Overcoming the synthetic opioid crisis requires innovative strategies that include targeting suppliers and rethinking “conventional” policies like arresting couriers and criminalizing substance abusers, according to a new RAND study.
The 30,000 opioid-involved overdose fatalities in 2018 are similar to the magnitude of deaths from HIV/AIDS at its peak in 1995, but addressing this epidemic requires novel legal and regulatory strategies as well as medical approaches, said the study, which was released Thursday.
Bryce Pardo, an associate policy researcher at RAND and lead author of the study, The Future of Fentanyl and Other Synthetic Opioids, argues this crisis is different because the flood of drugs pouring into the market in the U.S. and other countries is not driven by user demand, but by suppliers’ decisions.
The opioid overdose fatalities, concentrated in parts of Appalachia, New England, and the Midwest, are linked to illegally made fentanyl that the RAND Corporation believes is coming into the U.S. through multiple sources.
A principal source is China “…where the regulatory system does not effectively police the country’s expansive pharmaceutical and chemical industries,” the study said.
The fentanyl reaches U.S. customers through the U.S. postal service, private couriers like UPS and FedEx, and cargo freight, and is also carried in by smugglers from both Mexico and Canada, the study said.
The crisis is aggravated by the lack of regulation of pharmaceutical and chemical industries around the globe, which allows “producers to advertise and ship synthetic opioids to buyers anywhere in the world.”
Earlier this week, in a landmark ruling, an Oklahoma judge condemned the “false and misleading marketing” of opioids by Johnson & Johnson, one of the nation’s leading pharma companies, and ordered it to pay $572 million in fines.
Pharmaceutical fentanyl, according to the Centers for Disease Control and Prevention, is a man-made opioid pain reliever. It’s estimated at being 50 to 100 times more potent than morphine.
RAND said its study is the “most comprehensive document to be published on the past, present and future of illicit synthetic opioids. ”
Researchers examined synthetic opioid markets across the U.S. and in other parts of the world, such as Estonia (where fentanyl first appeared 20 years ago).
While looking at CDC mortality data, and interviewing drug policy/surveillance officials, law enforcement officials, public health professionals and researchers alike, RAND researchers concluded with what they called “Five Basics Insights” into the current state of the epidemic.
- However bad the synthetic opioid problem is now, it is likely to get worse before it gets better.
- The artificial nature of fentanyl is used as a “strategic device” for dealers to lower the costs of production, meaning the suppliers drive the market instead of the users.
- Synthetic opioids are more deadly, driving up the death toll rather than the number of active users.
- Researchers found that it takes time for fentanyl to become a geographic location’s drug of choice—but once it does, its popularity “can expand rapidly and even drive out other opioids.”
- Purchasing fentanyl has taken a futuristic turn, with the cryptomarket drug sales appearing “to be in the hundreds of millions of dollars per year.
Rethinking Drug Policy
Fentanyl is cheap to make.
RAND estimates that switching to synthetic opioids cuts the wholesale price of opioids by roughly 99 percent. It’s because of this that “the United States can no longer think of high prices as the first line of defense against wider use of opioids” when trying to buy time against the drug.
RAND says traditional counter-narcotics policies deployed by federal and local authorities are useful but do not go far enough.
In the area of supply control, RAND researchers say that since fentanyl’s spread across the globe is driven by suppliers’ decisions, supply disruption should be considered as “one piece of a comprehensive response, particularly where that supply is not yet firmly entrenched.”
Efforts such as poppy plant eradication and domestic police department enforcement against drug dealers can have a limited impact. The high prices of opioids are both a blessing and a curse because they can enrich dealers while impoverishing those who are addicted to them. By controlling the drugs on the street, neighborhoods can begin to see some relief.
But they added that harsher sentences, including drug-induced homicide laws for low-level retailers and couriers, are unlikely to make a difference.
In the area of prevention, RAND believes that the money spent on drug education programs for youth is well worth the investment, even if only a minority of young people respond well.
But RAND also suggests that “in addition to expanding conventional approaches, it might be time to invent new approaches and be open to trying ideas that seemed too risky or too alien in the past.”
“Indeed, it might be that the synthetic opioid problem will eventually be resolved with approaches or technologies that do not currently exist or have yet to be tested,” said Beau Kilmer, study co-author and director of the RAND Drug Policy Research Center.
“Limiting policy responses to existing approaches will likely be insufficient and may condemn many people to early deaths.”
The study authors called for an exploration of “innovative disruption efforts that confuse or dissuade online sourcing.”
One approach highlighted by RAND is a strategy used by Portugal, adapted from its earlier efforts at handling the high rates of HIV transmission from heroin needles.
Portugal has decriminalized drug possession and created “dissuasion commissions,” known as CDTs, which helped with interventions, drug treatment programs, and partnered with homeless shelters.
Other novel ideas include introducing cannabis instead of opioids, increasing medication treatment, heroin-assisted treatment (HAT), expanding access to Drug Content Testing technologies, and opening supervised drug consumption sites.
However, that idea is unlikely to find favor with the Department of Justice, which claims “that opening a supervised consumption site would violate federal law.”
RAND suggests changing the law or treating the sites like “state-legal cannabis stores … and ignore them.”
The other co-authors of the report are Peter Reuter, Bradley D. Stein, and Jirka Taylor.
The full RAND study, “The Future of Fentanyl and Other Synthetic Opioids,” can be accessed here.
Andrea Cipriano is a contributing writer to The Crime Report.