Report: Opioid fight needs new strategy, Cabinet leadership

The U.S. needs a nimble, multipronged strategy and Cabinet-level leadership to counter its festering overdose epidemic, a bipartisan congressional commission advises.

With vastly powerful synthetic drugs like fentanyl driving record overdose deaths, the scourge of opioids awaits after the COVID-19 pandemic finally recedes, a shift that public health experts expect in the months ahead.

"This is one of our most pressing national security, law enforcement and public health challenges, and we must do more as a nation and a government to protect our most precious resource — American lives," the Commission on Combating Synthetic Opioid Trafficking said in a 70-page report released Tuesday.

The report envisions a dynamic strategy. It would rely on law enforcement and diplomacy to shut down sources of chemicals used to make synthetic opioids. It would offer treatment and support for people who become addicted, creating pathways that can lead back to productive lives. And it would invest in research to better understand addiction's grip on the human brain and to develop treatments for opioid use disorder.

The global coronavirus pandemic has overshadowed the American opioid epidemic for the last two years, but recent news that overdose deaths surpassed 100,000 in one year caught the public's attention. Politically, federal legislation to address the opioid crisis won support across the partisan divide during both the Obama and Trump administrations.

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Rep. David Trone, D-Md., a co-chair of the panel that produced the report, said he believes that support is still there, and that the issue appeals to Biden's pragmatic side. "The president has been crystal clear," Trone said. "These are two major issues in America: addiction and mental health." Trone's counterpart was Sen. Tom Cotton, R-Ark.

The U.S. government has been waging a losing "war on drugs" for decades.

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The stakes are much higher now with the widespread availability of fentanyl, a synthetic painkiller 80 to 100 times more powerful than morphine. It can be baked into illicit pills made to look like prescription painkillers or anti-anxiety medicines. The chemical raw materials are produced mainly in China. Criminal networks in Mexico control the production and shipment to the U.S.

Federal anti-drug strategy traditionally emphasized law enforcement and long prison sentences. But that came to be seen as tainted by racial bias and counter-productive because drug use is treatable. The value of treatment has recently has gained recognition with anti-addiction medicines in wide use alongside older strategies like support groups. 

The report endorsed both law enforcement and treatment, working in sync with one another.

"Through its work, the commission came to recognize the impossibility of reducing the availability of illegal synthetic opioids through efforts focused on supply alone," the report said.

"Real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs," it added.

The report recommends what it calls five "pillars" for government action:

— Elevating the White House Office of National Drug Control Policy to act as the nerve center for far-flung federal efforts, and restoring Cabinet rank to its director.

— Disrupting the supply of drugs through better coordinated law enforcement actions.

— Reducing the demand for illicit drugs through treatment and by efforts to mitigate the harm to people addicted. Treatment programs should follow science-based "best practices."

— Using diplomacy to enlist help from other governments in cutting off the supply of chemicals that criminal networks use to manufacture fentanyl.

— Developing surveillance and data analysis tools to spot new trends in illicit drug use before they morph into major problems for society.

Participating as non-voting members in the commission's work were high-level executive branch officials, including representatives from law enforcement, the departments of State, Treasury and Homeland Security, the intelligence community, and the White House. Administration officials said Biden has already issued two executive orders to counter fentanyl trafficking and called on Congress to pass his $41 billion request to address the overdose epidemic.

In prepared statements, Republican commission members stressed the law enforcement response. "We must redouble our efforts to secure the border against illegal trafficking by targeting Mexican cartels flooding our streets with illicit opioids and force China's hand to crackdown on their pharmaceutical industry supplying cartels with the base compounds used to manufacture synthetic opioids," said Rep. Fred Upton, R-Mich.

Trone said it's going to take cooperation from both political parties. "We have to take this toxic atmosphere in Washington and move past it," he said. "Because 100,000 people, that's husbands, sisters, mothers, fathers. As a country, we are better than that."