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Feb. 10, 2025 15:30-16:00 - CSPAN
29:55
LIVE U.S. House of Representatives
Participants
Appearances
t
tammy thueringer
cspan 02:23
|

Speaker Time Text
unidentified
Our keynote reconvene here at 245.
Thank you.
On Tuesday, the chair of the Federal Reserve, Jerome Powell, gives an update on the economy and monetary policy before the Senate Banking, Housing, and Urban Affairs Committee.
His first appearance in front of lawmakers since the 119th Congress began in January.
We'll have live coverage at 10 a.m. Eastern on C-SPAN 3, on C-SPAN Now, our free mobile video app, and online at c-span.org.
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tammy thueringer ▲ ● ▼
Joining us now to discuss the fentanyl crisis in the U.S. is Dr. Jeffrey Singer.
He is a health policy studies senior fellow at the Cato Institute.
Dr. Jeffrey, or Dr. Singer, thank you so much for being with us.
unidentified
Thank you for having me.
tammy thueringer ▲ ● ▼
Why don't we start by having you talk about your background both as a practitioner and also as a health policy researcher at Cato?
unidentified
Sure.
Well, I'm originally from New York, as you could probably tell from my accent, but I've been in Arizona now for 45 years, and I've been practicing in private practice as a general surgeon for about 40 years.
And I'm also a senior fellow at the Cato Institute, where I work in the Department of Health Policy Studies.
The Cato Institute is a 501c3 nonprofit, non-partisan, libertarian think tank that develops public policy proposals based on the principles of individual liberty, limited government, free markets, and peace.
And I work in the health policy space there.
tammy thueringer ▲ ● ▼
Much of your research has focused on the fentanyl epidemic.
Where are we in this public health battle?
unidentified
Well, if the research holds, we're not anywhere close to seeing things get significantly better.
A study came out by the University of Pittsburgh School of Public Health.
It was published in 2018, where they were able to get data from the CDC going way back into the 1970s.
And what they demonstrated was, looking at the data, that the overdose rate from non-medical use of drugs has been on a steady exponential increase trend since at least the late 1970s.
The only thing that's changed is that at different points in time, different drugs are predominating among those drugs as the principal cause of overdose deaths.
So, for example, in the early 2000s, the principal cause of overdoses was diverted prescription pain pills that found their way into the black market and that recreational users like to use.
Then, as the policy establishment and the political establishment wrongly blamed it on doctors over prescribing prescription pain pills and clamped down on prescription on prescribing, which prescribing levels are now at 1992 levels, then the people using non-medically migrated first to heroin and then heroin got mixed in with fentanyl and then it became fentanyl.
And we'll see what's next.
But it's generally been on a steady increase.
Now, it spiked during the COVID pandemic, along with alcohol use and other substance uses.
You know, a lot of factors involved there, including the fact that because of border closures and supply chain issues, it was difficult to ship, grow, and ship opium, which is processed into heroin.
So the drug trafficking organization switched out to fentanyl, which they could synthesize easily in their lab.
And fentanyl is much more potent and potentially deadly than heroin.
So that also contributed spike.
Now that the pandemic has passed, we're starting to see an ebb in the overdose death rate.
We're also starting to see a return of heroin into the drug supply.
So that may also be contributing.
And we also have seen a lot of states and even federal policies start to accept harm reduction strategies, which have helped also to reduce deaths.
But we're still at just under $100,000 a year, which is amazingly high.
And if we continue our restrictionist sort of doubling down on the drug war, then I would predict it's just going to continue either at the same level or higher level.
tammy thueringer ▲ ● ▼
Dr. Singer, you mentioned some of the causes and not causes for the crisis.
Remind our viewers what exactly fentanyl is and what we know about how it impacts the human body.
unidentified
Okay, well, first of all, just a little bit of nomenclature.
So there are opioids and there are opiates.
That's O-P-I-A-T-E-S.
Opiettes are derived directly naturally from the opium plant.
So codeine and morphine are opiettes.
