Nearly 87,000 Americans died from drug overdoses in the 12 months ending in September 2024, recent federal estimates show. A year earlier, the death toll was 114,000. In the fight against illegal opioids, that counts as progress—but it’s still a long way from victory. Overdose remains the leading cause of death for Americans between the ages of 18 and 44.
In 2022, a bipartisan commission on combating synthetic opioid trafficking released its final report, a point-by-point strategy to address the opioid crisis and reduce its death toll. The commission involved four sitting members of Congress, defense and homeland security officials, drug office directors, and nongovernmental experts. More than 80 RAND researchers, analysts, and associates provided support.
The commission’s report called for a “whole-of-nation” approach to combating the crisis. It provided 78 recommendations to make that happen. Most have not been implemented.
Overdose remains the leading cause of death for Americans between the ages of 18 and 44.
RAND senior international and defense researcher David Luckey helped lead the commission’s research and draft its report. He’s a retired Marine Corps officer with more than a decade of additional service in the federal government. “This really has become one of my life’s missions,” he said. “This issue is one that warrants all of our attention.”
Q: The Trump administration has called for a renewed effort to stop the flow of illegal opioids over U.S. borders. What lessons did you take from the commission’s work that could inform that effort?
A: The commission provided more than three dozen recommendations to better combat opioid trafficking by reducing the supply and improving international cooperation. For example, it called for a stronger partnership with Mexico that would focus on intelligence and information sharing to combat drug traffickers. It also recommended trying to work with China to reduce sales of synthetic opioids and precursor chemicals, even recognizing that relations with China are difficult right now. But the United States also should be working with countries like India that might step in to fill the void if China does reduce its production. It should be working with express consignment carriers in the United States to provide greater screening of inbound packages, as well as with social media platforms to prevent online sales of fentanyl.
Q: The commission’s report came out three years ago. How do the recommendations apply to the present moment?
A: These recommendations remain just as relevant and important for consideration. Don’t forget, they had bipartisan support from members of both chambers of Congress. They had the support of cabinet-level officials. They were analyzed and considered and discussed and debated. If we’re serious about this problem, if we want to reduce all the deaths and harm, then these recommendations are a starting point. We should be putting resources and effort into achieving them.
Q: The commission called for a “whole-of-nation” effort. What would that look like?
A: It would have three main lines of effort: reducing the supply of illegal opioids coming into the country; reducing the demand for illegal opioids from users in the United States; and reducing the harms associated with opioid use. It would require international cooperation. It would require better coordination throughout the nation, from the federal level to local law enforcement. It would involve social media companies and express consignment carriers. This is a pervasive problem. It affects all elements of our society. It’s a health problem, a law enforcement problem, a national security problem. No single action is going to solve it.
This is a pervasive problem. It affects all elements of our society. It’s a health problem, a law enforcement problem, a national security problem. No single action is going to solve it.
Q: As you were working on the commission’s report, did any one fact or experience stand out to you as illustrative of the challenge here?
A: Two of the commissioners lost family members to fentanyl, a son and a nephew. Their efforts on the commission were motivated by wanting to prevent others from experiencing that pain. That really drove the work of the entire commission. RAND recently completed a study that found that more than 40 percent of Americans know someone who died of a drug overdose. People are losing their lives. People are losing their sons and daughters and coworkers and friends. The commission understood this and approached its work as if our own family members were at stake. The loss of life is horrific. The actual fiscal costs are huge. This is not just a drug problem. It affects all of us.
