February 08, 2022

Credit: POLITICO, Phelim Kine

A government commission tasked with developing solutions to the U.S. synthetic opioid crisis called Tuesday for urgent action after warning that spiraling overdose deaths threaten U.S. “national security and economic well-being.”

The commission’s much-anticipated findings echo President Joe Biden’s Dec. 15 declaration that the trafficking of fentanyl and other synthetic opioids into the U.S. constituted a national emergency.

The Commission on Combating Synthetic Opioid Trafficking, convened in May 2020 to develop a “strategic approach to combating the flow of synthetic opioids into the United States,” called for a decisive shift in U.S. policy to reduce the rising numbers of synthetic opioid overdose deaths. The synthetic opioid fentanyl, a drug approved for pain treatment, killed more than 64,000 Americans from April 2020 to April 2021, according to the Centers for Disease Control and Prevention. A recent Stanford-Lancet study warned that the U.S. synthetic opioid overdose death toll could rise to 1.2 million by 2029.

The Commission’s report includes 76 recommendations that provide the Biden administration a blueprint to reduce the supply of illicit synthetic opioids produced and exported by Mexican drug cartels using Chinese-manufactured raw materials.

“In terms of loss of life and damage to the economy, illicit synthetic opioids have the effect of a slow-motion weapon of mass destruction in pill form,” the report said. “U.S. and Mexican efforts can disrupt the flow of synthetic opioids across U.S. borders, but real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs.”

The bulk of the illegal synthetic opioids that reach the U.S. are sourced in China by Mexico’s Sinaloa and Jalisco New Generation cartels. They buy from legitimate and illicit Chinese suppliers through “purchases made on the open market, smuggling chemicals hidden in legitimate commercial shipments,” the 2020 DEA National Drug Threat Assessment noted. The cartels then produce counterfeit versions of Oxycontin, Xanax, Valium and Adderall laced with dangerous amounts of synthetic opioid.

Successful bilateral cooperation in combating the fentanyl flow peaked in May 2019 when Chinese President Xi Jinping responded to U.S. pressure by making all forms of fentanyl subject to production controls and anti-trafficking measures. That prompted a drastic reduction in direct shipments of fentanyl and related compounds from China.

But Mexican cartels and their Chinese suppliers quickly pivoted to the export and processing of unregulated chemicals that can be processed into synthetic opioids. The Chinese government moved to block that trade in June by adding six fentanyl precursor chemicals to the list of substances requiring government approval. Chinese suppliers responded by marketing the unregulated raw materials for precursors.

“This all goes back to China,” said Rep. David Trone (D-Md.), the commission’s co-chair. “China needs to do things differently like enforcing their anti-money laundering laws, preventing Chinese chemical manufacturers from exporting these legal precursors to known trafficking operations in Mexico, regulating the industry itself and [regulating] appropriately the other synthetic opioids that are out there.”

The commission recommends the U.S. government leverage its diplomatic influence on countries that share synthetic opioid overdose problems as well as international organizations, including the United Nations Office on Drugs and Crime, to pressure the Chinese government to take those necessary steps. China’s incentive in complying would be to avoid being “perceived as a ‘narco state,’” the report notes. The Commission also calls for U.S.-China collaboration in monitoring accounts on China’s WeChat instant messaging platform “that are violating terms of service by advertising fentanyl precursors.”

The Chinese Embassy in Washington, D.C. did not respond to a request for comment.

The report included an action plan to bolster the capacity of the Mexican government to address the activities of Mexican cartels that control the production and export of illicit synthetic opioids into the U.S. Those measures include U.S. technical assistance to Mexican judiciary and financial regulatory authorities to help them identify and disrupt drug cartels’ money laundering activities, along with State Department and Department of Justice assistance in curtailing imports of machinery to produce counterfeit pills laced with synthetic opioids.

The commission also recommended U.S. support for the disruption of “synthesis labs and counterfeit pill operations” by Mexican military authorities.

But the power and influence of drug cartels in Mexico make that a tall order.

“All the good people we have cannot be effective without the full cooperation of the Mexican government which we do not have,” said Trone. “Cartels control 30-plus percent of the GDP in Mexico, which means they are immensely powerful and the [Mexican] government has adopted a policy of ‘hugs and not bullets’ and have decided to compromise and try to save lives in the country by not having an open civil war with the cartels who are heavily armed with sophisticated weaponry all purchased in the United States.”

Trone has backed focus on the synthetic opioid supply side of the overdose crisis with an amendment co-sponsored with Rep. Abigail Spanberger (D-Va.) that tasks the Biden administration to “gain a commitment from China and Latin American governments to combat the production and flow of illicit fentanyl.” That amendment was included in the version of the China-focused COMPETES Act that the House passed on Friday.

The commission’s recommendations also include proposals to reduce the demand for illicit opioids in the U.S. Among them: increased federal funding for mental health support services and a national public health campaign highlighting the dangers of counterfeit pills.

The Commission also wants a dramatic expansion of public access to harm-reduction tools, including distribution and availability of the opioid overdose reversal medication naloxone and fentanyl test strips that reveal the presence of the chemical in illicit street drugs. The Office of National Drug Control Policy is “working with a sense of urgency to remove barriers” to access those tools, ONDCP Director Rahul Gupta told POLITICO in a written statement.

“The opioid crisis is a mental health crisis interconnected with the criminal justice problem we have in America where we’re treating addiction as a crime, not as a disease,” said Trone. “The next step is how we move together to bring real change and save literally hundreds of thousands of lives over the next couple of decades.”

But substance abuse experts say that the Commission’s recommendations have a glaring omission of a strategy proven to reduce opioid overdose deaths.

“We must follow Canada’s lead and move to [the concept of] safe supply if we really care about saving lives because in the years it would take to even make a dent in the fentanyl supply problem, tens of thousands of people will die of easily preventable deaths,” said Sanho Tree, director of the Drug Policy Project at the Washington, D.C.-based Institute for Policy Studies. “Canadian doctors are allowed to prescribe pure pharmaceutical substitutes like Dilaudid which users can inject as an effective substitute for heroin … and not be forced to play fentanyl roulette on the streets.”