Record fentanyl seizures at border contributed to soaring overdose deaths in US

Fentanyl seizures by federal law enforcement inspecting goods and people attempting to enter the United States from abroad shot up over the past 12 months, more than doubling the record-high level confiscated a year earlier.

The surge in U.S. Customs and Border Protection seizures at the nation's border is closely connected to the surge of drug overdose deaths occurring deep inside the U.S., which also hit a new high this year as a result of the prevalence of opioids.

"If they're seizing a lot, it's because a lot is coming in — because you don't know the percentage of how much is coming through that they're actually seizing," said Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health, said fentanyl is easier to produce and transport than other drugs.

"Only a very small concentration of fentanyl is needed in order to produce a high. So, this makes it much easier to bring fentanyl across the border – in smaller, but more potent, quantities than other drugs," Volkow wrote in an email.

"Based on the number of drug seizures reported in 2020 for fentanyl, it appears that the illicit drug market did not suffer during the pandemic, but actually expanded," Volkow added. "Rising fentanyl availability, decreased access to addiction treatment, increased social and economic stressors, and overburdened health departments collided in 2020 and were associated with a tragic rise in overdose deaths."

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Fentanyl seizures at the border

From October 2020 through September 2021, CBP seized 11,201 pounds of fentanyl. The federal government estimates that one kilogram of fentanyl is equivalent to 500,000 lethal doses, making last year's seizure equal to 2.5 billion fatal doses blocked from making their way into the country.

Fentanyl made up less than 2% of the nearly 625,000 pounds of drugs seized nationwide at ports of entry and by the Border Patrol, as drugs such as marijuana, methamphetamines, heroin, and cocaine were found in higher amounts than fentanyl. Still, fentanyl smuggling is particularly noteworthy because it is highly addictive, far more expensive per gram than other drugs, and a top cause of drug overdose deaths nationwide.

"Throughout the pandemic, the dedicated employees of CBP have continued to fulfill the agency's border security role, seizing more than 10,000 pounds of fentanyl in FY 2021," a CBP spokesman wrote in an email. "The majority of these seizures have occurred in ports of entry where CBP's Office of Field Operations has seen a 400 percent increase in fentanyl seizures since 2018."

The large majority of the fentanyl came through CBP's Office of Field Operations, either found while being smuggled in by vehicles seeking to pass through land ports of entry or in international packages and cargo brought in through seaports and airports. Of 21 field offices nationwide, the San Diego regional office in Southern California stopped the most, seizing 6,354 pounds of fentanyl. San Diego was followed by Tucson, Arizona, with 2,268 pounds.

In one example, a tractor-trailer that presented for inspection while driving from the northern Mexican city of Tijuana into San Diego, California, was caught by port officials in August with 5,500 pounds of meth and 127 pounds of fentanyl powder hidden in a shipment of plastic household items.

Border Patrol agents who work between the land ports of entry confiscated just over 1,000 pounds of fentanyl. In one instance, Border Patrol agents working at an immigration highway checkpoint near Amado, Arizona, seized 53 pounds of fentanyl from a vehicle driving on Interstate 19 in mid-October.

How fentanyl from the border factors into overdoses

While the high amount of seizures might indicate that law enforcement is getting better at stopping it from getting into the country and that little is getting past federal police, the opposite is likely the case, according to Sharfstein.

In addition, the fentanyl that does get past border authorities is not necessarily coming across in pill form, though it is the most popular form it is smuggled in. Fentanyl is being added to other drugs, unbeknownst to users.

"People aren't overdosing on fentanyl because they want to die — for the most part, I assume. People are overdosing on fentanyl because they don't know how much fentanyl is in their product," said Dr. David Herzberg, author of White Market Drugs: Big Pharma and the Hidden History of Addiction in America and associate history professor at the University of Buffalo in New York.

Drug overdoses in the government's most recent full year, March 2020 through this past February, were greatly affected by the pandemic, which disrupted life and work patterns for every American. More than 96,000 people died as a result of a drug overdose, up 30% from the previous year, according to the National Center for Health Statistics. Opioids, followed by synthetic opioids, were the leading killers.

Fentanyl is a synthetic opioid that is up to 100 times stronger than morphine and 50 times stronger than heroin. The CDC found most fentanyl overdoses were from illicitly manufactured fentanyl or that which is made illegally and smuggled into the country by Mexican criminal organizations. Although fentanyl was originally created and still serves as a legitimate pharmaceutical drug used to treat severe pain after surgery and in advanced-stage cancer patients, it is the illegal version that is causing more deaths.

The fentanyl supply chain

China produces the main ingredient used to make the fentanyl that Mexican drug cartels are smuggling into the U.S.

Declaring a war on fentanyl through heavy enforcement has not worked in this epidemic or others in recent decades, explained Herzberg.

"When smoking opium was prohibited in 1909, the people who had been smoking opium switched to a drug that was easier to swap, which in that case was heroin. And so they switched from smoking a relatively weak form of opium, which can cause addiction, but it's relatively safe compared to injecting heroin," Herzberg said.

Similarly, shuttering supply chains, or the specific drug cartels responsible for supplying fentanyl, would not address the demand in the U.S. and elsewhere, Herzberg warned.

"I don't have a historical example of shutting down a supply chain that resulted in a drug not being available domestically for any substantial length of time," Herzberg said. "Start by making the product safer by making sure that people know what they're getting. And the only way to make it safer and to have people know what they're getting is to have it in some way, shape, or form, legal. ... There are ways that you can set it up so that the people doing the selling recognize their best interest is selling a product."

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Sharfstein pointed to fentanyl test strips as a top resource for people who use drugs to ensure they are not getting an unexpected dose of fentanyl. He also called for greater availability of the emergency drug antidote spray naloxone and for swifter admission into drug treatment programs for those seeking help.

"As we continue to address both the COVID-19 pandemic and the opioid crisis, we must prioritize educating people about the risks of fentanyl, mounting prevention interventions, and making treatment options more widely available to people with substance use disorders," Volkow said.

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