8 The Opioid and Fentanyl Crises as Systemic Issues

Throughout the entirety of the opioid and fentanyl crises, it has been a systemic issue, not an individual issue—and it remains this way.

This essay was composed in November 2024 and uses MLA documentation.

For years, many individuals have suffered from the effects of the opioid and fentanyl crises. In addition to overdose deaths, this suffering comes in the form of poor treatment policies and facilities, police brutality, and general misconstructions surrounding substance users. In this paper I present the opioid and fentanyl crises as systemic, not individual, problems. First, I discuss the history of and connections between the opioid and fentanyl crises. Then, I briefly explore laws surrounding substance use disorder and the ways government officials enact those laws. Finally, I present the solutions offered regarding police training and additional police officer support systems, drug testing strips (and their legalization), and harm reduction centers.

History

In recent years, there have been three distinct waves of illicit substances and consequential substance use in the United States. According to “Deaths of Despair” by David Berreby, a graduate of Yale University and an author, the first wave was with prescription opioids in 1999; the second was with heroin in 2010, after the government placed restrictions on prescription opioids; and the third is the current abuse of synthetic opioids, like fentanyl, which started in 2013. Beyond their historical connection, the three drugs—opioids, heroin, and fentanyl—are linked in the way that many addictions progress. Bara Vaida, a journalist for CQ Researcher, states that many individuals with substance use disorder first use prescription opioids, then move to heroin, then to fentanyl.

In 1996, Purdue Pharma, a pharmaceutical company credited with creating common opioids such as oxycontin and oxycodone, targeted the sales of opioids to lower class communities, where the primary doctors were not familiar with the intensity of the opioid hydrocodone. Because of this, these lower-class communities became large “hot spots” for opioid overdoses (Vaida). Many of the doctors in these areas were prescribing opioids for injuries, like broken bones, that could’ve been treated with other prescriptions. Consequently, in the same year, “the CDC recorded 9,838 accidental drug poisonings that resulted in death.” (Vaida) It wasn’t until nine years after the 1996 CDC report that Purdue Pharma was charged with providing misinformation about how addictive the marketed opioids actually were.

Having access to opioids for longer than necessary is what led to the start of the opioid crisis in 1999. Many large enterprises, both legal and illegal, started supplying the United States with a substantial amount of opioids (Berreby). After the opioid crisis, the government restricted the prescription rate of opioids in 2006 and continuously monitors the prescription rates. This restriction, however, caused a lot of strife for many people who were already dependent on the drugs for pain relief. As a result of the restriction many patients were turned away by doctors and left to deal with their pain alone.

Due to the government’s actions, many people who had previously been on opioids—whether for cancer, surgery rehabilitation, etc.—lost the treatment they were receiving. Vaida states, “We have reached a dangerous point, many patients are being turned away from doctors for pills and are in so much pain they consider suicide.” Many turned to other options of pain relief, such as other prescription drugs, alcohol, or heroin (Vaida). Transitions to illicit street drugs created the heroin, then fentanyl, crises. Drug traffickers filled the void of prescription opioids by pushing illegal drugs, especially among lower class citizens (Berreby).

Fentanyl is a synthetic drug that is made in labs, and it is more addictive than heroin, cocaine, and methamphetamines. According to “Fentanyl Crisis” by Steve Rhodes, an editor for CQ Researcher, after the fentanyl is made, it is pressed into pseudo prescription pills and smuggled into the United States. Fentanyl is then mixed with other drugs, like heroin and meth, as they are cheaper materials than the illicit drug itself and dealers are trying to extend their supply as much as possible (Rhodes). According to Vaida, “[Fentanyl] is known to supercharge the highs from drugs.” Because of the chemicals that make fentanyl so addicting, some individuals formerly addicted to other drugs will turn to seeking out fentanyl solely (Vaida).

Just like many other things were, the fentanyl crisis was exacerbated by the COVID-19 pandemic. According to Vaida, 13% of people “sa[y] they either tried illicit drugs for the first time or increased their usage of them” during the pandemic. This occurred due to the increase of job losses that coincided with the pandemic. While the United States was in lock down and social distancing mandates were in place, many who were in rehabilitation centers were forced to leave to comply with the mandates (Vaida). Additionally, harm reduction centers were also harder to access due to the social distancing mandate. Because of this, it made it a lot harder for individuals with substance use disorder to gain access to rehabilitation and/or clean materials (Vaida).

