The White House recognizes the problem but is trying to solve it with yesterday’s methods.
The White House recognizes the problem but is trying to solve it with yesterday’s methods.
L ast week, after two Ohio State students perished of suspected drug overdoses, the university alerted students to “fake Adderall pills” circulating on campus that appear to contain the synthetic opioid fentanyl. Importantly, these deaths come on the heels of new provisional data from the Centers for Disease Control and Prevention indicating that the number of predicted overdose deaths in 2021 surpassed 107,000, a new record.
Unfortunately, a National Drug Control Strategy (NDCS) released by the Biden administration in April leaves little room for optimism. The document has major shortcomings that undermine its ability to defeat the deadly threat of illicit drugs. While the NDCS acknowledges the recent spike in deaths from overdoses, it does not pivot resources, nor enforcement and management efforts, toward cutting the supply of those drugs most responsible for the higher death toll: illicitly produced synthetic opioids, like the fentanyl apparently present in the fake Adderall plaguing Ohio State.
Such drugs, especially illicitly manufactured fentanyl and related substances called fentanyl analogues, can be produced without any derivatives of opium poppy plants and yet are very potent; fentanyl is roughly 50 times stronger than morphine. Importantly, fentanyl and related drugs are also cheap to produce. They’re so cheap that they are added to other illicit drugs — such as the fake Adderall, which many students seek as a study aid — to boost their effects, sometimes with unanticipated or even deadly consequences.
The White House recognizes the threat of synthetic opioids, having noted in April 2021 that “the availability of drugs with historically high purity and low price, along with the increased lethality of synthetic opioids, helps drive the overdose and addiction epidemic.” Missing from its new strategy, however, are any commitments to cut the supply of such deadly drugs by specific amounts by prescribed dates.
Worse, the NDCS provides no data on the purity-adjusted amounts of fentanyl and fentanyl analogues seized recently, nor does it present data on the black-market prices of such drugs. Data on purity-adjusted seizures and on changes in black-market prices are reasonable proxies for the effectiveness of efforts to cut supply. Higher prices reduce use, especially among people not yet addicted. Unfortunately, not only does the NDCS not present data on purity-adjusted seizures or prices of fentanyl and its analogues, but it also makes no commitment to report such data in the future.
A report accompanying the NDCS presents the strategy’s goal No. 7, stating “the supply of illicit substances into the United States is reduced,” which it supports with management objectives involving sundry law-enforcement activities. These performance objectives, however, are not even indirect measures of reductions in supply. Thus there is little reason for confidence that the NDCS will be effective in reducing the supply of the illicit drugs most responsible for the recent jump in overdose deaths.
Further, while the NDCS purports to use a data-driven approach to limit the harm from illicit drugs, it does not take advantage of new technologies to better track and manage increases in drug usage. For example, the most relevant data for the U.S. on prevalence of drug usage is from the National Survey of Drug Use and Health for 2020, showing the prevalence of self-reported misuse of opioids. Self-reported data on illicit drug use is dubious because of underreporting driven by stigma, which may differ by type of drug.
Instead, new methods of detecting illicit drug use by testing sewage water could benefit both public health and law enforcement. A 2019 study showed that wastewater-based testing for opioids including fentanyl could forecast overdoses and deaths. The National Institutes of Health also reported a year ago that human opioid exposure can be measured through wastewater. Canada successfully used new techniques to analyze occurrence of fentanyl in sewage and found that fentanyl levels were much higher in early 2020 than in early 2019 for several major Canadian cities. By contrast, the CDC recently reported that it sees sewage epidemiology tracking of fentanyl usage as something not for “immediate use” but rather to consider “down the road.” The White House could help re-establish U.S. technological leadership in fighting illicit drugs by having the CDC launch immediately a major program to develop and apply sewage epidemiology to provide real-time data on use of fentanyl and other opioids.
The White House should update the NDCS to include performance metrics that will clearly reflect reductions in supply of the deadliest illicit drugs, such as fentanyl and its analogues. The NDCS should include commitments to compile, and timely report to the public, data on purity-adjusted seizures and black-market prices of opioids, especially fentanyl and related substances. Finally, the White House needs to take full advantage of new real-time data-collection technologies, so as to reduce reliance on 20th-century methods based on self-reports of drug use.