Opioids are opiates that have been chemically modified to get a certain desired result.
So for example, dilaudid, which people have commonly taken, or oxycodone or hydrocodone, vicodin or norco.
These are opioids.
They use the original natural substrate of morphine and they make additional molecule, they add additional molecules to get a desired result.
And those are called semi-synthetic opioids because they still have some of the natural part.
And then there are completely synthetic opioids that don't require the plant at all and they could just be made in a test tube.
Fentanyl is one of them.
Fentanyl has been around since the 1970s.
We use it every day.
It's a very important drug.
It rapidly reduces pain and wears off quickly.
We use it in anesthesia.
If anyone has had a general anesthetic or even a procedure where they had intravenous sedation, they likely receive fentanyl.
We give it to patients recovering in the recovery rooms post-op and intensive care.
And we even have fentanyl skin patches.
One of the brand names is Duragesic that we've been giving to patients for decades, where you put a patch on your skin and over about 72 hours, a small dose slowly gets absorbed.
And that usually reduces your requirement for oral pain pills because you got that sort of in the background supplementing any pain pills you'll have.
So it's a very useful drug.
There are also what we call fentanyl analogs, which are modifications of fentanyl, slightly different than fentanyl.
And there are a few of them that we use in the medical field, mostly in anesthesia.
Alfentanyl, Sufentanyl, Remifentanil.
Now, in the black, just like methamphetamine, which by the way is a legal prescribed drug, was developed to treat ADHD.
And the brand name of the original methamphetamine brand name was Dezoxin.
We still prescribe it occasionally, even though there are more popular, like Adaral is more popular.
But like that, fentanyl can be made in a lab, in an underground lab, and then sold on the black market.
So that's why it's important to distinguish between fentanyl and illicit fentanyl.
tammy thueringer ▲ ● ▼
And our guest for the next 35 minutes or so is Dr. Jeffrey Singer.
He is a health policy studies senior fellow at the Cato Institute.
He's joining us for our discussion on the fentanyl crisis in the U.S. If you have a question or comment for him, you can start calling.
And now the lines are regional for this.
If you are in the Eastern or Central time zone, it's 202-748-8000.
If you're in the Mountain or Pacific, it's 202-748-8001.
There's also a line.
If you have been impacted by the fentanyl crisis, you can call 202-748-8002.
And Dr. Singer, you mentioned that it can be made.
The illicit version can be made chemically.
Once it's made, how does it get into the U.S. legal or illegal crossings?
And which borders are we looking at?
unidentified
Okay, well, first of all, it's very easy to synthesize.
And once it's made, according to the data from the government, roughly 90% is smuggled in by legal U.S. citizens or residents, mostly in cars and trucks, through legal border crossings, not through the illegal entry points.
And it doesn't just come in through the southern border crossings.
It comes in through the airports.
It comes in through the mail.
It occasionally comes in through the northern border crossings.
It's so powerful, and that's why it's gotten popular for the drug trafficking organizations to use that a very small amount can be hidden very easily.
Most dogs at border crossings are not able to smell fentanyl, so it's easy to smuggle through.
And a lot of people think that the illegal migration across illegal border crossing areas is related to this, but that's actually a mistake because, like I say, the government's own data shows that most of it comes legally.
And think about it.
If you were in the drug trafficking business, it makes much more sense, especially considering the billions of dollars that this brings you for sales on the black market.
It makes much more sense to pay a handsome sum to some U.S. citizen who will then drive it through the border and deliver it as directed to someone on the other side and will not be suspected at all by law enforcement than it is to trust somebody who is trying to maybe migrate up to the United States through Central or South America or elsewhere and put some of it in their backpack and tell them when you get across to the other side,
make sure you hand it over to somebody.
I mean, it just makes no sense.
It makes much better business sense to spend that money on hiring people to do it.
The precursors to make fentanyl originally were mostly coming from labs in China, but as pressure has been placed on the Chinese government to put pressure on these labs that are making the precursors, they're now coming from a lot of other places.
So we're seeing them made in India.