Laws

However, problems for people with substance use disorders began far before the COVID-19 pandemic. Throughout history, people who use drugs, especially those who are people of color, are often met with criminalization, brutality, and racism. In “Understanding Racial Inequalities in the Implementation of Harm Reduction Initiatives” by Andrea M. Lopez et al., the authors discuss that one of the biggest issues in the opioid crisis is punitive governance. Punitive governance is described as an ideology that punishment, safety, and justice are all entwined. Because of this ideology, many who may have drugs on their person or have taken drugs fear the brutality of the police. Similarly, people who use drugs were found to be wary to carry preventatives for overdoses such as Narcan and Naloxone, as they feared an officer would assume they were associated with drugs. Another of the many issues punitive governance causes is that it reduces how much those who use drugs trust harm reduction centers. In “Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions” by Callan Ellswick Fockele et al., scholars of medicine from the University of Washington, the authors state that in 2023 there was a bill to “increase criminal penalties for drug possession and public use.” My question is this: How do we expect drug-using individuals to become sober when there is no motivation for them to receive help?

Many police officers use their discretion when it comes to overdose situations. According to “Police Officers’ Perceptions of Their Role at Overdose Events: A Qualitative Study” by Jessica Xavier et al., scholars of population and public health from the University of British Columbia and Simon Fraser University, there were concerns from people who use drugs about police officer discretion. Police officer discretion is often molded by an officer’s “attitude” towards substance abuse. Given this discretion, it can cause problems such as lack of support or mistreatment of drug users. Contrarily, Xavier et al. states, “Substance use is being recognized as a health issue, rather than a criminal one, that requires public health measures.” In a study that was performed in Xavier et al.’s article, they asked officers their thoughts on policing and their roles in the opioid crisis. Many participating officers said they didn’t feel they need to be there for every overdose situation. The officers felt as though their only purpose at overdose scenes is for the protection of other first responders and bystanders. What is clear is that drug users are not considered in these responses. At the same time, people who use drugs have fears and anxieties about being arrested by the police, regardless of whether they have drugs on them. Many drug users said that they don’t like to carry Naloxone in the case they are caught with it, as it associates them with drugs, in which case they fear the police will arrest them for having Narcan or Naloxone. (Lopez et al.) People who use drugs are scared when they see someone who has overdosed or if they have overdosed themselves. They refuse to call the police for the same reason of not wanting to be arrested for taking drugs.

Solutions

When it comes to solutions for the crises there are many avenues and nuances to consider. As far as police officers, they need a larger support system. Police officers are required to “wear many hats”: they have to take on the role of medical professionals, social workers, and, of course, police officers, but they are only trained for one of those jobs (Xavier et al.). Many officers in the study conducted by Xavier et al. described that they are typically first on the scene of overdoses because medical personnel are spread thin and aren’t able to get there immediately. If officers are expected or required to perform jobs and tasks that they don’t have training for, it could cause anxiety and more stress on the job. It may not be far-fetched to believe that this added stress and anxiety could lead officers to make more stereotypical judgments of those who suffer from substance use disorder. I think it would be beneficial for officers and those they help on a daily basis if officers had more basic training in medical- and social work-related fields.

Officers had concerns over three main types of overdose intervention, according to a study that Fockele et al. conducted. The first concern regarded leave-behind Naloxone: they felt that more civilians would be treating the overdoses, in which cases the person who overdosed would not get the further medical attention they need. Along with this, giving Naloxone to a person who has overdosed and is unconscious can be dangerous, as it can make them violent (Xavier et al.). Another common intervention is Buprenorphine treatments. Buprenorphine minimizes the effects of withdrawal to make the withdrawal process easier for individuals and make it less likely that they will relapse (Fockele et al.). This treatment is, for example, given in medication form to those who are addicted to opioids to help them get clean. The concern with these two medications is that they have limited adaptability. The third most common intervention is HIV testing, though many officers felt as though HIV testing would seem coercive when given right after an overdose (Fockele et al.).

Among the officers participating in Xavier’s study, there were strong opinions that one of the best solutions we as a society could apply is focusing on “bolstering health and social supports” (Xavier et al.). Many officers felt that first responders are spread very thin, so adding that extra level of support would help them in the long run in addition to helping those with substance use disorder. Similarly, Stahler et al. state that more inter-organizations are desperately needed for treatment, healthcare, social services, criminal justice, and harm reduction centers. For example, there are some pharmacies that will sell clean needles. The issue many individuals have with this solution is pharmacies not being consistent (Lopez et al.). If more pharmacies took on this role of helping distribute clean materials, it could help with costs in funding harm reduction centers and help those who don’t have harm reduction centers near them.

