As the opioid crisis continues to intensify, the numbers paint a grim picture. Unfortunately, stemming the availability of these drugs with opioid legislation is no small task. Take a look at the current figures.

Shifting Drug Waves in a Sea of Overdoses

Opioids in the U.S. MedTruth Infographic

Originally, prescription opioids Vicodin and OxyContin were the leading cause of opioid deaths. Had this remained the case, the current epidemic might be a simpler one to address. Unfortunately, the street drug heroin soon surpassed prescriptions.

In recent years, heroin has been overtaken by the current number one opioid killer, fentanyl, according to Vox. Noted as being 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin, this drug is the most powerful prescription painkiller.

Around 2013 the “third wave” of rising opioid deaths coincided with the increased availability of synthetic IMF, or illicitly manufactured fentanyl, without a prescription.

Unregulated Illegal Drugs Pouring in From Mexico and China

Illegal drugs have multiple clandestine source points, which makes their flow difficult to detect and control. Illicit fentanyl, for instance, can be ordered online from China and delivered to the purchaser’s home by mail.

China and Mexico appear to be the main sources of illicit fentanyl, according to the Drug Enforcement Agency (DEA). It seems that a smaller amount of high-purity IMF originates in China, while larger quantities of lower-quality IMF come from Mexico. There are also indications that Mexican drug sellers may be bringing in Chinese IMF as well, according to Axios

Perhaps surprisingly, most illicit drugs enter the United States through legal ports of entry. The majority of heroin is in fact driven across the border, mixed in with legal goods in large tractor trailers, although border-crossing body smugglers are active as well, according to the Washington Post

Unlike IMF, most heroin has a single source point: Mexico. The Trump administration has taken to using this fact to bolster its argument for a border wall.

But Elaine Carey, dean of the College of Humanities, Education and Social Sciences at Purdue University, told the Washington Post that a border wall is unlikely to stop the flow of drugs.

Drug trafficking entities are “nimble organizations,” she said. In other words, drug traffickers are able to adapt quickly with changing conditions and policies and can consequently be difficult to outwit.

“The way opioids flow or any drug or narcotic, it’s from all different ways. Yes, it comes across the border, but it comes through airports, ships, on trucks, too. A wall’s not going to do anything unless you deal with the demand,” Carey told the Washington Post. 

Earlier this month, Congress signed the INTERDICT Act into law as a preventative measure. This law equips U.S. Customs and Border Protection agents with scanning devices and other technologies to detect synthetic opioids such as fentanyl at ports of entry and in the mail.

Photo by VanveenJF on Unsplash

Additionally, the Senate Homeland Security spending bill funded upgraded drug detection technologies, Customs and Border Patrol infrastructure improvements and additional agents for opioid trafficking enforcement.

Whether the war on opioid drugs will succeed remains unclear.

Longstanding Barriers Thwarting Federal Opioid Prescription Regulation

As Elaine Carey mentioned, a primary factor that must be addressed in an attempt to resolve the opioid epidemic is the demand. This means taking a closer look at the availability of prescription opioids, which are the primary gateway to addiction. In fact, there’s a direct correlation between the rate of opioid prescribing and that of opioid-overdose deaths, according to a study in the New England Journal of Medicine

Apparently, there are serious limits to what the government’s ability to reign in prescribing.

Herschel Nachlis, a research assistant professor in the Department of Government, shares his research regarding barriers to the regulation of know dangerous tranquilizers, sedatives, and stimulants between the 1930s and 1980s in the Washington Post.  He draws parallels between the four broad factors that “consistently hobbled national policymaking” over that 50-year period and current prescription opioid regulatory challenges.

 

Factors Historically Affecting Opioid Legislation

1.The FDA’s stringent pharmaceutical regulatory process is designed to keep dangerous drugs, such as thalidomide, off the market, not to appropriately monitor and regulate drugs once approved. Once a drug is on the market, the FDA’s power to mediate newly-discovered harm is almost exclusively limited to labelling and marketing concerns. This discrepancy between the FDA’s pre- and post-approval regulatory scope derives from an interplay of various historical and political factors.

2. In the absence of real FDA post-approval regulatory power, the government doesn’t have another mechanism for seriously influencing much less altering physician and consumer prescription drug behavior. In fact, even the FDA’s rather-limited jurisdiction overlabelling and marketing is typically hampered by challenges in producing requisite new data, by a plethora of procedural obstacles and by a need to negotiate compromises with pharmaceutical companies themselves. And even once the FDA wins one of these long drawn out battles, drug labels don’t necessarily alter behavior. The information on labels, he says, is often limited, misunderstood and merely advisory in nature.

3. The medical profession and the pharmaceutical industry fight congressional efforts (with necessary presidential approval) to impose new restrictions on drugs or to transfer drugs to stricter regulatory categories. The medical profession acts out of concern for its operational autonomy, while the pharmaceutical industry – no surprise – acts vigorously to safeguard its profits. These are two industries with significant resources and connections, and their efforts at obstruction are often successful.

4. It’s just plain easier in this culture to attack illegal drugs than to restrict prescription ones. Legislators and policymakers are reluctant to impose restrictions on prescription drugs that are successfully used by millions of their constituents. It’s typically much more politically expedient to attack the ills of street drugs, a tactic that’s been used by any number of presidential administrations. (Think “Just Say No.”)

 

“In the past and present, regulation has been hampered by weak regulatory tools, limited political incentives and organized interest groups’ opposition to regulation,” Nachlis states.

“Given those challenges, advocates looking to end the opioid epidemic might seek other routes, such as state and local regulations and prevention efforts, or federal funding for treatment and recovery programs.”


No Easy Answers For Stemming the Opioid Tide

Opioid Legislation in the Senate

If there were any easy answers for slowing down the flow of both illegal and prescription opioid drugs, we probably would’ve seen them by now.

When it comes to illicit drugs, we can hope that Customs and Border Protection will receive appropriate funding for sorely-needed drug-detection technologies and adequate staffing to implement these technologies. It is imperative that funding for a border wall doesn’t compromise these resources.

Unfortunately for those impacted by opioid addiction, the reach of federal prescription drug regulation in resolving the U.S. opioid epidemic is unlikely to improve anytime soon.

 

Read more:

How Likely Are Americans to Die from an Opioid Overdose?