And these are from the Drug Enforcement Administration reports on this, that they're coming from India, from Myanmar, from parts of Southeast Asia.
And just recently, we learned that there are Canadian quote-unquote super labs that are making fentanyl directly, the precursors and the fentanyl.
Most of them, those super labs are shipping it to drug traffickers in Australia and New Zealand.
But some is coming south of the border in the United States.
The point is that when you have drug prohibition, the opportunity to make money by set, and remember, this is not, people seem to talk about it as if, you know, drug trafficking organizations south of the border launch missiles into the United States that explode and release fentanyl into the air that then goes, you know, looking around for people to go into and kill.
That's what they say.
They're sending fentanyl in here.
They're poisoning our country.
No, we have drug prohibition.
And just like with alcohol prohibition, as long as there's a market and there are people who want to buy it, the market is going to be met.
And there's a term we use in the policy world called the iron law of prohibition, which is the harder the enforcement, the harder the drug.
Prohibition incentivizes the drug traffickers to come up with more potent forms of the drug that are easier to smuggle in smaller sizes.
And once you've taken the risk of smuggling them, you could subdivide into more units to sell so you get more bang for the buck.
During alcohol prohibition, we weren't smuggling in beer and wine into this country.
They were smuggling in whiskey.
And in fact, there's a real-life example of the Iron Law prohibition.
It probably happened yesterday during the Super Bowl.
When people are tailgating in football games, they're drinking beer and wine in the parking lot, but you're not allowed to bring any alcohol into the stadium.
Most people don't smuggle in beer and wine.
They smuggle in the hard stuff in flasks.
So it's our drug war actually that is making this happen.
So when the source of prescription pain pills that found their way into the black market dried up, the users were then sold heroin.
And then around 2012, the traffickers realized that if they add a little bit of fentanyl to the heroin, it'll make it more potent so they can smuggle it in in tinier packages.
And so it started appearing in heroin in around 2012 and gradually increased in amount.
And we saw this originally show up in the eastern part of the United States and work its way west because the eastern part, most of the heroin smuggled in was called white powder heroin from places like in Afghanistan and Asia.
And that's easier to mix fentanyl in with, whereas the heroin coming in from south of the border is mostly black tar heroin, which you can mix it in with, but it's more difficult.
But that's why it made its way in that direction.
So by the time the COVID pandemic hit, there were supply chain problems.
The ingredients to make heroin, because you have to convert morphine to diacetyl morphine, which is heroin.
And you need acetic anhydride.
And that was, there was a backlog in the supply chain for acetic anhydride, which by the way is used for other things like making aspirin.
And it was also getting difficult to ship opium around the world because of all the border closures due to the pandemic.
So the cartels switched to fentanyl because that was easier to make and an abundant supply.
And then for a few years during the pandemic, that was almost exclusively the opioids smuggled into this country.
So many non-medical users of, let's say, heroin, they weren't necessarily thrilled that they were getting fentanyl because it's a completely different experience.
But they had a dependency and they took what they can get.
And then over time, their tastes would change and they start to like fentanyl.
Now that those problems have abated, we're starting to see heroin reappear again because we have a very healthy black market.
And if there's a demand for heroin, the demand will be met.
So there was just a report in Axios about a month or so ago that we're seeing a big boom in heroin again in the United States.
tammy thueringer ▲ ● ▼
We have callers waiting to talk with you.
We'll start with Jim in Texas on the line for Impacted by the Fentanyl Crisis.
Good morning, Jim.
unidentified
Good morning.
I just want to start out.
People may be surprised that whether you are prescribed opioids for chronic pain or whether you're recreational use, the rate of developing severe opioid use disorder is about 7%, regardless of which of the populations you're part of.
So I think most people think that if you use opiates even one time, you're probably going to turn into an addict.
The other thing is, I mean, we have created the crisis, the fentanyl crisis, because of, you know, started out with trying to reduce prescriptions and then rescheduling of Hydrocoda and things like that.
