December 17, 2022

Where is the outrage about the fentanyl crisis?


PERF members,

The Washington Post published an important series this week detailing the failure of successive administrations to address the enormity of the fentanyl crisis, the challenge of detecting and confiscating the chemicals used to make fentanyl, how fissures in the U.S.-Mexico relationship hindered the fight against fentanyl, fentanyl’s reach into small towns like St. George, Utah, a Colorado prosecutor’s investigation into five fentanyl deaths that occurred in one apartment, and the violence and addiction that the drug trade has brought to Tijuana, Mexico.

It includes this tragic story: In November 2020, Sarah Fuzzell died of a fentanyl overdose in Southern California at age 24. Thanks to excellent police work by a multiagency law enforcement task force, Sarah’s dealer was identified, convicted, and sentenced to ten years in prison. The day after testifying at the dealer’s sentencing hearing, Sarah’s 30-year-old sister Megan—a medical researcher who volunteered at medical clinics to raise awareness about the dangers of drug overdoses—also died of a fentanyl overdose.

Following Megan’s death, Ed Byrne, an agent with Homeland Security Investigations and a member of the task force who has witnessed nearly 500 fatal overdoses, asked the question we should all be asking: “Where’s the outrage?”

I don’t want to take away from the hard work of Agent Byrne and countless agents, officers, and deputies with federal, state, and local law enforcement agencies. They regularly risk their lives to try to reduce overdose deaths. But the scope of the problem today is shocking. After plateauing for a few years from 2017-2019, the number of overdose deaths in the U.S. spiked to more than 90,000 in 2020, and provisional CDC data show it rose further in 2021 to more than 107,000. More than four times as many Americans died from a drug overdose in 2021 as were killed in homicides. “[F]entanyl is now the leading cause of death for Americans ages 18 to 49,” the Post concluded from CDC data.

Source: NIH National Institute on Drug Abuse

As the graph below shows, this increase in overdose deaths was mostly due to synthetic opioids, particularly fentanyl.

Source: NIH National Institute on Drug Abuse

The numbers from individual cities are also staggering. In 2021, more than 1,200 people died from unintentional drug overdoses in Philadelphia alone, more than 1,400 died in Chicago, and more than 2,700 died in New York City. In Jefferson County, Kentucky, which includes Louisville, 2,250 people died of drug overdoses in 2021. And in Los Angeles County, some 1,500 people died from a fentanyl overdose that year.

This crisis demands action at all levels of government. Over the past ten years, PERF has issued several reports on the opioid crisis with guidance for local police agencies: New Challenges for Police: A Heroin Epidemic and Changing Attitudes Toward Marijuana in 2014; Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use in 2016; The Unprecedented Opioid Epidemic in 2017; and Policing on the Front Lines of the Opioid Crisis in 2021. The recommendations in those reports include:

  • Share information to track overdoses. Use ODMAP and other tools to track fatal and nonfatal overdoses. This information can be used to connect cases and flood resources into an area experiencing a spike in overdoses.
  • Develop close working partnerships with public health agencies, treatment providers, social service agencies, and prosecutors. Meet regularly with partners to discuss trends, develop strategies, and hold each other accountable.
  • Conduct strategic enforcement and prosecution. As part of that working partnership, identify enforcement and prosecution targets that are most likely to reduce the number of overdoses. Then work closely with prosecutors when taking enforcement action.
  • Equip officers with naloxone to reduce overdose deaths. Agencies should provide officers with naloxone, an easy-to-use medication that reverses the effects of opioid overdoses. This practice has become far more common over the past ten years.  
  • Educate the public about the dangers of opioids. The public needs to understand that fentanyl is far deadlier than previous drugs, and it may be found in drugs believed to be other substances, such as heroin, prescription opioids, and cocaine.
  • Provide avenues for treatment. Look for opportunities to connect people with treatment resources. Some agencies, such as the Gloucester, Massachusetts Police Department, have pledged to connect anyone who comes through their doors asking for help with a treatment provider. Other agencies, such as the Arlington, Massachusetts Police Department, reach out to drug dealers’ customers after taking enforcement action against the dealers. The Police Assisted Addiction and Recovery Initiative (PAARI) can provide interested agencies with more information about these types of programs.
  • Advocate for evidence-based treatment in jails. Jail can be an opportunity to help addicted people receive evidence-based addiction treatment, including medication-assisted treatment.
  • Support officers’ well-being. Today’s officers are responding to far more overdose scenes than officers did in the past. Be aware that these incidents can be traumatic, and provide officers with the resources and support they need to process this trauma.

There is an important role for local law enforcement. They see this problem up close on a daily basis, and sometimes their response can be the difference between someone living and dying. Police have saved countless lives by carrying naloxone. But this issue is about much more than just the police. This is a public health crisis that overlaps with countless other policy challenges, including border security, healthcare, and foreign relations. It requires a collaborative approach.

The Post details several areas where the federal government’s response has fallen short. One area is data collection, and that’s a complaint we’ve heard repeatedly during our meetings on this topic over the past ten years. Too often the information on overdoses is months old. As I mentioned above, local agencies should work with partners to track overdoses locally and regionally, but better federal data collection is needed to track and respond to the problem in a timely and cohesive manner. Police chiefs know that to fix today’s problems, you need yesterday’s data; information from six months or a year ago is useless.

Efforts to halt the smuggling of fentanyl into the country have also been largely unsuccessful. In 2019, Congress approved funding for more advanced scanning technology at ports of entry. According to the Post, the systems have been installed at several busy border crossings, but “they require officers to conduct labor-intensive reviews because the CBP lacks the ability to automate the process with artificial intelligence software and centralized command centers.”

To address the crisis, we first need the will to act—and act now. When I first came to Washington in the ‘80s, I worked as an assistant to the nation’s first “drug czar.” The country was awash in cocaine, which led to sharp increase in homicides and violence as well as a large number of fatal overdoses, though just a fraction of what we’re seeing today. The death of basketball star Len Bias captured the country’s attention and created a sense of urgency about this issue.

The national response to that crisis erred in significant ways. But the sense of outrage and the commitment to action from the federal government were useful. There has been a lot of hard work on this issue at the federal level over the past few years, including BJA’s Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) and DEA’s “One Pill Can Kill” campaign. But we need to further support that work and provide additional resources, because the crisis is receiving far less attention than it deserves, even though fatal overdoses are now far higher than they were in the ‘80s.

I want to challenge local, state, and federal public officials to prioritize the fentanyl crisis in the coming year. This issue understandably fell out of the spotlight amid a greater public health crisis, but it’s time we all began to focus on it. There will be no easy solutions, and we’ll need an organized, nationwide effort to bring down the number of deaths.

In particular, we need leadership from the very top. President Biden has extensive experience on these issues from his time on the Senate Judiciary Committee in the ‘80s and ‘90s, and he played a leading role in creating the position of federal drug czar. We need him to chart a new course, because the one we’re on now isn’t working.

Postscript: As I finalized this piece on Friday, I received a call from Attorney General Merrick Garland informing me of several major initiatives DOJ is announcing on drugs. He told me that he recently met with families who have lost loved ones to the fentanyl epidemic, which is devastating families across the country. One of the department’s top priorities, he said, is to go after the drug cartels that are flooding our streets with fentanyl.

That phone call is a hopeful sign that some of our government officials get it.