Fatal drug overdoses—primarily from illegally manufactured synthetic opioids—have increased sharply in recent years. And they’re not slowing down. Potent and dangerous synthetic opioids affect a wide range of policy areas and require a comprehensive response. It’s time to meet this everything problem where it is: everywhere.
Arnold Alier has been a paramedic since 1987. The past two years put a strain on first responders that he had never seen in all his time rushing from emergency to emergency.
“We had the pandemic with COVID, and then we had this shadow that kept following us the entire time,” he said.
That phantom stalking Alier—and paramedics across the United States—was an ever-growing number of overdoses from opioids. In recent years, the numbers of overdoses from illegally manufactured synthetic opioids has jumped.
As a leader at the South Carolina Department of Health and Environmental Control, Alier is working to stem this rising tide of deaths. He uses deidentified data from emergency medical services to zero in on overdose hotspots. It’s part of a state program that helps first responders better target vulnerable areas. Alier continued to track the increasing fatalities from opioid-related overdoses even as he shifted gears to help paramedics and emergency medical technicians respond to a once-in-a-century pandemic.
“Despite all our efforts, the numbers continue to increase,” said Alier. “It especially got worse during the pandemic, just like we have seen nationwide.”
Between June 2020 and May 2021, more than 100,000 Americans died from a drug overdose. This is more than twice the number of deaths from motor vehicle accidents or gun violence in that same period. About two-thirds of those fatal overdoses involved illegally produced synthetic opioids. The main culprit is fentanyl, which is easy to produce, highly potent, and—when used outside of health care settings—potentially deadly.
“More people have died from overdoses in this country in the last two decades than the combined number of Americans who have died in combat operations in every war America has taken part in,” said David Luckey, a senior international and defense researcher at RAND. “If that’s not a reason to bring people together to come up with ideas on how to resolve this problem, I don’t know what is.”
Luckey and Bryce Pardo, policy researcher and an associate director of the RAND Drug Policy Research Center, were given an opportunity to do just that by serving on the staff of the Commission on Combating Synthetic Opioid Trafficking. The commission was created by Congress to examine the threat of synthetic opioids and devise a strategic approach to countering the illegal flow of these drugs into the United States.
The commission, a bipartisan group of senators and representatives, executive branch members, and subject-matter experts, released its final report after conducting scores of interviews, receiving dozens of briefings, and analyzing data on drug use and supply. The Homeland Security Operational Analysis Center, operated by RAND, supported the commission with research and analysis.
In a letter in the commission’s final report, co-chairs Senator Tom Cotton and Congressman David Trone emphasized the need for new ways to decrease demand for synthetic opioids and reduce overdose deaths.
“These alarming statistics are more than just numbers on a page; they represent devastating losses to families and communities, including personal losses to members of this very commission,” wrote Cotton and Trone.
Whether measured in lives or in dollars, the effect of America’s overdose crisis “should shock everyone,” the commission’s report reads. “It is unacceptable.”
What Makes Synthetic Opioids Different?
The properties of some synthetic opioids make them ideal for illegal suppliers. And the sudden shift toward illegally manufactured fentanyl in recent years has contributed to deadly results among those who use drugs.
Unlike heroin, which comes from poppy fields that need time and space to mature for harvest, synthetic opioids can be made quickly, indoors, and with chemicals that can be easy to acquire.
“You only need one guy and access to precursor chemicals to manufacture it in a couple days. So, from a production standpoint, fentanyl is much, much, much cheaper, and it’s easier to conceal,” said Pardo. “The dealers and traffickers are seeing the economic benefits of moving away from heroin and toward fentanyl. This is likely to set us up for a long-term transition toward fentanyl.”
Many synthetic opioids are also much more potent than heroin and other drugs. As little as one or two milligrams of fentanyl can be enough to achieve the same effect as 30 to 50 milligrams of heroin.
“Very little is needed to elicit a desired effect. That means it’s very hard to dose accurately. The margins of error are much smaller,” said Pardo. “If you’re off by a couple milligrams with heroin, it’s not a big deal, right? If you’re off by a few milligrams with fentanyl, it could put you into a grave.”