Anti-opioid campaigners in the US have welcomed Donald Trump’s threat to hit Mexico, China and Canada with increased trade tariffs if they do not curb the smuggling of the powerful drug driving the US opioid epidemic.
Families and doctors grappling with a crisis that has claimed about 900,000 lives say the move may signal that a second Trump administration will finally get serious about tackling the flow of fentanyl into the US. But they also warn that much more needs to be done to reduce demand for opioids and to rein in the power of the pharmaceutical industry which created the epidemic.
Trump said last week that he will issue an executive order on his return to the US presidency next month imposing a 25% tariff on goods from Mexico and Canada until their governments clamp down on the smuggling of fentanyl and other drugs into the US, and on people crossing the northern and southern borders illegally.
The president-elect also said he will impose a 10% additional tariff on imports from China as the leading manufacturer of the precursor chemicals used by drug cartels to manufacture fentanyl, a highly potent synthetic opioid that is now the single largest cause of drug overdose deaths in the US.
Ed Bisch, who lost his 18-year-old son Eddie to a prescription opioid overdose in 2001, said that tariffs are a sign that Trump “means business”.
“I’m optimistic that the threat of substantial tariffs will lead to major cooperation in reducing the fentanyl poisoning of America,” he said.
Bisch and other campaigners also say that some of Trump’s cabinet choices may signal a greater engagement with the crisis by the next administration, particularly as Robert F Kennedy Jr, who is nominated as health secretary, was a heroin user and the vice-president-elect, JD Vance, wrote a bestselling book, Hillbilly Elegy, about growing up in a household and region hit by drug addiction.
Trump campaigned in 2016 and again this year on commitments to tackle the opioid epidemic which has devastated regions of America in ways that are often unseen in other parts. The crisis dragged entire communities deeper into poverty, drove up crime and greater dependency on welfare, and tore families apart.
Millions of children have been raised by their grandparents because the intervening generation was imprisoned, dead or in no condition to parent. In West Virginia, the state worst hit by the epidemic, nearly half of all grandparents are raising their grandchildren.
The opioid crisis has also played an important part in undermining public confidence in government institutions and medical practice in parts of the US because the epidemic grew out of the pharmaceutical industry pushing the wide prescribing of narcotic pain killers from which drug makers made billions of dollars with the complicity of the Food and Drug Administration (FDA). The epidemic then evolved as illegal supplies of heroin and then fentanyl drove up the death toll.
But critics say Trump failed to follow through on his campaign promises in 2016 and his next administration will be a test of how really committed is he is on the issue in the face of what is likely to be major pushback from the drug industry.
As president in 2017, Trump declared the opioid crisis a public health emergency.
“No part of our society, not young or old, rich or poor, urban or rural has been spared this plague,” he said at the time.
But two years later, the Government Accountability Office (GAO) criticised the Trump administration for a lack of coordination of efforts and failing to fulfill a legal requirement to issue a national drug control strategy.
Robert Kent, who served as general counsel for the White House office of national drug control policy under Joe Biden, credits Trump with declaring the epidemic an emergency and establishing an opioid commission that issued guidelines on how to combat the crisis.
“In Trump’s first term, he was the one who declared an opioid public health emergency, which is still in effect. The problem was there were no concrete actions taken specifically as a result. He didn’t put significant new resources into it,” he said.
Kent said that the Biden administration put a greater emphasis on “harm reduction” such as the provision of overdose antidotes and test strips allowing drug users to detect fentanyl. But he fears those may be in danger from Republicans who see such measures as enabling drug use.
Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing and one of the first doctors to raise the alarm about the dangers of mass prescribing prescription painkillers, said harm reduction was necessary but did not get to the root causes of the epidemic.
“It’s not hard for Trump to do better than Biden did on opioids. There were some good things that came out of the Biden administration. It was nice to see the federal government move more in a direction of harm reduction. But beyond that there wasn’t really that much done so by Biden,” he said.
“When Biden ran for office, he put out a platform on how he would address the opioid crisis if he was president, and it was an excellent platform. But he never really implemented the plan.”
Kolodny said that if Trump wants to have a significant impact in reducing opioid addiction he needs to create cheaper and easier access to treatment.
“The vast majority of people with opioid use disorder actually want help for it. The reason they keep using fentanyl is that it’s much easier to get fentanyl and cheaper to get fentanyl than it is to get yourself onto buprenorphine or methadone treatment or find a doctor or programme that will very quickly enroll you in treatment when you ask for it,” he said.
Researchers are still trying to decipher a drop in overdose deaths in the US last year. They believe better treatment and prevention are playing a part. The Drug Enforcement Administration said earlier this month that the amount of fentanyl found laced into other drugs had dropped and that they were therefore less potent and dangerous. The DEA head, Anne Milgram, attributed that to the Biden administration’s targeting of Mexican cartels and their supply chains.
But Kent is cautious.
“There’s a lot of people running around because we’ve seen a slight reduction in overdose deaths feeling like that’s mission accomplished when we’re only losing 93,000 people versus 111,000 a year. I would never define that as success in my world. Even within those numbers, underserved communities are being higher impacted at this point. In Black and brown communities the numbers are going up while the other numbers are going down. So there’s work to be done,” he said.
Kent said he agrees with the need for an increased focus on the border.
“We need to increase the number of staff at the border, just for a whole bunch of reasons, including illicit drugs coming across. There needs to be an investment in screening technology. And there needs to be a continued effort with China, trying to convince China to work with its chemical companies to stop selling the chemical precursors to the Mexican cartels so they can create the fentanyl,” he said.
Bisch and others whose lives have been hit by the opioid epidemic are also keen to see broader reform of a system that enabled the drug companies to push mass prescription of opioids on the public in ways not permitted in other countries.
Bisch supports Trump’s nomination for attorney general, Pam Bondi, who as Florida’s attorney general cracked down on doctors and “pill mills” churning out opioid prescriptions to anyone who would pay. In 2010, Florida dispensed more opioid prescriptions than every other US state combined as people travelled from across the country to buy the painkillers in bulk. Bisch wants to see Bondi use federal laws to prosecute the drug company executives who made false claims about the safety of prescription opioids in order to get them approved.
He also backs Trump’s nomination of Kennedy, who has accused the FDA of putting the financial interests of the pharmaceutical industry ahead of people’s health by effectively encouraging the prescribing of too many drugs and the selection of Marty Makary to head the FDA. Makary has said doctors in the US prescribe too many medications compared with the rest of the world.
“The best way to lower drug costs in the US is to stop taking drugs we don’t need,” he told the US Senate in September.
In nominating Makary, Trump said the “FDA has lost the trust of Americans and lost sight of its primary goal as a regulator”. He said Makary and Kennedy would work together to “properly evaluate harmful chemicals poisoning our nation’s food supply and drugs”.
Bondi is expected to have a relatively easy path to approval by the US Senate. But Kennedy and Makary may face a more difficult time. Kennedy, in particular, will face scrutiny over his rejection of vaccines. But Kolodny said they will also be up against the pharmaceutical industry.
“I’ll actually be shocked if Kennedy gets confirmed and if Makary gets confirmed for FDA commissioner because big pharma doesn’t want them, and big pharma has a lot of muscle on Capitol Hill,” he said.
