WASHINGTON — So many pills sold online contain potentially fatal amounts of fentanyl that buyers would face better odds playing Russian roulette, National Drug Control Policy Director Dr. Rahul Gupta said during an Aug. 31 White House event with families who have lost loved ones to overdoses.
About 50 family members from all over the country sat at half a dozen tables, framed photos of the people they lost positioned in front of them.
Gupta spoke about watching one of his patients struggle with addiction and die.
“I want you to know that in so many cases, for a lot of you also, it was out of your control,” Gupta told them.
President Joe Biden in February’s State of the Union address bragged about the seizure of 23,000 pounds of fentanyl in the preceding months and called for a “major surge” against fentanyl, with more detection machines at the border and tougher penalties for traffickers.
In addition to disrupting the fentanyl supply chain, he has sought to bolster treatment resources and promote public awareness campaigns to alert young people to the danger lurking in pills not prescribed by a doctor.
He faces criticism from Republicans who say he should do more to secure the entire border to help cut off the flow of drugs, while some policy experts say focusing on supply is misguided.
Capitol Hill lawmakers have authored a laundry list of fentanyl-related proposals but most are sitting in committee.
In the meantime, more people are dying.
Gupta said in an interview to The Dallas Morning News last month that the administration’s efforts have shown progress in the form of massive fentanyl seizures and a “flattening” in the rate of fatal drug overdoses.
Driven by fentanyl, drug overdose deaths have risen dramatically for years.
The most recent Centers for Disease Control and Prevention statistics show nearly 107,000 overdose deaths in 2021, a fivefold increase from 2001. About two-thirds of those were attributed to synthetic opioids such as fentanyl, including 1,858 in Texas.
That trendline has leveled off somewhat according to provisional CDC numbers that predict 110,469 drug overdose deaths between March 2022 and March 2023, but that number remains staggeringly high.
Biden has adopted a “commercial disruption” approach that involves identifying the fentanyl supply chain and targeting choke points, including the supply of precursor chemicals used to produce fentanyl, Gupta said.
Those chemicals typically flow to Mexico from China and have legitimate industrial uses, which complicates efforts to cut them off.
The administration has sanctioned more than 170 individuals involved in fentanyl trafficking since Biden took office, many of them members of the Mexican cartels that supply most of the fentanyl flowing into the United States.
Sanctions are intended to block those on the receiving end from conducting business. Americans face civil or criminal penalties if they engage in any transactions with sanctioned individuals.
About 76% of those sanctions have been placed on members of the Sinaloa Cartel and the Jalisco New Generation Cartel, major fentanyl suppliers, and their global networks, according to the White House.
The administration has expanded the High Intensity Drug Trafficking Area program through which federal, state and local authorities coordinate anti-trafficking efforts that seek to secure large busts.
Government officials say increased use of detection technology at ports of entry has helped enable historic fentanyl seizures at the border.
While headlines on seizures typically cite the amount or how many fatal doses were involved, the dollar value of the product seized is also important.
“We denied $22 billion to traffickers by interdiction,” Gupta said. “So we cannot ignore the fact that when we disrupt their business, it hurts them. It makes it more difficult for them to do their business. So that’s the angle we’re taking. We’re going after not just the pills, the production, the supply chain, but also their profits.”
The White House has organized meetings with foreign leaders to coordinate the international response. It has increased access to nasal sprays that can counteract overdoses and designated fentanyl mixed with Xylazine as a national emerging threat.
Xylazine is a powerful sedative approved for veterinary use. Also known by the name “Tranq,” the DEA has warned it is increasingly being mixed with fentanyl.
What Republicans say
For many Republicans, the fentanyl epidemic has become politically synonymous with illegal immigration and border security.
Texas Republicans in Congress have placed much of the blame for the crisis on Biden’s border policies and they disagree on the viewpoint that large drug seizures are encouraging signs.
Freshman Rep. Monica De La Cruz, R-McAllen, who represents a South Texas swing district, said repeatedly in an interview last month with The News that the key to addressing fentanyl is securing the border. Massive fentanyl seizures reflect the hard work of federal law enforcement agencies, she said, but they demonstrate a policy failure rather than any success by the Biden administration.
“When we start securing our border we’re going to see that the Border Patrol agents are not going to be seizing the historic amounts that they’re seizing right now,” she said.
