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The opioid epidemic is a complex public health crisis that can be ameliorated by addressing root causes of drug use; expanding access to treatment and harm reduction strategies; and reducing the supply of illicit opioids entering the United States. A whole-of-society and whole-of-government approach is needed at the national, state, and local levels to address this overdose epidemic.
The United States has the world’s highest rate of opioid-involved deaths. Over the past few decades in particular, the overdose epidemic grew rapidly during times of economic insecurity and the COVID-19 pandemic, leading to social isolation and barriers for accessing in-person addiction treatment. Moreover, the rapid introduction of fentanyl—a synthetic opioid lethal in small amounts—to the illicit drug supply has driven recent waves of the opioid crisis. In addition to causing devastating losses of life in families and communities, the overdose crisis is now responsible for an estimated $1 trillion in annual costs to the U.S. health care and criminal justice systems, as well as lost productivity from premature deaths. Without urgent intervention, more than a million additional people in North America are expected to die from opioid overdose by the end of this decade.
Meanwhile, some Republican politicians have weaponized this crisis to irresponsibly perpetuate anti-immigrant rhetoric. But the truth is that the opioid epidemic is a complex public health issue that cannot be credibly linked to immigration or asylum-seekers.
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According to the Commission on Combating Synthetic Opioid Trafficking, the overdose epidemic presents one of the most pressing national security, law enforcement, and public health challenges in the United States today. It also presents a complex and multifaceted challenge that cannot be tackled by a single approach. In addition to centering public health solutions that focus on expanding access to prevention, treatment, and recovery support services, the administration and policymakers must focus on fostering international cooperation to detect and disrupt illicit opioid production and trafficking from China to Mexico. As they consider options to meet these challenges, it is imperative that the ineffective war on drugs—which treated addiction as a criminal justice rather than public health issue and led to overcriminalization for communities of color—not be repeated.
Government officials and policymakers should implement these actionable and evidence-based recommendations to address the complex challenges of the opioid overdose epidemic:
Public health solutions
- Expand access to evidence-based treatment and recovery services, such as naloxone, an opioid overdose reversal agent, and fentanyl test strips; medication-assisted treatment (MAT), which includes medications and therapy to treat opioid use disorder; and syringe services programs.
- Address the needs of heavily affected communities by implementing policies and programs that support equitable access to treatment and recovery services, eliminate discriminatory policies, and invest in communities by addressing health disparities.
- Tackle the underlying causes of drug use in communities by implementing policies and programs that address the social determinants of health and support people in meeting their basic needs, such as child care, universal paid sick time, and workforce development investments to reduce poverty, address socioeconomic inequities, and improve economic security.
Border security solutions
- Invest in scanning technologies at all ports of entry to screen passenger vehicles and freight cargo entering the United States to help ensure that illicit opioids are not being trafficked across land borders.
- Deploy personnel and resources in strategic and targeted fentanyl anti-trafficking operations to interdict illicit fentanyl at land ports of entry, airports, and rail and maritime freight shipping hubs.
- Continue partnering with the U.S. Postal Service to leverage technology to intercept illicit opioids, ensuring it has the capacity and resources to detect lethal narcotics entering the United States through the international mail system.
- Conduct evidence-based research and oversight of drug interdiction efforts to ensure that enforcement measures are effective and implemented in a timely manner and that law enforcement officials involved are adhering to the highest professional standards.
Foreign policy solutions
- Target key actors in fentanyl trade through individualized sanctions and prosecutions to disrupt key choke points in the global fentanyl production and supply chain and to prevent these actors from accessing the U.S. and international financial systems.
- Create accountability mechanisms for the chemical and pharmaceutical sectors, with help from international partners and major private sector players in these industries, to devise and implement safeguards, akin to “know your customer” regulations in the banking sector, that can disrupt global fentanyl production and trafficking.
Criminal justice and racial equity solutions
- Build trust between police and the communities they serve to ensure quality drug enforcement standards that strengthen police-community relations, drive down drug-related violence, and hold law enforcement accountable to maintaining equitable and just standards in their enforcement practices.
- Implement pre-booking diversion programs to divert individuals with often-untreated substance use disorders away from the criminal legal system and into appropriate treatment and support services, helping to reduce overdoses in the long run.
- Rethink the automatic scheduling of all fentanyl-related substances to ensure that the response to the opioid overdose crisis complements public health efforts that increase the availability of prevention and treatment, specifically by allowing scientists to continue developing treatments for fentanyl-related overdoses, without fueling mass incarceration.
- Invest in reentry programs for criminal legal system-impacted individuals with substance use disorders to expand access to treatment and recovery services upon release, decreasing overdose risks and recidivism as well as costs to the criminal justice and health care systems.
Conclusion
The seriousness of the current opioid crisis demands that elected officials set aside their ideological differences and join forces to get behind an evidence- and solutions-based approach. Failing to recognize the public health roots of this crisis and instead weaponizing the crisis will needlessly cost lives.