Somewhere in America right now, a teenager searches the internet for drugs. The pills they buy might look like the real thing—Xanax, maybe, or Adderall—but chances are, they’re not getting what they think they are.
The U.S. Drug Enforcement Administration estimates that six out of 10 pills bought online actually might contain lethal doses of the opioid fentanyl, says Rahul Gupta, director of the Office of National Drug Control Policy.
“So, the odds of dying from those pills is worse than playing Russian roulette with your life,” he told a session at the 2023 NCSL Legislative Summit.
“Substance use cuts across every geographic boundary, every sociocultural boundary. It doesn’t matter what race you are, how rich or poor you are, where you live.”
—Rahul Gupta, Office of National Drug Control Policy
More than 110,000 Americans died from drug overdoses in 2022, Gupta says.
“Substance use cuts across every geographic boundary, every sociocultural boundary. It doesn’t matter what race you are, how rich or poor you are, where you live,” he says. “It’s got your number.”
An iteration known as “tranq dope”—a potent cocktail of fentanyl, heroin and the animal tranquilizer xylazine—is the latest scourge to hit the streets, Gupta says. It is particularly problematic because the xylazine tends to increase the effect of the other drugs.
The costs of opioid addiction and trafficking fall mostly on the states: an economic loss of $1.5 trillion in 2020 alone, Gupta says. He outlines a two-pronged federal approach that includes treating addiction and disrupting drug trafficking profits. Making the drug naloxone, which can reverse an overdose, available over the counter has been a game-changer, he says, as have efforts to disrupt the fentanyl supply chain—chemicals from China, production in Mexico and sales in the U.S.
“We’re going after every choke point in this supply chain,” Gupta says, “and we’re putting sanctions on all of these folks to make sure that we’re choking off those important points the cartels and others depend on to create this deadly substance that kills Americans.”
Expanding Treatment Access
In Oklahoma, fentanyl overdose deaths increased sixfold from 2019 to 2021, and fentanyl was involved in nearly three out of four opioid-related deaths, compared with 10%-20% in previous years, says state Sen. John Haste, vice chair of the Health and Human Services Committee.
The Legislature focused on prevention and treatment by expanding access to naloxone, including requiring hospitals and prisons to provide it to at-risk patients and inmates upon release, he says. Telehealth can now be used for medication-assisted treatment, and fentanyl test strips have been legalized, Haste says.
The state Department of Mental Health and Substance Abuse has launched a campaign to reduce the number of accidental overdoses through education awareness and resource access, he says. As part of the campaign, the department is placing more than 40 vending machines in targeted areas that freely dispense naloxone and fentanyl test strips. “This is the largest program of its kind in the country,” Haste says. “All around Oklahoma, you can see messages reminding the public to utilize test strips and naloxone on billboards, buses, local businesses and other strategic locations.”
In Hawaii, legislators are looking at safe alternatives to opioids for pain relief.
“It’s easy to say, just stop opioids, stop all drugs,” says Rep. John Mizuno, chair of the Hawaii House Committee on Human Services. “We know that chronic pain is complex; in addition to pain, you’ve got mental health. We need to think about the person’s quality of life. We’ve got to balance the patient’s right to manage his or her pain.”
Mizuno suggests that legislators meet with their state’s top pain management physician to learn about safe pain alternatives, including nerve blocks, implanted medication pumps, physical therapy, acupuncture, massage therapy, chiropractic treatment and medical cannabis.
His state has asked that Medicaid expand coverage for native Hawaiian healing that previously has been covered only for tribal members.
Mizuno says coverage is the main barrier to safer treatments, many of which might not be paid for under private health insurance or federal programs.
“But the best thing to do is work with your colleagues, work with your medical providers, and try to get these safe alternatives (covered),” Mizuno says. “It’s a lot better than being addicted to opioids.”
Lisa Ryckman is NCSL’s associate director of communications.