Disrupt the Supply of Illegal Drugs

Introductory Paragraph

The United States is facing an illicit drug trade contributing to thousands of deaths each year. In 2020 over 100,000 Americans died of an overdose and the majority of those were contributed to by a synthetic opioid. A key strategy to reduce opioid misuse is preventing illicit opioids, including heroin and synthetic opioids, from ever reaching communities. This is almost exclusively the role and responsibility of law enforcement at both the federal and state level, and requires cooperation between local jurisdictions and federal partners to ensure success. In addition, disrupting opioid supply, in our increasingly global and virtual society, has added a complexity to the problem that has required international collaboration and closer scrutiny over internet communications and mail delivery services.

Key Information

In the United States, Fentanyl is classified as a Schedule II controlled substance, meaning there is a potential for misuse and dependence, but it does have an accepted medical use and can be prescribed for restricted use. Although prescribed synthetic opioids are sometimes diverted to the illicit market, the main reason for the surge in high purity synthetic opioids is the increase in manufacturing from clandestine labs. These synthetic opioids are either pressed into pills or left in powder form and mixed with heroin.

The response to the national opioid supply dilemma generally reflects three different types of reactions which need to be de-coupled from rational, strategic, and effective responses documented in the balance of this article

• Over-reaction. Seizures of synthetic opioid-laced heroin by law enforcement have led to calls by politicians for increased punishment for possession and/or sale of illicit Fentanyl. This has included escalating mandatory minimum sentencing, and even capital punishment for sale of heroin. There is no evidence that escalating criminal punishment will have any effect on reducing risk of overdose or use in general. Research has suggested that these policies will fail to address the issues involving Fentanyl and will continue the harmful trend of mass incarceration in the US.

• Un-informed Reactions. Fentanyl is an extremely powerful opioid that can be lethal in small amounts, and overdoses have been reported by law enforcement personnel as having occurred through inhalation or absorption through the skin during routine encounters. However, these instances are more myth than reality, and can lead to misplaced fear when law enforcement and emergency responders come upon a suspected overdose. Such fear can lead to a delay in responding to an overdose that could cause brain damage and even death.

• Inconsistent Reactions. Many efforts are centered around placing individual synthetic opioids and opiate-like psychoactive substances into Schedule I of the Controlled Substances Act. This could properly prioritize enforcement across all states and facilitate more uniform state-level responses. However, the context of variability in current actions by states is reflected in more than the legalization and decriminalization of marijuana. In an examination of prosecution rates by state, it was found that possession of methamphetamine was the most commonly charged controlled substance offenses in 30 states. In 14 states, it was heroin. Cocaine possession was the most commonly charged offense in three states and the District of Columbia. Marijuana possession was the most commonly charged drug offense in 2 states. Likewise, prison terms for felony controlled substance offenses ranged widely, averaging 17 months in Arizona to 111 months in Iowa.

Relevant Research

Commission on Combating Synthetic Opioid Trafficking was established under the National Defense Authorization Act for Fiscal Year 2020. It was charged with examining aspects of the synthetic opioid threat to the United States — specifically, with developing a consensus on a strategic approach to combating the illegal flow of synthetic opioids into the United States. The final report distributed by the Rand Corporation "describes items involving the illegal manufacturing and trafficking of synthetic opioids, as well as the deficiencies in countering their production and distribution, and includes action items directed to appropriate executive branch agencies and congressional committees and leadership."

Complexities within Assumptions about Supply and Demand. This article examines unintended consequences of disrupting supply without changing demand, since other drugs can fill the gap. If someone is used to a specific supply and that supply is confiscated and thus supplanted by a more potent or inconsistent supply, overdoses spike. According to Edward Sisco at the National Institute of Standards and Technology, "If lawmakers follow through on proposed legislation that would criminalize xylazine and make it illegal, then, suppliers could potentially replace it with yet another substance. We're in this continual loop of cat and mouse, trying to keep up with whatever the bad guys are deciding to do.” This article evaluates the so-called "iron law of prohibition" which states that the more intense law enforcement cracks down, the more potent drugs become, in part due to increased risks in transporting and manufacturing. The theory suggests that drug criminalization spurs traffickers to minimize the size of their product, leading to an uptick in potency. A market that favors the most potent supply, arguably, makes drug use less predictable and, in turn, more deadly. In a related research paper, funded in part by the Centers for Disease Control and Prevention, competing claims were tested and it was found that efforts to interrupt the supply were indeed associated with an increase in fatalities. The authors looked at data collected over two years from Marion County, Indiana, which includes Indianapolis, and found that when police seized opioids, fatal overdoses spiked in the immediate vicinity. Fatal overdoses increased at one week, two weeks, and 21 days after supply was reduced by the arrests. Diane Goldstein, a retired police lieutenant and executive director of the Law Enforcement Action Partnership asks, “So how is that saving lives?” since the drug busts led to the unintended consequence of those with a dependency taking more risks to seek out a less familiar substance and overdose deaths increased for three weeks.

