Those two drugs and other Fentanyl analogs are manufactured and trafficked illegally to underground networks in the United States or directly to individual users. China has become a key source of such illegal shipments. Contrary to President Trump's claim -- as part of his pitch for his "big, fat, beautiful wall" -- only a small proportion of such illicit opioid drugs, including heroin, are ever carried across the border into the United States by undocumented immigrants. The bulk of what enters through Mexico comes hidden in vehicles that cross at legal entry points. There are many other modes of smuggling as well. A Senate report found that the U.S. postal service has become an unwitting conduit, as have commercial carriers like FedEx and UPS. Illicit sellers also operate through Internet sites and the Dark Web. When it comes to such drugs, a wall will make no difference.
The opioid crisis has now entered an even more dangerous phase. Doctor-prescribed opioid pain killers are no longer its main driver, and even when they are, they're often combined with cocaine or benzodiazepines. Moreover, in 2016, illicit Fentanyl and heroin accounted for two-thirds of opioid-related deaths. Illicitly produced and trafficked Fentanyl and Carfentanil and their chemical kin may, in the end, dwarf the Oxycontin catastrophe.
And newer forms of high-potency painkillers will undoubtedly emerge as well. Take Dsuvia, which received FDA approval late in 2018 amid considerable controversy created by fears of addiction. It's 500 times stronger than morphine and 10 times as potent as Fentanyl. How long before Dsuvia produces its own addiction and illegal trafficking problem?
No Easy Fix
The opioid emergency requires a multi-faceted and sustained solution. Addiction treatment would have to become better in quality and more equitably available. Because opioid misuse and addiction are particularly prevalent in parts of the country suffering from job cuts and low incomes, they would have to become a focal point for public investment and job retraining. The shape-shifting inflow of opioids from abroad would have to be stanched through measures that went beyond punishment. Corporations that endanger public health through their negligence and chicanery would have to face more than a rap on the knuckles.
In addition, a political order rigged by money and lobbyists would have to be revamped. From 2000 through 2018, companies making pharmaceuticals and health products spent a total of $3.8 billion lobbying in Washington, employing 1,407 lobbyists, not a few of whom had once worked in various capacities in the federal government, including as members of Congress. In 2018 alone, the amount devoted to lobbying just by the pharmaceutical firms that were among the top ten spenders came to $58 million -- and that doesn't count the $21.8 million mustered by the Pharmaceutical Research and Manufacturers of America (PhRMA), which represents drug and biotech companies.
Given the scale, multiple causes, and consequences of the opioid crisis, the $6 billion earmarked for it isn't remotely sufficient, while the moves the Trump administration and the Republican Party have made to cripple the Affordable Care Act will only hurt the effort. Meanwhile, every day, 130 people in the United States die from opioid overdoses and 70% of those battling addiction don't receive long-term treatment, even though the necessary medicines are available.
So, Mr. President, if you want to tackle a genuine national emergency and are eager to spend another $5.7 billion or far more on a project that will, in the end, make you look better to everybody, including your base, take on the opioid epidemic -- and forget that useless wall.
Rajan Menon, a TomDispatch regular, is the Anne and Bernard Spitzer Professor of International Relations at the Powell School, City College of New York, and Senior Research Fellow at Columbia University's Saltzman Institute of War and Peace Studies. His latest book is The Conceit of Humanitarian Intervention.
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Copyright 2019 Rajan Menon