Commentary: If you’re not scared of fentanyl, you’re not paying attention

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My wife, Sheryl WuDunn, and I were at a conference last week on addiction, and I come away scared.

If you’re not frightened of fentanyl, you’re not paying attention. It’s a synthetic opioid that is cheap and deadly, and it’s hard to overstate its impact.

Fentanyl is a major reason for the soaring new numbers of drug deaths just release by the federal government. They show that about 108,000 Americans died last year from overdoses. That’s a 15% increase, on top of a 30% increase a year earlier.

Then, there’s alcohol, which kills 140,000 Americans a year, the Centers for Disease Control and Prevention says. In short, we’re losing a quarter-million Americans a year to addiction — more than we were losing annually to combat in World War II, the Civil War or any other conflict.

Fentanyl is now commonly sold in the form of fake OxyContin or Percocet pain pills, which look safe. But, especially for people not used to opioids, a single pill can kill you.

Consider Charlie Ternan, a university student who was well adjusted and had plenty of friends. He was just three weeks shy of graduation. Charlie’s back was hurting, so he bought Percocet painkillers online and took a single pill. It turned out to be a fake pill laced with fentanyl. Charlie was 6 feet, 2 inches tall and 235 pounds; he was not the kind of person who would have seemed vulnerable to a single pill.

Yet, his friends found him unresponsive in his room. He apparently had died within 30 minutes of taking the pill.

A leading cause of death among Americans

That’s happening all across America, particularly among 15- to 24-year-olds. I had a 15-year-old neighbor who died last year from a fake pill. Overall, fentanyl is now the leading cause of death among Americans ages 15-45.

One takeaway from the conference, which was sponsored by Lines for Life, a terrific nonprofit that works on addiction, mental health and suicide: Make sure everyone in your family knows never to take a pill that doesn’t come directly from a pharmacy. Pills bought online can seem cheap but don’t be tempted. Fentanyl is so inexpensive that counterfeit pill makers now make fake Xanax, fake Adderall, fake Percocet and fake OxyContin — all laced with fentanyl.

They look indistinguishable from the real thing, and there’s often an underground trade among young people for pills. So get the message out: A single pill can kill, and no one should ever take a pill that he or she hasn’t obtained directly from a pharmacy. It’s just not worth the risk.

My life has been about taking measured risks by covering wars, riots and genocide. I’m OK navigating through checkpoints in Yemen or Syria — but these days, I would never take a pill from a friend.

Beyond the rise of fentanyl, another reason I worry is pricing trends: Drugs are getting cheaper. Both fentanyl and meth are dropping in price, and that’s a disaster. It used to be that getting high on opioids would cost maybe $20; now, a high is possible with a $5 fentanyl pill. A high from meth costs about the same.

Meth, by the way, may also be becoming more dangerous. There’s no data on this, but there’s a widespread perception among those on the front lines that today’s meth is both more lethal and more likely to produce psychosis than the homemade meth of 15 years ago.

A 10% increase in cigarette prices reduces demand by about 5%. For drugs, the impact is even greater. A 10% increase in street drug prices reduces demand by at least 5% and perhaps as much as 9%. Conversely, lower prices mean more sales.

‘Wreak havoc on illicit drug supply chain’

The implication is that we should be doing everything we can to interrupt supply chains and raise street drug prices. The single most successful strategy to reduce tobacco consumption was not warning labels or limits on purchases by kids; it was taxes that raised prices.

Pressure on China seems to have reduced direct shipments of fentanyl from Chinese companies to the U.S., but now, Chinese companies send precursor chemicals to Mexico. We should systematically work to wreak havoc on the illicit drug supply chain so as to increase production costs and raise American street prices of fentanyl and meth alike.

I spoke at the Lines for Life conference, and my main message was that the United States (and Oregon) should be doing far more to respond to this challenge. When we’re losing a quarter-million lives a year, we need a response equivalent to what we saw during the Great Depression, World War II or COVID-19. Instead, only 10% of people with addictions even get treatment, even though treatment pays for itself.

Losing more each week than on 9/11

Let’s just be clear: This response is a scandal. It’s a failure of the political system, of public health and medicine, of journalism and of the private sector. We lose far more people each week to addiction than were lost in the 9/11 attacks, and yet, we can’t muster a firm response.

As many readers know, I’ve commended the robust, bipartisan American response to Russia’s invasion of Ukraine. The Biden administration and Congress moved heaven and earth and allocated $53 billion to help Ukraine — and the addiction crisis at home should also be a top priority with similar resources and focus.

The other point I tried to make in my remarks is that our response has to be about more than just harm reduction or pill seizures or even treatment (although treatment is incredibly cost-effective). We also have to grapple with the number of Americans who have been left behind economically, who suffer pain and trauma and who self-medicate as a result.

That means addressing childhood trauma with early-childhood programs. It means early-literacy programs, so all kids read by the end of the third grade. It means raising high school graduation rates and providing career training.

If the 1968 federal minimum wage had kept pace with inflation and productivity, it would now be about $23 an hour. If all workers today were getting $23 or more an hour and were less stressed by the lack of universal health care and child care, I think we’d have less of an addiction crisis.

America’s despair is a giant problem on a giant scale and needs a giant level of attention. We know what works — not perfectly but better than what we’re doing now.

We have the solutions, and we have the resources. We just lack the political will.

Nick Kristof, a Pulitzer prize-winning journalist and former New York Times columnist, has written extensively about poverty, genocide, addiction and homelessness. This was first published at Substack.