And when you think about it, if 8%, 8.5% of the adult population suffers from chronic pain, this has a huge impact.
There's a lot of people out there that unnecessarily, you know, either go to illicit drugs, heroin, fentanyl, simply because it's become unaffordable to go through the rigmarole of going to pain management doctor, which in fact I'm currently driving to a pain management doctor right now.
Now, I've had chronic back pain for decades.
It used to cost me about $300 a year, everything, doctors, prescriptions, whatnot, to address my chronic pain.
Now, it's costing over $100,000 a year.
Now, of course, I don't pay all of that.
The VA covers most of that.
So you may have your comments on that.
And what is the solution?
Do we reschedule the drugs?
I don't think we make them all legal, but let me hear what you have to say.
Thank you.
Okay.
Thank you, Caller.
Well, first, I want to correct you about the addiction rate.
Actually, this is government data.
If you could check out my blog post, I've written about this a lot.
According to the Substance Abuse and Mental Health Services Administration, which conducts the National Survey on Drug Use and Health, they've been tracking the addiction rate to prescription pain pills, for example, for adults aged 18 and over since 2002.
And the addiction rate to prescription pain pills for adults has never been higher than 0.8%.
The population's growing, so 0.8% may become a bigger raw number, but it's never been more than 0.8%.
And they've also tracked that for heroin and for other opioids.
And it's all less than 1%.
I know you're not supposed to say that because they've had a lot of movies on Hulu and Netflix suggesting that that's not true, but you could go to the website of the National Institute on Drug Abuse and find out for yourself.
And opioid use disorder is a broad term.
So there's addiction, which comes under that umbrella.
And addiction is defined as compulsive use despite negative consequences.
And you see that with alcohol use disorder, gambling addiction.
So in other words, even though you want to stop, it's an underlying compulsive behavioral disorder that makes you continue to do it and you know it's harming you.
Also under the umbrella of opioid use disorder is dependency, which is a completely different thing.
Opioids are a kind of drug that when you've taken them steadily for a couple of weeks, then your body adjusts physiologically.
And if you suddenly stop taking it, you can go into a withdrawal reaction.
And that comes under opioid use disorder as well, but you really don't have this compulsive disorder.
So I've had surgical patients who were critically ill in intensive care for weeks and they became dependent on the morphine they were getting intravenously.
And we just tapered them off of it gradually over a couple of months to avoid withdrawal.
And then they never craved it.
They never felt that they needed it again.
And there are a lot of other drugs, by the way, that cause dependency, including antidepressants, beta blockers, which are commonly prescribed for high blood pressure.
If you abruptly stop that when you've been on it for a while, you could actually get a fatal withdrawal relax.
You could have a stroke or a heart attack.
So dependency and addiction are two different things.
Now, as far as the pain management issue is concerned, unfortunately, because our policymakers have wrongly concluded that this is all the fault of doctors treating pain.
And to be honest, there have been some dishonest doctors out there who are using their medical degree to sell prescriptions.
And some of them are high-profile cases.
Of course, I don't blame that on the chemical.
I blame it on prohibition because you could make a lot more money selling prescriptions for painkillers than you can taking care of a patient in your office because prohibition makes it a very lucrative business for people who want to be dishonest.
So anyway, because of that, doctors have been put under pressure by law enforcement, by state laws, and they're afraid to prescribe pain pills now.
And in fact, the latest data show that we're now prescribing at below 1992 levels, which is back in the days when the National Institute on Drug Abuse was urging us to prescribe more because they said we were under-prescribing.
And the overdose rate, of course, has gone up.
So a lot of pain patients, you know, not only have we obviously not done anything to reduce the overdose rate by doing this, but we made a lot of pain patients go untreated or be abruptly tapered by their doctors who are afraid they'll get a visit from law enforcement.
And some of them in desperation are going to the black market to get their supply.
And the dangers of the black market are that you don't know what you're going to get.
So you may think you're purchasing oxycodone, which is what you usually use, but it could turn out that it's counterfeit and it's fentanyl.