Impactful Federal, State, and Local Policies

Controlled Substances Act. The Comprehensive Drug Abuse Prevention and Control Act of 1970 includes the Controlled Substances Act (CSA), which allows federal jurisdiction over specific plants, drugs, and chemical substances. It established a classification or scheduling system for drugs. See Safe Solutions article, "Reduce Criminal Diversion of Prescription Drugs."

Ryan Haight Online Pharmacy Consumer Protection of Act 2008. The Ryan Haight Act amended the CSA in 2008 by adding a series of new regulatory requirements and criminal provisions designed to combat the proliferation of “rogue Internet sites” which unlawfully dispense controlled substances by means of the Internet.

International Policy Collaboration with Canada. A white paper published by the US Department of Health and Human Services and the Public Health Agency of Canada represents cooperation between the two countries to find effective approaches to addressing the opioid overdose crisis across three working groups covering border security, health, and law enforcement.

International Policy Collaboration with China. A large number of synthetic opioids, specifically Fentanyl, come to the US from China. Cooperation between the U.S. Drug Enforcement Agency and the China Ministry of Public Security reflects China’s actions toward combating global synthetic drug trafficking. The US and China have agreed to work together to exchange more law enforcement and scientific information to coordinate actions. China has agreed to crack down on the exports of substances that are controlled in the US, but not in China. On 2015, China took an important step in international coordination by controlling a list of 116 synthetic drugs that were widely abused in the U.S. When evaluating a substance for control, the provision allows China to consider harm to the public in countries other than China. DEA continues to share information with Chinese officials to secure scheduling of additional Fentanyl-class substances in China due to the wave of recent deaths in the United States from these synthetic opioids.

Available Tools and Resources

SAFE Project:

• The Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training by SAFE Project is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system.
• See the wiki titled "Reduce Criminal Diversion of Prescription Drugs" for more detailed information on the illegal distribution and misuse of prescription drugs, encompassing activities like selling medications, doctor shopping, and theft or forgery of prescriptions.
• See the wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs" for more detailed information on diversion and deflection programs that aim to redirect individuals away from the justice system, particularly those with behavioral health needs, to reduce recidivism, address personal needs, and optimize justice system resources.
• See the wiki titled "Expand First Response and Crisis Intervention Teams" for more detailed information on expanding the implementation of innovative multidisciplinary teams (including mental health professionals, peers, EMS/Fire, etc.) to help reduce overdoses and connect individuals to community-based treatment.

2019 National Drug Control Strategy The 2019 National Drug Control Strategy from the Office of National Drug Control Policy (ONDCP) establishes the national initiatives and priorities to combat illicit drug use and treat people suffering from substance use disorders.

Organized Crime Drug Enforcement Task Force (OCTDEF) In 2014, OCTDEF launched the National Heroin/Fentanyl and Opioid Initiative and has funded over 60 initiatives across the country. The ultimate goal is to develop multi-agency, multi-jurisdictional cases against criminal organizations. The initiative leverages the national structure of resources and information sharing capabilities to identify the local street level distributors who are responsible for overdose deaths, as well as their network of suppliers at the local and regional level. OCDETF investigators and prosecutors attacked the opioid epidemic by prosecuting rogue physicians, pharmacists, internet sales, and pill mill operations. Their traditional diversion investigations involved overwriting of Oxycodone by doctors, and misuse of Fentanyl patches by users who clipped the edges to consume the gel inside.

The Joint Criminal Opioid Darknet Enforcement (J-CODE) is an FBI-led initiative created in 2018 to bring together a variety of federal agencies to disrupt illicit opioid sales online. J-CODE combines the efforts of the FBI, USPIS, HSI, DEA, U.S. Customs and Border Protection, Department of Justice, Financial Crimes Enforcement Network, Naval Criminal Investigative Service, Department of Defense, and Bureau of Alcohol, Tobacco, Firearms and Explosives. As many of these markets cross borders, Europol is also an invaluable international partner in J-CODE’s work to make a global impact on darknet drug trafficking."

Promising Practices

DEA 360 Strategy targets drug trafficking organizations. In the past, the DEA has targeted low-level, first time non-violent offenders who usually are selling to get high themselves.  This new strategy will target all drug deals, but start from the top down. "These drug trafficking organizations are predators. There's no other way to describe it. They look for the vulnerable, they exploit them by finding them while they are trying to get treatment; that's how severe, how bad these drug trafficking organizations are to find their customer and peddle their poison. We're going to put together a task force and this task force is going to put together building federal cases based on these overdoses, and there is significant sentencing around and this is a way to impact straight into the organization and take out upper level members of an organization that directly impact the flow of drugs.” -Thomas Gorman, Assistant Special Agent in Charge, DEA

U.S. Postal Service (USPS). At a time of massive growth in postal shipments from China due to e-commerce, investigators found that the USPS received electronic data on just over a third of all international packages, making more than 300 million packages in 2017 much harder to screen. Data in a Senate report showed no significant improvement during 2017, despite the urgency. The USPS did later succeed in making progress, as indicated in the total packages with opioids seized by U.S. Customs and Border Protection. However, implementing the use of electronic data is slowed by the need to negotiate with international partners, and the challenges persist.