border wall won't stop those deaths. But Washington putting a few tens of billions of dollars into drug treatment, naloxone rescue kits, and education might do the trick.