Obama officials’ inaction on fentanyl fueled fatal escalation of opioid crisis
In May 2016, a group of national health experts issued an urgent plea in a private letter to high-level officials in the Obama administration. Thousands of people were dying from overdoses of fentanyl— the deadliest drug to ever hit U.S. streets— and the administration needed to take immediate action. The epidemic had been escalating for three years.
The 11 experts pressed the officials to declare fentanyl a national “public-health emergency” that would put a laserlike focus on combating the emerging epidemic and warn the country about the threat, according to a copy of the letter.
“The fentanyl crisis represents an extraordinary public-health challenge — and requires an extraordinary public-health response,” the experts wrote to six administration officials, including the nation’s “drug czar” and the chief of the Centers for Disease Control and Prevention.
The administration considered the request but did not act on it.
The decision was one in a series of missed opportunities, oversights and half-measures by federal officials who failed to grasp how quickly fentanyl was creating another— and far more fatal— wave of the opioid epidemic.
In a few years, fentanyl, a synthetic painkiller 50 times more powerful than heroin, became the drug scourge of our time. Fentanyl has played a key role in reducing Americans’ overall life expectancy.
Between 2013 and 2017, more than 67,000 people died of synthetic-opioid-related overdoses— exceeding the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined. The number of deaths, the vast majority from fentanyl, has risen sharply each year. In 2017, synthetic opioids were to blame for 28,869 out of the overall 47,600 opioid overdoses, a 46.4 percent increase over the previous year, when fentanyl became the leading cause of overdose deaths in America for the first time.
“This is a massive institutional failure, and I don’t think people have come to grips with it,” said John Walters, who was chief of the White House Office of National Drug Control Policy between 2001 and 2009. “This is like an absurd bad dream, and we don’t know how to intervene or how to save lives.”
Federal officials saw fentanyl as an appendage to the overall opioid crisis rather than a unique threat that required its own targeted strategy. As law enforcement began cracking down in 2005 on prescription opioids such as Oxycontin and Vicodin, addicts turned to heroin, which was cheaper and more available.
Then, in 2013, fentanyl arrived, and overdoses and deaths soared.
“Fentanyl was killing people like we’d never seen before,” said Derek Maltz, a former agent in charge of the Drug Enforcement Administration’s Special Operations Division in Washington. “A red light was going off — ding, ding, ding. This is something brand new. What the hell is going on? We needed a serious sense of urgency.”
But for years, Congress didn’t provide significant
funding to combat fentanyl or the larger opioid epidemic. Agencies like the U.S. Customs and Border Protection and U.S. Postal Service didn’t have funding or policies in place to watch out for the drug entering the country, and there were significant delays in the CDC’S data collection.
Facing hotly contested midterm elections in 2018, Congress finally passed legislation aimed at addressing the increasingly politicized opioid crisis, including a measure to force the Postal Service to start tracking international packages.
“How many people had to die before Congress stood up and did the right thing with regard to telling our own Post Office, ‘You have to provide better screening’?” Sen. Rob Portman, R-ohio, the sponsor of the legislation, asked on the Senate floor last fall.
Local and state leaders in hard-hit communities say the federal government wasted too much time at a cost of far too many lives.
“Everybody was slow to recognize the severity of the problem, even though a lot of the warning signs were there,” said Republican Gov. Chris Sununu of New Hampshire, which has one of the nation’s highest fentanyl overdose rates.
Drug-treatment experts compared the government’s slow response to an earlier failure to face the AIDS epidemic in the 1980s.
“There was a stigma about being gay,” said Luke Nasta, executive director of the largest drug-treatment facility on Staten Island, New York. “There is also a stigma about being addicted to drugs. The entire society is suffering, and the government can’t seem to get their arms around this epidemic.
“If it’s an epidemic, then treat it like an epidemic.”
Opioid explosion
The first wave of the opioid epidemic began in 1996 after drug manufacturer Purdue Pharma introduced what it claimed to be a wonder drug for pain: Oxycontin, a powerful opioid that was aggressively marketed to physicians as less addictive than other prescription narcotics. As the medical community embraced the new drug, it became a blockbuster for Purdue, generating billions in sales.
