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The fentanyl crisis has emerged as one of America’s most pressing public health emergencies, with devastating consequences that touch every corner of society. Only ‘layering’ up on the worst opioid addiction disaster (arguably) in US history. In a shocking revelation of the crisis’s scope, fatal drug poisonings reached a record 111,451 in the 12 months ending in August 2023, with fentanyl driving the majority of these deaths. Yet as the body count rises, America’s response remains fragmented, ineffective, and mired in political theatre.

A Perfect Storm

What makes fentanyl particularly dangerous is its unique nature as a synthetic drug. Unlike traditional narcotics such as heroin or cocaine that require crop cultivation, fentanyl is purely chemical-based. As DEA officials note, the only limitation on fentanyl production is access to precursor chemicals, making it potentially limitless in supply. This fundamental difference from traditional drugs has created an unprecedented challenge that our current drug control infrastructure seems woefully unprepared to address.

The crisis is further complicated by the cartels’ deceptive tactics. Drug traffickers are pressing fentanyl into counterfeit pills designed to look identical to legitimate medications like oxycodone, Percocet, or Adderall. This practice has led to countless deaths among users who had no intention of taking fentanyl, creating an unprecedented public health challenge that demands far more urgent attention than it’s receiving.

The Politics of Failure

As the crisis deepens, American politicians have reduced this complex challenge to simplistic campaign fodder. Republicans, led by former President Trump, hammer Democrats over border policies, while Vice President Kamala Harris responds by touting her prosecution record and promising more border agents. Lost in this rhetorical crossfire is any meaningful discussion of what primary prevention and demand reduction; or drug use exiting treatment and recovery – the very elements experts say are crucial to addressing the crisis.

It has been said by many a pundit… “we cannot arrest our way out of this mess”, but be rest assured, we cannot ‘treat our way out’ either, especially with treatment is but a ‘mop’ and the faucet of demand continues to flow unchecked, only driving supply.

A Global Criminal Enterprise

The fentanyl supply chain represents a complex international network that makes a mockery of traditional drug enforcement approaches. The DEA has identified two primary cartels responsible for most of the fentanyl entering the United States: the Sinaloa cartel and the Jalisco cartel. These organisations operate as sophisticated multinational corporations, with operations spanning more than 45 countries.

The supply chain typically begins in China, where precursor chemicals are purchased, before moving through Mexico, where the final product is synthesised. Last year alone, the DEA seized enough fentanyl to kill every American – approximately 410 million deadly doses. Yet, significant quantities continue to enter the country through various means: by air, land, and sea, often through the Southwest border. This stark reality raises serious questions about the effectiveness of our current enforcement-first approach.

The Social Media Scandal

Perhaps most damning is the role of social media companies in this crisis. These platforms have become what DEA officials call “the last mile” in the deadly supply chain, providing cartels with direct access to potential victims. Despite their own terms of service prohibiting drug sales, social media companies have provided what law enforcement describes as minimal cooperation in addressing the crisis. The result is a digital marketplace for death, operating in plain sight.

Institutional Inertia

The international response has been equally inadequate. China, the primary source of precursor chemicals, has effectively ceased cooperation with U.S. law enforcement over the past year. Mexico’s president has gone so far as to deny that fentanyl is even synthesised in his country, despite overwhelming evidence to the contrary. Meanwhile, U.S. authorities are left to combat what amounts to a multinational criminal enterprise with fragmented resources and inconsistent international support.

Again, the demand coming from not only a now ‘addicted’ cohort, but a demographic that wants to either party or medicate away everything from perceived ‘boredom’ and trauma’ to genuine cultural and psycho-social despair you have the incentive that addiction for profit actors love. When a society tacitly enables pleasure seeking as a ‘right’ and refuses to identify contributing factors to self-harming behaviours or celebrated unaccountability that needs to be called out and addressed, then those ‘supplying’ have a continuingly enabled ‘demand’ for the preferred ‘agent of symptom annihilation’.

Ground-Level Reality

The human cost of this institutional failure is stark. At DEA headquarters, a memorial wall now displays over 4,000 photographs of fentanyl victims, with hundreds more being added regularly. These images – showing victims as young as 12 or 13 – stand in silent rebuke to the political grandstanding and institutional paralysis that characterises the current response.

The stories of survivors paint an equally damning picture. Crystal Long, who survived multiple overdoses before finding recovery, describes fentanyl’s overwhelming pull: “All of your problems go away… it’s like this tingling feeling from head to toe that just you’re calm, nothing else matters.” Her survival, thanks to a drug court program, represents the exception rather than the rule in a system that prioritises enforcement over treatment.

We see here again a perception in, arguably, the world’s most affluent and ‘free’ nation that every form of positive emotional disruption is viewed as trauma, and the faux right to comfort as all costs drives self-soothing behaviours in some many of the population who are not genuinely traumatised or suffering privation.

