Sep 11, 2023 - Health

The politicization of the fentanyl crisis

Illustration of a large blue pill looming over a small podium

Photo illustration: Axios Visuals

The country's fentanyl crisis has become a potent political weapon, reflecting its deep and emotional impact on millions of Americans.

Why it matters: The opioid epidemic was once a rare topic that brought Republicans and Democrats together. But even as overdose deaths continue to climb, the discourse around fentanyl has become more politicized and, at times, less aligned with reality — especially when Republicans talk about its connection to the U.S.-Mexico border.

  • "When it gets to the front page, sometimes the incentives can be to use it more as a partisan weapon," said Keith Humphreys, a professor of psychiatry and behavioral services at Stanford.
  • But also, "there is a human part. Everyone's upset. We have all these dead bodies. People are burying their children and communities are getting destroyed."

Driving the news: The White House last week issued a memo outlining the stakes of the government funding debate, zeroing in on "life and death priorities like fighting the fentanyl crisis" and insisting that "House Republicans have a pressing choice to make."

  • House Republicans' border oversight hearings have regularly invoked the smuggling of fentanyl across the U.S.-Mexico border alongside migration issues.
  • And fentanyl repeatedly came up during the first GOP presidential debate, with at least one candidate calling for military involvement against Mexican cartels.
  • "When these drug pushers are bringing fentanyl across the border, that's going to be the last thing they do. We're going to use force and we're going to leave them stone-cold dead," Florida Gov. Ron DeSantis said.

The big picture: As the opioid epidemic has grown and evolved, so has its role in American politics.

  • What started as prescription drug abuse has become increasingly deadly as heroin replaced prescription opioids as the drug at the heart of the crisis, and then itself was replaced by synthetic fentanyl.
  • The epidemic has once again taken a turn as fentanyl is increasingly mixed with xylazine, a powerful sedative approved for veterinary use that undermines the effectiveness of opioid overdose treatments.
  • Fentanyl contamination of other drugs is also rising, leading to overdose deaths among people who may not have even known they were using fentanyl.

State of play: Once a relatively consensus issue, fentanyl now plays a leading part in some of America's most contentious political conversations.

  • And while much of the discussion and legislation regarding the epidemic at the federal level was previously focused on prevention and treatment, the focus has increasingly been on how to reduce the supply of fentanyl — which has meant highly charged conversations about the border, international relations and law enforcement.
  • One House Republican aide who has been working on the opioid issue for years said the shift is partially because of how the epidemic has changed. The rise of overdoses among people who don't even know they're consuming fentanyl, for example, is a different problem than addressing opioid use disorder.

Between the lines: Americans' exposure to the epidemic has also spiked.

  • Now, 29% of Americans say they or someone in their family have ever been addicted to opioids, per KFF polling. One-third said they're worried someone in their family will overdose on opioids, and 39% said they're worried someone in their family will unintentionally consume fentanyl.
  • In 2021, nearly 107,000 Americans died from a drug overdose, and three-quarters of those deaths involved opioids, per the CDC.

Yes, but: Prominent Republicans have conflated the flow of illicit fentanyl from Mexico across the U.S. border with the country's migration crisis, which experts say is inaccurate.

  • Although the majority of the U.S. fentanyl supply comes from Mexico, which makes it clearly an issue tied to the border, the vast majority enters the country through legal ports of entry.
  • "If illegal immigration disappeared tomorrow, the fentanyl supply would be unaffected," Humphreys said.

And Republicans' claims that Biden's "open border" policies have empowered cartels are "not at all correct. There has been no weakening of security at the U.S. border since the Biden administration came in," said Vanda Felbab-Brown, a senior fellow at the Brookings Institution.

  • "The opposite, the Biden administration has authorized money to significantly increase inspections of personal and cargo vehicles at that border, the principal mechanism by which drugs are smuggled across the U.S.-Mexico land border," she added.
  • But Felbab-Brown criticized the administration's approach to inducing cooperation from the Mexican government.
  • "It's time to get tough," she said. "That doesn't entail bombing a bunch of lives in the mountains of Sinaloa, but I would be very willing to get quite tough at the border."
  • Humphreys, on the other hand, said that in the age of synthetic opioids, "I don't think you can stop fentanyl from crossing the border."

What we're watching: The fentanyl debate isn't just playing out at the federal level.

  • Blue states like Washington and Oregon have grappled with how and whether to decriminalize drugs, with state and local officials at times having diverging opinions.
  • Oregon's experiment in decriminalizing small amounts of illicit drugs has been followed by higher overdose rates, widespread open-air drug use and lengthening treatment waiting lists, the New York Times recently reported.

The bottom line: "Fentanyl stands apart from other domains of policy, because people are dying daily," Felbab-Brown said. "This is not a delayed threat. This is an immediate life or death situation."

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