Earlier this week, the New York Times published a stunning photo essay with a curious title: as Barbara Kingsolver eloquently but puzzlingly details, “In Appalachia, the Opioid Crisis Never Ended.“ While Kingsolver and photographer Tamara Reynolds deftly recount the heartbreaking ways children can inherit either opioid addiction itself or its collateral consequences, the most newsworthy part of the piece is that an editor at the paper of record could believe the crisis had ended.
While we made significant progress in the first half of the decade, the idea that the opioid crisis had ended is shockingly ill-informed. The most recent year of full data (2023) shows that drug overdose deaths were still 10 times higher than in 1999, with opioids accounting for about 76% of those.
Of course, the best sign that the opioid crisis hadn’t ended is that Donald Trump continues to believe it’s useful.
When You Don’t Believe in Public Health, the Opioid Crisis is Anything but a Public Health Problem
I’ve written multiple times about the unique problems the opioid crisis poses for Republicans:
Past addiction crises were easy for the conservative movement. As the right increasingly shifted towards a view of public spending as solely a means of caging and killing people, dismissing drug epidemics as moral failings or symptoms of inherently defective communities took trivial effort when those communities were never (crack cocaine) or always (meth) going to vote for Republicans anyway. Opioids, however, cut too wide a swath of the populace for that; blaming addiction on moral failings or community culture probably doesn’t sit too well with vital middle-class voters as they’re burying their sons, daughters and neighbors. The old saws won’t work, but a party that fundamentally believes in public spending only to cage and kill people designedly cannot afford to treat it any other way.
The solution to this dilemma so far has been to turn fentanyl trafficking into a bogeyman to throw violence at. While a limited number of US manufacturers make fentanyl for its legitimate medical uses, the majority of illicit fentanyl is imported; War on Drugs messaging could simply be folded into existing anti-immigration sentiment. (As the previous paragraph’s source demonstrates, Trump even found a way to shoehorn it into his favorite economic tool.)
Then this fall, Trump suggested that his campaign of Venezuelan boat strikes—both potential war crimes and potential regular-type crimes—was justified by the “25,000 lives“ each strike would save by dumping “fentanyl all over the ocean.“ The math is impossibly hyperbolic (that’s 3% of all overdose deaths, each) even before you consider that Venezuela isn’t a major player in the US drug trade, and their “contribution“ is a trickle of cocaine from neighboring Colombia (which is closer to the US anyway). Now, with war on the horizon, Trump has pivoted to Venezuelan oil.
On the home front, Trump has turned the overdose fight over to an old unreliable—mass incarceration. The bipartisan HALT Fentanyl Act moves several fentanyl derivatives permanently into Schedule I, the most punitive category of substances under the Controlled Substances Act. He followed this up with a bizarre executive order designating fentanyl a “weapon of mass destruction,” proclaiming that:
Illicit fentanyl is closer to a chemical weapon than a narcotic. Two milligrams, an almost undetectable trace amount equivalent to 10 to 15 grains of table salt, constitutes a lethal dose.
Toxicologically, this statement is iffy at best. Trump isn’t wrong that two milligrams of death would kill anyone reading this, but the order neglects to mention that fentanyl is dosed in micrograms, or one-thousandth of a milligram—the amount he’s suggesting is 20 times a typical fentanyl dose. (The idea that 2mg would be “an almost undetectable trace amount“ comes entirely out of left field; commercially available test strips easily detect one-millionth of that amount per millileter.) What it means legally is far from clear, but the general understanding should be familiar: the administration expects that just one more round of enhancing state violence will finally solve the drug problem this time.
As State-Sanctioned Drug Violence Gains Steam, What Actually Works Gets Left Behind
Amid all the talk about the same drug policy that’s been failing since Richard Nixon’s presidency, you’d be forgiven for not knowing of another strategy with surprising results. Harm reduction, “an umbrella term for interventions aiming to reduce the problematic effects of behaviors,” aims to decrease the safety risks from drug use rather than punishing it directly, with programs like naloxone access, fentanyl detection strips and safe needle supply drops. While harm reduction isn’t new, it’s faced decades of stigma, struggling for funding and deployment opportunities against a perception that it would “facilitate illegal drug use.“ Despite this, a solid evidence base suggests that harm reduction results in both fewer deaths and better recovery rates.
If you’re wondering how the Trump administration felt about this evidence: the quote about “facilitat[ing] illegal drug use” is from a new executive order banning federal substance abuse grants from funding harm reduction efforts. The agency administering those grants, the Substance Abuse and Mental Health Services Administration, lost half its staff in the early-term federal employment cuts, and the new HHS general counsel has pushed to ban medication-assisted treatment, which treats opioid addiction with medications that ease dopesickness.
For those who think the only purpose of government is violence on the outgroup, harm reduction is an inconvenient solution to a convenient problem.