A Glimmer of Hope?

Recent CDC data showing a 13 percent decline in overdose deaths between May 2023 and May 2024 offers some encouragement. This improvement is attributed to expanded treatment access, over-the-counter naloxone availability, and increased border seizures. However, with deaths still hovering near 100,000 annually, celebrating such marginal improvement seems premature at best.

The Path Forward

The solution to the fentanyl crisis requires more than campaign promises and border security theatre. It demands a three-pronged approach that has thus far been largely absent from the national conversation: demand reduction, supply reduction, and recovery support.

Demand Reduction: The most glaring oversight in current policy is the lack of comprehensive demand reduction strategies. While politicians focus on border security, they largely ignore the factors driving Americans to seek out opioids in the first place. Effective demand reduction requires:

• Expanded access to mental health services, particularly in underserved communities where fentanyl use often takes root
• Prevention programs that address the root causes of addiction, including trauma, poverty, and lack of economic opportunity
• Educational initiatives that go beyond by include the “just say no” messaging, as this powerful protective factor now seems to have been erased (if not eroded) in our first world entitled culture. Not uptake, No problem! No, is powerful and needs to be empowered and equipped, not undermined by throw away and evidence-deprived ideology that saying no doesn’t work.
• Early intervention programs in schools and communities, with particular focus on the vulnerable 12-25 age group that’s increasingly falling victim to fentanyl. This must include sound anthropologically anchored resilience building factors in the individual, family and the community.

Supply Reduction: While current supply reduction efforts focus almost exclusively on border interdiction, a truly effective strategy must be more comprehensive:

• International cooperation agreements with real enforcement mechanisms, particularly with China and Mexico
• Regulatory reform to better track and control precursor chemicals
• Enhanced prosecution of social media platforms that fail to adequately police drug sales
• Targeted disruption of cartel financial networks through enhanced cooperation between law enforcement and financial institutions
• Investment in advanced detection technologies at all points of entry, not just the Southwest border

Recovery Support: Of course, for those caught in the tyranny of this addiction, we need a fundamental shift in how we approach recovery, particularly in light of recent scientific evidence. A 2024 study in the Journal of Addiction Medicine has conclusively demonstrated that Medications for Opioid Use Disorder (MOUD) remain highly effective even against highly potent synthetic opioids like fentanyl. Whilst this can be a good start, it can also be an ongoing addiction trap, as much lived experience and earned resiliency has made clear. The healthcare system should not place bureaucratic barriers in the way of these proven treatments but should also harness them to other proven drug use exiting protocols that empower the substance use to live substance free. That is what recovery has always meant.

The evidence is clear:

• Both buprenorphine and methadone have proven effective in preventing death and opioid overdose – This, again, is a great start, but the Gold standard for treatment isn’t ‘death prevention’, it is the exiting of practices that facilitate the near death experiences.
• Higher daily buprenorphine doses (>16mg per day) show increased effectiveness
• Low-dose buprenorphine initiation protocols have demonstrated feasibility even with ongoing opioid use
• These Medically Assisted Treatments (MAT) must be part of a more holistic approach for recovery to not only be lifesaving, but also life affirming, developing and recalibrating – thus ensuring the very thing causing all this grief is no longer in play.

Despite this compelling evidence, we continue to underutilise these life-saving treatments. A comprehensive recovery support system must include:

• Creation of robust aftercare programs to prevent relapse and support long-term recovery
• Investment in job training and educational programs for recovering addicts to break the cycle of addiction and poverty.
• Immediate expansion of medication-assisted treatment programs, with particular attention to optimal dosing strategies that research shows are most effective
• Removal of bureaucratic barriers that prevent addiction specialists from prescribing treatment medications, especially given the proven effectiveness of MOUD against synthetic opioids
• Insurance reform to ensure that recovery programs are covered at the same level as other medical conditions, including coverage for higher-dose treatment protocols that research shows are more effective

The tools and knowledge to implement these solutions exist. What’s lacking is the political will to move beyond simplistic enforcement narratives and invest in comprehensive solutions. The success stories – like Crystal Long’s journey through drug court to recovery – demonstrate what’s possible when we implement evidence-based solutions. But these success stories remain the exception rather than the rule.

Each day we delay implementing this comprehensive approach, more faces appear on the DEA’s memorial wall. The choice is clear: we can continue with the current failed approach of political posturing and enforcement-only solutions, or we can implement the comprehensive strategy that evidence shows will work. The fentanyl crisis is not unsolvable – it’s simply unsolved because we’ve lacked the courage and commitment to implement real solutions.

Until we embrace this three-pronged approach and marshal the resources and political will to implement it effectively, Americans (and all other cultures wrestling with this nightmare) will continue to die needlessly. The question isn’t what needs to be done – we know what works. The question is whether we’re finally ready to do it.