One of the instituted solutions to the opioid and fentanyl crises is harm reduction centers. Harm reduction centers provide those who use drugs with clean materials and trained staff to minimize the risk of overdosing. When the officers who participated in Xavier’s study were asked about potential solutions, there were mixed feelings about harm reduction centers. One officer stated that harm reduction centers were “enabling…so over the top brutal that it’s just ridiculous” (Xavier et al.). Others saw the benefit in utilizing the centers. There have been many harm reduction sites implemented throughout the United States. Another intervention similar to the harm reduction is the syringe service program. According to Vaida, there have been around 375 syringe service clinics opened that have provided individuals with sterile equipment.

Another solution is the use of fentanyl testing strips. Several states have fentanyl testing strips and Narcan in vending machines that don’t cost money, so anyone who needs either resource can take what they need. The issue with this solution is when the vending machine is stocked, it is cleaned out extremely fast. Another issue with fentanyl strips is that many correlate the use of them with an encouragement to use illicit substances. On the other hand, in defense of fentanyl strips, The National Harm Reduction Coalition states that “because of the war on drugs and criminalization of people who use drugs, people often are unaware of the exact composition of the substances they’re using, [which] makes evidence-based harm-reduction strategies such as fentanyl test strips…and access to safe supply more vital than ever” (Rhodes). For those with substance use disorder, fentanyl testing strips are a necessary tool to know whether the drugs have been laced with fentanyl, as it is incredibly hard to know what the drugs contain. However, in many states, fentanyl testing strips are considered illegal as it alludes to the assumption that an individual has illicit drugs.

In Xavier’s study with the police officers, there were several officers who felt that involuntary treatment or the ability to force or coerce individuals with substance use disorder into mandated treatment was the best solution (Xavier et al.). There are many issues with this solution, as I believe that it wouldn’t be as effective in stopping the crises as other solutions. This solution would also take more workers and would likely be less cost efficient. Some officers also believed that increased and longer sentencing for drug related crimes would be a better solution (Xavier et al.). This solution would not be very cost effective, as prisons would fill up quickly and empty slowly, which would encourage the building of other prisons. In addition, prison doesn’t guarantee an individual’s desire to stop using drugs; they could easily relapse after being released. I think longer sentencing would exacerbate the issue due to substance users’ fear of police officers—and why upend someone’s life for minor offenses?

Throughout the entirety of the opioid and fentanyl crises, it has been a systemic issue, not an individual issue—and it remains this way. The opioid and fentanyl crises were created out of a lack of oversight and planning by pharmaceutical companies, and were perpetuated by a widespread belief that substance users were inherently bad, didn’t want help, or lazy. In order to continue to make progress in stopping the opioid and fentanyl crises, we need to make drastic changes, such as additional training and support to help our first responders. We also need to change outlooks on those who suffer from substance use disorder.

Works Cited

Berreby, David. “Deaths of Despair: Why are So Many Americans Without College Degrees Dying Prematurely?” CQ Press, 27 Jan. 2023, https://doi.org/10.4135/cqresrre20230127.

Fockele, Callan Elswick, et al. “Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions.” Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, vol. 25, no. 4, June 2024, pp. 490–99. EBSCOhost, https://doi-org.dist.lib.usu.edu/10.5811/westjem.18033.

Lopez, Andrea M, et al. “Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives.” American Journal of Public Health, vol. 112, no. 6, 2 Sep. 2022, widgets.ebscohost.com/prod/customerspecific/mel/auth.php?database=eb.

Rhodes, Steve. “Fentanyl Crisis: Can This Opioid Epidemic Be Curtailed?” CQ Press, 17 Jan. 2024, https://doi.org/10.4135/cqr_ht_fentanyl_2024.

Stahler, Gerald J, et al. “At the Crossroads in the Opioid Overdose Epidemic: Will EvidenceBased ‘Radical’ but Rational Drug Policy Strategies Prevail?” American Journal of Public Health, vol. 113, no. 7, 15 Apr. 2023, doi:10.2105/AJPH.2023.307320.

Vaida, Bara. “Opioid Crisis: Can the Tide be Reversed?” CQ Press, 6 Aug. 2021, https://doi.org/10.4135/cqresrre20210806.

Xavier, Jessica, et al. “Police Officers’ Perceptions of Their Role at Overdose Events: A Qualitative Study.” Drugs: Education, Prevention and Policy, vol. 30, no. 4, pp. 361–372. Taylor & Francis Group, 03 May. 2022, widgets.ebscohost.com/prod/customerspecific/mel/auth.php?database=eb.