Rep. Keith Self of Texas highlighted a Republican bill that would use any assets seized from drug traffickers to pay for physical barriers along the Southwest border and for grants to organizations fighting fentanyl.
Self and other Texas Republicans also have co-sponsored legislation to reduce the quantity thresholds that trigger a mandatory minimum prison term for trafficking fentanyl.
“The increasing amounts of fentanyl being seized are indicative of the fact that more fentanyl is pouring across our open border, not less,” Self said in a statement.
Gupta said he’s visited the border multiple times. The fact that fentanyl is overwhelmingly seized at official ports of entry, typically in vehicles driven by U.S. citizens, is evidence that’s how most of it enters the country, he said.
Critics have questioned that conclusion by suggesting fentanyl could be pouring through less secure areas of the border undetected.
“While our Border Patrol agents are working day in and day out to seize these drugs and save American lives, they estimate only 5 to 10% of fentanyl is caught before it enters our nation,” said Rep. Michael McCaul, chairman of the House Foreign Affairs Committee.
Gupta said it makes sense for traffickers to go through ports of entry because that allows them to maximize their profits by transporting large quantities in the most efficient way possible rather than carrying smaller quantities across rugged terrain.
The White House asked Congress for another $800 million in August to combat fentanyl, a request that includes funding for more drug-detecting machines at the border.
“The president and this administration is not going to give up on seizing drugs in a way that’s historic and is saving American lives,” Gupta said.
The House passed bipartisan legislation, supported by the White House, that would permanently place fentanyl-related substances in the most restricted classification under the Controlled Substances Act.
Critics see such proposals, along with tough talk about seizures and tougher penalties, as just the latest chapter in an ineffective war on drugs.
“The supply reduction focus is misguided and more political theater than anything else,” said Sanho Tree, director of the Drug Policy Project at the Institute for Policy Studies.
Seizures are an important data point reflecting how drugs are coming into the country, Rep. Veronica Escobar, an El Paso Democrat, said in an interview, but she acknowledged it’s unclear exactly how much fentanyl is crossing between the ports of entry.
Escobar said she’s seen data that shows few of those who seek to evade detection by the Border Patrol have drugs on them when captured.
“We have to figure out how to measure success and address the challenge on the supply side but we are absolutely neglecting the demand side as a country,” Escobar said. “As long as there’s a demand for these drugs, the drug traffickers are creative, innovative and entrepreneurial enough to figure out a way to get it in.”
She cited bipartisan legislation she’s introduced that aims both to bolster resources at land ports of entry and start to fix the immigration system.
“The cartels and the drug traffickers are highly sophisticated, highly motivated and very innovative. They adapt to anything and everything,” she said. “We can’t … fool ourselves into believing that if we build high enough walls and militarize the border enough, that that will solve it.”
A host of acronym-laden proposals have been introduced in Congress this year in response to the fentanyl epidemic.
The Halt All Lethal Trafficking of Fentanyl Act, supported by the White House, passed the House 289-133 but has yet to be taken up by the Senate.
Nearly all Republicans voted for the measure along with 74 Democrats. The bill would place fentanyl-related substances on Schedule 1, the most restricted classification under the Controlled Substances Act.
Supporters see that as a way of cracking down but critics say it could hamper research and treatment options.
Among Texas Democrats, only Reps. Vicente Gonzalez of McAllen and Henry Cuellar of Laredo supported it.
Treatment vs. interdiction
Some drug policy experts view publicizing seizures as an important message to drug trafficking organizations. Their profits come at a high price, and authorities are keeping drugs off the street that would otherwise be poisoning Americans.
“Supply matters,” said Uttam Dhillon, who served as acting administrator of the U.S. Drug Enforcement Administration from 2018 to 2020. “Enforcement is a critical part of reducing drug overdose deaths.”
The principle that “supply creates demand” was illustrated when communities flooded with prescription opioids saw more people become addicted and then overdose, he said.
Compared to marijuana or even cocaine, small amounts of fentanyl are so potent it’s far easier to hide and smuggle.
Advances in anti-trafficking technology at ports of entry are encouraging, Dhillon said, but Biden has failed to aggressively deploy technology and physical barriers as a way to secure the rest of the border.
“Can you solve this problem? You can mitigate this problem significantly by increasing border security,” he said.
