Updated November 21, 2024 at 08:23 AM ET
Over the last four years, as street fentanyl overdose deaths surged, the Biden administration scrambled to fund addiction treatment programs and expand use of opioid-treatment medications like buprenorphine and naloxone. There are signs those efforts may be helping, with fatal overdoses dropping 14.5% over the last year.
But during the campaign that led to President-elect Donald Trump's victory, he promised a very different approach, cracking down on fentanyl smugglers, securing the U.S.-Mexico border and executing drug dealers.
"You know, I'd like to end the drug epidemic, if that's okay," Trump said.
After the election, the man Trump named to serve as border czar threatened U.S. military action against Mexican drug cartels. Tom Homan said in a Fox News appearance the new administration will use "the full might of the United States special operations to take them out."
Critics say there's no indication Trump's efforts to secure the southern border during his first term were effective in stopping fentanyl. Studies show nearly ninety percent of people convicted of fentanyl smuggling are U.S. citizens, not migrants or Mexicans as Trump has suggested.
"Everything got worse. The drug supply got worse and [fentanyl] became more readily available," said Kassandra Frederique, who heads an organization called the Drug Policy Alliance that supports the decriminalization of addiction.
Still, many addiction experts said Trump's tough talk — and the promise that his second term will bring a quick fix to the fentanyl crisis — appealed to voters at a time when 96,000 people in the U.S. are still dying from drug overdoses every year.
"People are tired of the theft, they're tired of the open drug use and they want some accountability," said Tom Wolf, an activist in California who is in recovery from opioid addiction.
Keith Humphreys, a prominent drug policy researcher at Stanford University, agrees. He said there is a public perception that Biden era policies, treating fentanyl as a medical problem that should be "destigmatized" went too far.
"I think there's a bit of a backlash to the idea of seeing drug use as sort of an inalienable right," Humphreys said.
From Drug War to quagmire?
But even many addiction experts who want a tougher response to the fentanyl epidemic voiced concern at the Trump team's rhetoric. Wolf said he fears the new administration could pivot too aggressively away from treatment and public health toward a full-scale drug war.
"I'd like to see the pendulum stop in the middle," Wolf said. "We all know the drug war of the 1980s was over draconian and as a result it failed."
Some of Trump's most aggressive proposals have sparked alarm from drug policy analysts, who said they would do more harm than good.
"Even invoking the idea of military action in Mexico against traffickers is the worst idea anyone has ever had," said Jonathan Caulkins a researcher at Carnegie Mellon University. "If that is anything other than empty rhetoric, it is plain stupid."
Many experts believe U.S. military action against the cartels, which Trump also proposed during his first term, would do little to slow fentanyl smuggling or save American lives, but could shatter diplomatic relations and destabilize Mexico.
"It's quite difficult to control fentanyl because it's so easy for the illegal supply chains to produce and distribute it," Caulkins said.
Experts say cartels or other drug gangs can easily rebuild illegal drug labs after they're destroyed and can operate from almost any location. A recent investigation by CBC News found fentanyl production in Canada has already surged, with a growing number of "superlabs" now operating north of the U.S. border.
In a critique published, last week, the libertarian Cato Institute said launching military strikes inside Mexico to target fentanyl production would lead to a "quagmire" without stemming "the flow of drugs across the U.S. southern border."
Experts have also condemned Trump's plan to implement the death penalty against drug dealers, pointing out that many people experiencing addiction in the U.S. also traffic and sell drugs to support their habit.
"There are thousands, if not hundreds of thousands, of Americans who are our neighbors who are doing something illegal, dealing drugs," said Brandon Del Pozo, a former police chief who studies drug policy at Brown University.
"The idea we might execute them? That shocks the conscience."
Some experts said they believe Trump might implement more moderate drug policies, toning down his approach now that the political campaign is over.
"You have very tough rhetoric, but then the actual policies are more of a bipartisan consensus which really is a balanced policy," said Kevin Sabet, a long-time addiction policy researcher.
Sabet noted that Trump signed a bipartisan measure in 2018 that increased funding for some drug treatment programs. "I actually come at this with a sense of hope," he said.
But Frederique with the Drug Policy Alliance predicted Trump will attempt to implement many of his most aggressive ideas in hope of a quick end to the crisis.
"Someone is saying to you that we will just turn off the faucet, cut off the supply chain, arrest all the people and then we won't have to deal with this anymore," Frederique said. "While that can be attractive to people, it's a mirage."
Fentanyl deaths are dropping. Will that last?
Another reason many experts voice concern over Trump's apparent pivot toward a fentanyl crackdown is the growing evidence that the Biden administration's public health approach may finally be helping.
Drug deaths dropped sharply over the last year, a trend that saved about 16,000 lives according to the Centers for Disease Control and Prevention.
"The latest data show that our efforts are working," said Dr. Rahul Gupta, head of the White House Office of National Drug Control Policy. "Every life saved means one less grieving family and community."
Researchers are divided over why drug deaths are dropping so rapidly. Some believe street fentanyl reaching the U.S. may be less potent, increasingly diluted with other chemicals that come with serious long-term health risks but trigger fewer fatal overdoses.
Keith Humphreys at Stanford University said it would be a mistake for Trump's team to cut programs developed by Democratic administrations, including the Affordable Care Act, that appear to be helping.
"My fear would be that [Trump] continues chopping away at the Affordable Care Act and Medicaid, which are the financial backbone of the American addiction treatment system," Humphreys said.
Vanda Felbab-Brown, a drug policy expert at The Brookings Institution, said what's needed now is even more healthcare in Black, Native American and rural white communities that remain highly vulnerable to fentanyl overdoses.
"That would take require sustained special focus by the next administration and it's not clear there's any thinking along those lines," Feldbab-Brown said.
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