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 have died of an overdose and the majority of those are 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 role is almost exclusively the role and responsibility of law enforcement at both the federal and state level, and requires cooperation between 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 responses to the national opioid supply dilemma generally reflects three different types of responses that need to be de-coupled from rational, strategic, and effective responses that are 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. These instances, however, 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 NPS into Schedule I of the Controlled Substances Act (CSA). 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.

HHS 5-Point Plan HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid misuse and addiction, and to enable individuals to achieve long-term recovery:

• Better Addiction Prevention, Treatment, and Recovery Services This involves working across the continuum of care and has evolved to explicitly include harm reduction.
• Better Data Strengthen public health data reporting and collection to improve the timeliness and specificity of data, and to inform a real-time public health response as the epidemic evolves.

• Better Pain Management Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.

• Better Targeting of Overdose Reversing Drugs Target the availability and distribution of overdose-reversing medications to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations.

• Better Research Support cutting-edge research that advances our understanding of pain, overdose and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms.

Relevant Research

Commission on Combating Synthetic Opioid Trafficking -- Final Report

The Commission on Combating Synthetic Opioid Trafficking was established under Section 7221 of 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."

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” that unlawfully dispense controlled substances by means of the Internet.

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 October 1, 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 new provision also 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

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

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

Organized Crime Drug Enforcement Task Force
Organized Crime Drug Enforcement Task Force (OCTDEF) National Heroin/Fentanyl and Opioid Initiative
Since its inception in December of 2014, the ultimate goal of this initiative has been to develop multi-agency, multi-jurisdictional cases against criminal organizations. The Initiative leverages the national structure, 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. In the last several years, 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. Today, OCTDEF funds 60 Heroin/Fentanyl and Opioid Initiatives across the country.

The Joint Criminal Opioid Darknet Enforcement (J-CODE)- An FBI-led initiative that brings together a variety of federal agencies to disrupt illicit opioid sales online. "Created in 2018, JCODE combines the efforts of the FBI, USPIS, HSI, Drug Enforcement Administration (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 JCODE’s work to make a global impact on darknet drug trafficking."

U.S. Postal Service (USPS) At a time of massive growth in postal shipments from China due to e-commerce, the investigators found that the postal system received the 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 the Senate report shows no significant improvement during 2017 despite the urgency.  The U.S. Postal Service said it has made dramatic progress in the last year in total packages with opioids seized by U.S. Customs and Border Protection... implementing the use of electronic data is slowed by the need to negotiate with international partners, but the service is making progress.