Over the next decade, doctors and corrupt painmanagement clinics prescribed massive amounts of opioids. The flood of incoming pills found its way onto the street and into the drug trade.
The DEA started to crack down on the illegal trade in 2005. As the supply of prescription opioids tightened, America’s pill addicts became desperate. Street prices soared. Mexican drug cartels saw an opening to sell more heroin — a cheaper, more potent way to get high. That set off the second wave of the epidemic by 2010 and an increase in overdose deaths.
Then fentanyl hit the streets. A synthetic opioid developed in 1960 by a Belgian physician, fentanyl is normally reserved for surgery and cancer patients. It is up to 100 times more powerful than morphine, its chemical cousin.
For traffickers, illicit fentanyl produced in labs was the most lucrative opportunity yet, a chance to bypass the unpredictability of the poppy fields that produced their heroin. The traffickers could order one of the cheapest and most powerful opioids on the planet directly from Chinese labs over the internet.
It was 20 times more profitable than heroin by weight. By lacing a little of the white powdery drug into their heroin, the dealers could make their product more potent and more compelling to users.
Enforcement shift
The third wave of the opioid epidemic was about to begin. Ground zero was Rhode Island, already reeling from a crippling prescription pill and heroin problem.
The first signs were detected in the spring of 2013 when the state morgue in Providence detected a spike in overdose deaths. On Aug. 30, 2013, the CDC in its Morbidity and Mortality Weekly Report highlighted the state’s unusual spike. It didn’t attract much national attention.
Eighteen days before the CDC’S memo, then-u.s. Attorney General Eric Holder traveled to San Francisco to issue one of the biggest policy proclamations of his career: a rollback of the aggressive prosecution strategy that had been launched to target the crack cocaine crisis of the 1980s and ‘90s.
Calling the new policy “Smart on Crime,” Holder said he was directing federal prosecutors to stop bringing low-level, nonviolent drug charges that would trigger mandatory minimum sentences. The charges had resulted in harsh sentences for first-time offenders, many of them young black men. Holder told his prosecutors to focus on large drug-trafficking organizations.
He wanted a major reduction in the burgeoning federal prison population, but his initiative also was part of the Obama administration’s strategy to favor drug treatment over incarceration.
Underlying threat
In January 2014, the DEA issued a bulletin warning local authorities nationwide about “killer heroin” cut with fentanyl. First responders were told to “exercise extreme caution” because fentanyl could be absorbed through the skin. The bulletin resulted in a few local news stories, but, again, there was little national attention.
In March, a month after actor Philip Seymour Hoffman’s heroin overdose generated national headlines, Holder released a video to notify the public of the rising number of heroin deaths across the country. He called heroin an “urgent and growing public health crisis.” Between 2006 and 2010, heroin overdose deaths had increased by 45 percent.
Holder made no mention of fentanyl; top officials in Washington were still focused on heroin and prescription pain pills.
Former DEA agents said they provided Holder with a personal briefing three months later that included a 30-slide Powerpoint presentation about the dangers of fentanyl in June 2014. Several DEA officials were present, including the agency’s administrator at the time, Michele Leonhart.
The Powerpoint presentation, which The Washington Post reviewed, warned that heroin was being laced with fentanyl and there had been an “outbreak” of fentanyl overdoses in the Northeast. While raising red flags, the Powerpoint presentation itself did not request any particular action.
Leonhart did not respond to requests for comment. Holder declined an interview request. His former spokesman said it was up to the DEA to ask the attorney general for specific action.
“It says something that the people pointing fingers at the attorney general can’t point to a single action they recommended that he declined to take,” said Matthew Miller, Holder’s former spokesman at DOJ. “Eric Holder made fighting the opioid crisis a major focus, he strongly supported the DEA’S work in this area, and if the officials trying to now lay the blame at someone else’s feet had asked for more assistance, he would have given it, as he did in nearly every instance a law enforcement agency made such a request.”
Ten months after the briefing, Holder left the administration.
Unchecked outbreak