There is no simple way to end the overdose crisis in America. The policy decisions and societal factors that led to the five-fold increase in overdose deaths since the turn of the century are many and complex, and so are the solutions. If we want to turn the tide on the overdose epidemic, it is imperative that we learn from our past mistakes and craft evidence-based and public health focused drug policies that meaningfully address the root causes of addiction and the growing instability and potency of our nation’s illicit drug supply.
The HALT Fentanyl Act, which was recently signed into law by President Trump after receiving broad bipartisan support in Congress, does none of those things. The bill, which permanently classifies all fentanyl related substances in the most restrictive drug classification category (Schedule I), has been pitched by its proponents as a “commonsense bill” that provides law enforcement with the “the full suite of tools they need” to tackle the overdose crisis and “keep these poisons out of our communities.” These are fine sentiments, but unfortunately they do not align with the history of our nation’s war on drugs or even the track record of the policy itself.
What the members of Congress who support the HALT Fentanyl Act invariably fail to mention when describing the lofty results they expect the bill to achieve is the fact that the policy has already been in effect on a temporary basis since 2018. During that time—a time when the Drug Enforcement Administration continuously had all illicit fentanyl related substances not already regulated by the Controlled Substances Act placed into Schedule I—overdose deaths in the United States skyrocketed from 67,367 deaths in 2018 to 107,941 in 2022. Surely, if the automatic scheduling of all fentanyl related substances truly rid our communities of new variants of these illicit opioids, the result wouldn’t have been a 40,000 person increase in overdose deaths.
In practice, this legislation is doubling down on the failed, punitive approaches of the war on drugs with no acknowledgement of the fact that the policies it promotes have already been tried many times over without success. The HALT Fentanyl Act will enshrine mandatory minimum penalties for the possession of fentanyl related substances that have proven to be ineffective at deterring crime and deterring drug use while also disproportionately impacting Black and Brown communities. It will also place all fentanyl related substances on Schedule I regardless of whether or not the substance in question is actually harmful to people, potentially imprisoning people for possession of a harmless substance.
For more than 50 years, US drug policy has been built upon the idea that it was possible for the federal government and law enforcement to reduce the general public’s accessibility to illicit substances and, by extension, reduce the frequency and risk of illicit drug use through the increased criminalization of those substances and the people who sold and used them. In recent years increased emphasis has been placed at times on a public health approach to addressing drug use that often emphasizes evidence-based prevention, treatment, recovery, and even harm reduction interventions, but we never broke free from the belief that, in certain circumstances, we could arrest our way out of this crisis.
Since the beginning of the overdose crisis, multiple presidential administrations and Congresses have done their best to halt and disrupt illicit drug markets, often with good intentions. And, with each new punitive regulation or massive investment in law enforcement, all they have succeeded in doing is taking an already dangerous illicit drug supply and supercharging it into the rapidly changing, unpredictable and hyper-deadly illicit drug supply that we have now.
Just as the prohibition of alcohol in the 1920s led to beer and wine being replaced by moonshine and bathtub gin, the federal government’s supply-side crackdowns on prescription opioids led to a massive influx of heroin into the illicit drug market. When attempts to seize heroin proved successful enough to meaningfully eat into the profit margins of those who trafficked it, it was replaced by fentanyl and fentanyl related substances, which were easier to transport and cheaper to produce. And, when fentanyl came to dominate the opioid supply in the United States, drug sellers began mixing the drug with adulterants like xylazine and medetomidine to mimic the type and duration of the high produced by those drugs, with devastating unintended consequences.
We cannot predict what illicit substance would replace fentanyl related substances if the HALT Fentanyl Act winds up succeeding in getting fentanyl related substances out of the illicit drug supply. But, we can unequivocally say that if fentanyl related substances are taken off the streets, they will be replaced by a different illicit drug and there’s a decent chance it winds up being a deadlier, more dangerous drug than the one we just got rid of. And, while all of this is going on, our nation’s prison system will continue to grow, further filling with disproportionately Black and Brown low-level drug sellers and people living with substance use disorder who have had their lives destroyed and families torn apart in the name of a drug war we never had a hope of winning.
The truth is that we cannot end the overdose epidemic without simultaneously addressing both the root causes of addiction and the variety of factors that lead to an unsafe and dangerous drug supply. Ending the overdose epidemic also means addressing housing instability and economic inequality. It requires significant increases in mental and physical health care access, and reductions in racial health inequities and a wide variety of stigmas. And it calls for a massive shift in our criminal justice and policing systems that allow us to keep our communities safe while also dismantling carceral systems that destroy the lives of people who use drugs and their families without meaningfully impacting drug use patterns.