Dalgarno Institute

Endnotes

• Everyone’s tough on drugs again
• DEA’S Faces of Fentanyl documents extent of drug crisis
• Full DEA head: ‘We don’t know the exact amount’ of fentanyl that gets through to the U.S.
• Recovering fentanyl addict speaks out about dangers of the drug
• Dramatic turnaround for fentanyl addict
• Medications for Opioid Use Disorder Remain Effective as Highly Potent Synthetic Opioids Permeate North American Illicit Drug Supplies

A recent study has unveiled concerning evidence about the impact of vaping on young adults’ physical fitness, drawing parallels between the effects of vaping and traditional smoking. This research, presented at the European Respiratory Society’s annual meeting, highlights the potential risks associated with vaping, which could be as detrimental to physical health as smoking. This article delves into the study’s methodology, key findings, and the broader implications for public health.

Key Findings: The study revealed stark differences in physical performance between vapers, smokers, and those who neither vaped nor smoked. Both vapers and smokers exhibited reduced exercise capacity, with maximum outputs of 186 watts and 182 watts, respectively, compared to 226 watts among the control group. Additionally, average oxygen consumption was lower for vapers and smokers (2.7 litres per minute and 2.6 litres per minute, respectively) than for their non-vaping counterparts (3 litres per minute).

 For complete article

Just when we thought we had a handle on teen substance abuse (we did NOT), along comes social media to throw a digital wrench in the works. It turns out those shiny apps on our kids’ phones aren’t just for sharing selfies and dance videos – they’re inadvertently serving as virtual gateways to drug and alcohol experimentation. While health officials have been patting themselves on the back for decades of anti-drug campaigns, social media algorithms have been quietly undermining their efforts, one viral post at a time. Parents, educators, and health professionals, it’s time to face facts: we’ve got a new drug dealer in town, and it’s hiding in plain sight on every teenager’s home screen. 

Leveraging Social Media for Prevention

While social media poses significant risks, some experts see potential in harnessing these platforms for substance use prevention and education. Government agencies and health organisations in the United States have launched anti-vaping campaigns on Instagram, Facebook and TikTok, which may have contributed to recent declines in teen vaping rates.

However, these efforts are still vastly outnumbered by pro-substance content. Researchers emphasise the need for sustained investment in developing effective social media-based prevention strategies. This could involve partnering with social media influencers to create engaging anti-drug content or collaborating with young people to co-design relevant messaging that resonates with teen audiences.

The Australian government has begun experimenting with influencer-led campaigns to spark conversations among youth about the harms of vaping and nicotine addiction. While this approach leverages influencers’ authenticity and established audience relationships, experts caution that careful vetting and risk mitigation plans are necessary.

For complete article

(Not ‘Recreational’ Drugs – But Recreational use of toxic substances)

Recreational drug use poses significant health risks, particularly concerning cardiovascular health. Recent findings presented at the European Society of Cardiology (ESC) Congress 2024 reveal the alarming impact of recreational drugs on the likelihood of repeat serious cardiovascular events. The study underscores the urgent need for healthcare systems to address drug use effectively within cardiac care settings.

Study Insights from the ESC Congress 2024: The research, conducted as part of the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, investigated the prognostic impact of recreational drug use on patients admitted to intensive cardiac care units (ICCU) across 39 centres in France. Over two weeks in April 2021, systematic urinary testing revealed that 11% of patients had recently used recreational drugs, including cannabis, heroin, opioids, cocaine, amphetamines, and MDMA.

Key Findings: Patients with a recent history of recreational drug use faced a tripled risk of experiencing a repeat serious cardiovascular event, such as cardiovascular death, non-fatal heart attack, or stroke, within one year of their initial admission. After adjusting for various factors, including age, sex, and existing health conditions, recreational drug use remained an independent predictor of adverse cardiovascular outcomes.

The study found that among 1,392 patients screened, 64 (4.6%) experienced cardiovascular deaths, with a higher incidence among drug users (5.7%) compared to non-users (4.5%). Non-fatal heart attacks occurred in 24 patients (1.7%), with drug users showing a higher incidence (5.1%) compared to non-users (1.3%). Strokes were similarly more common among drug users (1.9%) than non-users (0.6%).

Specific Drug Risks: The type of drug used also influenced cardiovascular risk. MDMA users exhibited a 4.1 times increased risk, those using heroin and other opioids faced a 3.6 times higher risk, and cannabis users had a 1.8 times increased risk of serious cardiovascular events. These statistics highlight the varying impacts of different substances on heart health.

Healthcare Implications: Given the significant risks associated with recreational drug use, the study’s authors advocate for routine screening of ICCU patients for recent drug use. This proactive approach could enhance risk stratification and enable personalised care strategies, including facilitating drug withdrawal programs. Despite the high rate of underreporting drug use, systematic screening is not yet recommended by current guidelines but could provide critical insights into patient care.

Source: ESC