As the primary election season kicks into high gear this week with the Iowa caucuses, Republican presidential candidates are pitching their messages to voters. One of the main themes at the rallies and town halls has been immigration, and specifically how, according to the presidential hopefuls, the U.S.-Mexico border issue is a leading driver of the influx of illicit fentanyl. But fentanyl is overwhelmingly trafficked by U.S. citizens. There’s a misconception in the general population about the role that illegal immigration plays in the current fentanyl crisis. And it stems from misinformation disseminated by politicians and others.
According to an article in yesterday’s Washington Post, Republican candidates running for President assert that resolving the border issue is a key to halting narcotic overdose deaths. This presupposes that illegal immigration is a prime cause of the flow of illicit fentanyl into the U.S. Many Americans believe this to be the case.
In late 2022, an National Public Radio‐Ipsos poll found that 39% of all voters and 60% of registered Republicans are of the opinion that most of the fentanyl entering the U.S. is smuggled in by illegal migrants or asylum seekers crossing the border. But this is demonstrably false.
More than 90% of fentanyl seizures occur at legal border crossing points, according to the U.S. Customs and Border Protection, and not on illegal migration routes. And it’s the U.S. citizens who, when crossing legally, are subject to less scrutiny and do the vast majority of the smuggling. The libertarian-leaning Cato Institute states that U.S. citizens comprise more than 86% of convicted fentanyl drug traffickers, which is 10 times greater than convictions of illegal immigrants for the same offense.
This isn’t a new phenomenon. A Drug Enforcement Agency intelligence report cited the predominance of U.S. citizen drug runners in 2017.
Another misconception is that the fentanyl crisis suddenly got worse under President Biden. This belies the evidence that the emergency has existed for quite some time before Biden was inaugurated, and in fact accelerated under the Trump Administration.
According to the National Institute on Drug Abuse, around 71,000 people died from a drug-related overdose in 2017, the first year of Trump’s presidency, an increase of around 10,000 from the previous year. During his time in office, the number rose to close to 92,000. Since then, under the Biden Administration, the number has increased further to approximately 119,000 in 2022, the last year for which data has been released. Here the term “drug-related overdose” refers to illicit drugs of all kinds and prescription opioids.
Narrowing the numbers of fatal overdoses down to illicit fentanyl, at the end of the first year Trump was in office, a then record 29,000 people died of synthetic-opioid-related overdoses, which was a 46% increase from the year before. And by the end of 2020, deaths involving synthetic opioids reached almost 58,000. During the Biden Administration this trend has continued, as roughly 75,000 synthetic-opioid-deaths occurred in 2022.
Successive Administrations have pursued supply-side policies aimed at reducing importation of illicit opioids. The Obama, Trump and Biden Administrations increased the number of border patrol agents to more than 20,000.
Yet the smuggling persists, mostly by U.S. citizens trafficking contraband through official ports of entry along the border.
While attempting to cut off supply is a logical step in tackling the huge problem, the success of such policies has been extraordinarily limited.
Additionally, the federal government has only recently acknowledged that a large part of the problem exists on the demand side.
To the Biden Administration’s credit, it recognizes this issue. According to Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, only around 10% of people in the U.S. who need addiction care receive therapy. He has urged increases in resources earmarked for treatment of substance abuse.
The encouraging news is that now federal, state and local officials are emphasizing prevention and treatment of substance abuse. Such demand-side policies take time to develop, get implemented and produce positive results. But in the long run they’re more likely to succeed than a strictly supply-side approach.
Continuing expansion of the Affordable Care Act under the Biden Administration, for example, has been pivotal in making available public health resources that are essential for combating substance use disorders, particularly for those on Medicaid.
The Biden Administration has also eased restrictions on the use of buprenorphine, a drug used specifically for opioid use disorders.
Furthermore, in October of 2021, without much fanfare, the Biden Administration proposed a new set of policies to stem the rise in drug overdose deaths. These demand-side measures were grounded in a building consensus around expanding federal support of harm reduction strategies for people who actively use illicit drugs: For example, wider distribution of fentanyl test strips, which helps users avoid street drugs contaminated with the deadly synthetic opioid.
More controversially, the Biden Administration’s plan embraces expansion of needle exchange programs, which for several decades have demonstrated effectiveness in reducing the spread of contagious diseases such as HIV and hepatitis.
At the municipal level, we’re also observing gradual implementation of programs designed to reduce harms in those who are using illicit drugs. New York City in 2022 authorized the establishment of two supervised injection sites for drug users in Manhattan. In March 2023 Mayor Eric Adams indicated he wants to expand the number to five sites by 2025. The facilities will provide clean needles and administer medication, such as naloxone, to reverse overdoses. At the same time, users are offered different options for addiction treatment.
Other city and local governments, especially on the West Coast of the U.S., have launched large-scale programs focused on limiting HIV virus transmission and overdoses through the promotion of safer drug use.
To be clear, there is an ongoing major fentanyl crisis and the U.S. federal response under successive Administrations has been inadequate, and not proportionate to the enormity of the problem.
As of late May 2023, the White House reports that the Biden Administration has invested about $5.5 billion in increasing access to mental healthcare and preventing and treating opioid addiction. While this seems like a sizable sum, it’s still comparatively small.
By contrast, the federal government spent more than $18 billion on Operation Warp Speed to develop Covid-19 vaccines, with tens of billions more going towards procurement of Covid-19 tests, vaccines, and treatments. Also, the domestic federal government response to HIV has risen to more than $28 billion per year. Thus far, there isn’t nearly the same level of funding directed at the illicit fentanyl emergency.
Blaming the fentanyl crisis on illegal migrants crossing the border from Mexico to the U.S. is both wrong and short-sighted. It fails to admit that the predominant traffickers are Americans and that allocating resources towards reducing demand will in all likelihood yield better outcomes than a policy aimed narrowly at supply.