Dhillon also has criticized Biden’s DEA for not issuing an updated version of its National Drug Threat Assessment since early 2021. Congress should demand real-time tracking and response to an assortment of metrics, he said — the most important of which is how many people are dying.
“You can look at all the performance measures in the world but the only one that matters is drug overdose deaths,” he said. “That number has to go down. It is the only real measure of progress.”
Katharine Harris, a fellow in drug policy at Rice University, also views overdoses as the most important measure of progress. She warned against an overemphasis on interdiction without working to reduce demand.
“They can go ahead and do the large seizures and all of that but we need to recognize that that is never going to be enough … We have a demand for drugs here,” Harris said.
“That is what we need to be addressing and all the supply-side measures you want aren’t going to address that. And we have decades of drug war policies as evidence that that’s the case.”
Tree, the drug policy expert, described Biden as a long-time drug war proponent, citing his support for enhanced drug crime penalties during his time as a senator.
He suggested the rise of highly-potent fentanyl has come in part as a response to the fight against drugs and compared it to the country’s experiment with banning alcohol a century ago. He said prohibition turned a nation of beer and wine drinkers into consumers of hard liquor because that was the most economically efficient way for bootleggers to deliver intoxicants.
Fentanyl is now so cheap and easy to produce that it has supplanted other drugs such as heroin.
“Fentanyl has won the war on drugs,” he said. “People are yearning for the ‘good old days’ of heroin. They want heroin. They can’t find it.”
Harris said there remains too little access to treatment medications such as methadone and buprenorphine that can help people who have become addicted.
The federal government’s primary focus thus far has been to provide funding to state and local governments.
“It has helped,” Harris said. “We’ve seen a lot of effort toward, for example, increasing providers who can treat people for addiction but we’re still not seeing the level of medication-assisted treatment… access that we need to be seeing right now.”
And she warned even more powerful synthetic drugs are on the horizon.
“This is just the beginning,” she said.
Bills in Congress
Here are a few of the bipartisan fentanyl-related bills backed by Texas members of Congress:
- Rep. Monica De La Cruz, R-McAllen, who serves on the House Financial Services Committee, has sponsored a bill that passed the House 402-2 that would direct the Government Accountability Office to study the finances of criminal cartels trafficking fentanyl. The bill is awaiting action in the Senate.
- Sen. John Cornyn, R-Texas, has introduced the same measure in the Senate, along with other proposals such as a bill that would increase access to fentanyl test strips and another one that would expand access to overdose reversal agents. The Senate also included in its annual defense policy bill a Cornyn proposal to allow the Defense Department to train the Mexican military to combat drug cartels there.
- The Senate approved legislation from Sen. Ted Cruz, R-Texas, intended to bolster understanding of the increasingly prevalent Xylazine.
- Rep. Beth Van Duyne, R-Irving, supports legislation that would sanction Chinese manufacturers of synthetic opioids. That bill has passed the House and is in committee in the Senate.
- Rep. Tony Gonzales, R-San Antonio, has supported bills that include a bipartisan proposal to permanently place fentanyl-related substances on the most restricted schedule for drugs. That bill is in committee.
- Rep. Michael McCaul, R-Austin, chairman of the House Foreign Affairs Committee, has bipartisan legislation that would declare international fentanyl trafficking a national emergency and direct the Treasury Department to target, sanction and block the financial assets of transnational criminal organizations and key members of drug cartels involved in international fentanyl trafficking. That bill is in committee.
- Rep. Colin Allred, D-Dallas, has co-sponsored legislation intended to bolster data collection and improve treatment access for prisoners. Another bill he backs would provide grants to stock naloxone in elementary and secondary schools, both public and private, and train school staff on preventing overdoses. Those bills are in committee.
- Rep. Jasmine Crockett, D-Dallas, and Rep. Lance Gooden, R-Terrell, introduced a bill that would expand access to fentanyl test strips, which are still criminalized as drug paraphernalia in many states, including Texas. Such strips help drug users avoid inadvertent overdose from pills laced with the low-cost killer. The bill is in committee.
- Rep. August Pfluger, R-San Angelo, is the lead Republican co-sponsor of the Combating Illicit Xylazine Act to schedule the highly dangerous sedative. That bill is in committee.
