Overdoses killed 108,000 people in the US last year, more than Covid-19 or diabetes, yet overdose prevention has barely gotten mention this election cycle.
On the relatively rare occasions when presidential candidates Donald Trump and Kamala Harris discuss opioids, they draw from “war on drugs” rhetoric – suggesting that tougher border and law enforcement policies are the answer to the problem.
Harris’s campaign has promised to spend $160bn on efforts to keep fentanyl from crossing the border.
“As president, I will double the resources for the Department of Justice to go after those transnational cartels and take action to stop the flow of fentanyl coming into our country, which is destroying entire communities,” she said in a speech in Las Vegas in September.
Trump has used more explicit language to blame the overdose crisis on migrants crossing the border.
“What we actually know, from our own law enforcement agencies no less, is that almost all fentanyl entering the country is brought by American citizens through legal ports of entry and not by immigrants,” says Ryan Marino, an addiction medicine specialist and professor at Case Western Reserve University’s school of medicine. “Not to mention that a non-insignificant amount is actually trafficked by members of law enforcement.”
Misleading rhetoric that places the blame for the overdose crisis outside US borders is frustrating for medical professionals, activists and family members of opioid users whose main goal is to stop preventable overdose deaths.
“We’ve lost over 1 million loved ones, neighbors and family members to preventable drug overdoses since the 90s, yet our political candidates continue to offer the same drug war playbook that created the current crisis we’re in,” says Kassandra Frederique, executive director at Drug Policy Action. “Both Harris and Trump have used the overdose crisis as an opportunity to compete for who can appear tougher on immigration and the border instead of offering a real plan to save lives.”
Frederique suspects that Harris and Trump are avoiding meaningful engagement with the realities of the overdose crisis because some of the blame lies with their respective administrations.
The Trump administration criminalized all fentanyl-related substances in 2018, which led to more fentanyl seizures. These policies did not curtail overdose deaths – they continued to climb, from fewer than 70,000 in 2018 to nearly 108,000 in 2022.
“It’s easier to point fingers at the border to distract voters from the harm their policies and inaction have caused. While the Biden-Harris administration has taken important steps toward embracing harm reduction and expanding access to [the overdose-reversal drug] naloxone, their efforts have ultimately fallen short of the scale and magnitude this crisis demands,” Frederique says.
On the local level, election candidates are also avoiding the topic, even in the cities most ravaged by overdoses, such as Baltimore.
Logan Hullinger, a Baltimore-based independent journalist, has covered the political silence on the overdose crisis in the city.
“I’m a recovering addict myself, and I overdosed multiple times during the 10 years I was in active addiction,” he says.
Hullinger hoped his reporting could offer a humane, insightful perspective compared with media coverage that exacerbates the stigma surrounding people who use opioids. But he’s been frustrated at how little Baltimore politicians are engaging with the topic. He says they often say they are unable to comment on the crisis due to the city’s ongoing lawsuits against pharmaceutical companies and drug distributors.
“At times, it feels as though the lawsuits have been used as an opportunity to avoid talking about a public health crisis that isn’t exactly good PR for the city,” Hullinger says.
Local candidates in other overdose hotspots, such as San Francisco, are taking a similar approach to Harris and Trump, and promising crackdowns. Still, crackdowns do nothing to help with addiction.
“Targeting the supply without addressing the demand actually increases the risk and leads to more overdoses,” says Marino. For people who are dependent on opioids, losing access to a reliable supply could mean they look to more unfamiliar, dangerous sources.
Frederique notes that since the beginning of the prescription opioid overdose crisis, a chain reaction of crackdowns have made the drug supply increasingly dangerous.
Prescription opioid restrictions did not stop people from using opioids, but “did send people to the underground heroin supply, which was cheaper”, says Frederique. Heroin crackdowns led to illicit fentanyl, fentanyl crackdowns led to fentanyl analogues. Now that those, too, have been criminalized, nitazenes, a class of synthetic opioid that can be up to 40 times more potent than fentanyl, are already circulating in the US, as the Guardian has previously reported.
Access to overdose-reversal drugs, such as naloxone; opioid cessation drugs, such as methadone; and drug testing services is proven to drastically reduce the risk of overdose fatalities.
Frederique and Marino advise voters to push politicians to put more resources into these proven strategies, but have different ideas about whether voters care enough to do so. Frederique says that voters “absolutely” care about this issue and that they “want and deserve a real plan that puts health and saving lives first. Most Americans agree that the drug war has failed.”
Marino, on the other hand, has found that it’s more politically popular to focus on immigration and drug interdiction. Hullinger is also ”unsure where the [opioid] crisis ranks among voters’ priorities”. He says voters do care about the state of Baltimore’s drug scene, “but not always for the right reasons. Many people, for example, consider drug users public nuisances, and they demand that the city does more to ‘clean up’ their neighborhoods.”