And that's happening all too frequently.
Also, a lot of pain patients are committing suicide.
There's been a doctor Stefan Kertesh at the University of Alabama, Birmingham, has been keeping track of that.
I hope that answers your question.
tammy thueringer ▲ ● ▼
And Dr. Singer mentioned a blog post.
You can find his writings online at cato.org.
We'll go next to Heather in Canton, Ohio, line for impacted by the fentanyl crisis.
Good morning, Heather.
unidentified
Good morning.
I have a question.
My brother is a fentanyl addict, and he is insane.
Even if he doesn't have it, he still thinks that he's getting zapped, like if he touches metal.
He actually, he mutilated himself down there, thinking that he had bugs in it.
And I'm wondering if he'll ever be okay again.
I really feel terrible about what your brother is going through.
He may have some underlying psychological disorder as well as addiction to the fentanyl.
So it's hard for me to say without getting familiar with his case.
But some people turn to drug use as a form of self-medication for whatever underlying mental health condition they have.
So that may be part of your brother's problem.
It's rare for just using an opioid continuously.
I'm not aware of it causing you to develop psychosis.
It's not been associated with that.
tammy thueringer ▲ ● ▼
Let's hear from Dennis, also in Ohio on the line for impacted by fentanyl crisis.
Good morning, Dennis.
unidentified
Hey, good morning.
Hey, I'm calling.
The reason I'm calling is because Trump can do anything he wants to do to try to stop this, but the American people are hooked on illegal drugs.
They want it.
So they're going to do anything they can to get it, which of course, if they can't get it the way they want, our crime rate goes up and it's just a huge problem.
I don't know how you're going to solve this.
Even if he tries to stop coming through the border, American people want these drugs and they're going to do whatever they can to get them.
So what do we do?
That's right.
That's what we, well, in 1920, when we instituted alcohol prohibition, we had a whole lot of people dying from tainted bootleg alcohol.
We had a whole lot of corrupt politicians.
We had the growth of organized crime.
We had a crime wave in cities where gangs were fighting over territory for distribution of alcohol.
And we kept tightening up the border.
This time, the border was coming through the northern border where whiskey was made in Canada.
And finally, in 1933, we got smart and said, you know what, this was a bad idea.
Let's make it legal and regulate it.
So now, for example, when I go to my drug dealer, which is the nearby liquor store here in my area of town, I happen to like bourbon.
And when I go to the aisle that has bourbon on the shelf and I look at a bourbon bottle that says 45% alcohol, it never even enters my mind that maybe they're lying to me.
Maybe it's 50% alcohol.
Maybe it's got fentanyl in it.
That's because it's legal.
And if a teenager goes into that store, the retailer is going to seek ID to make sure the teenager is 21 or over because the dealer doesn't want to lose his liquor license.
So that's a good way to keep it.
It doesn't work 100% of the time.
There's always fake IDs and things, but it's a good way to reduce access to young people.
So the answer is that we need to end the war on drugs.
As long as people are going to want this, a healthy black market will exist and organizations will always find a way.
You could put walls on borders.
You could do all sorts of things, but it's sort of like water going downhill in a brook.
You could add boulders to different parts of the brook, but the water is going to find its way around the boulders and trickle downstream because gravity takes the water downstream.
So that's, and like I said, the iron law prohibition.
The harder you enforce it, the more you're ensuring the fact that something even more deadly and dangerous is going to come around.
For example, in the last couple of years, we've all heard that the cartels have been adding the veterinary tranquilizer, xylosine, to fentanyl.
I think the DEA reported about a year ago that 23% of seas fentanyl had xylosine in it.
The users referred to as trank.
That's not even an opioid, so you can't reverse it, but it potentiates the effect of the fentanyl.
So again, you could smuggle it in smaller sizes.
And now there's another synthetic opioid, not in any way chemically related to fentanyl.
The category is called nitazines.
It was actually developed in the 1950s by a company that's now called Novartis, but never brought to market.
And since around 2019, it's been making its way into the black market.
In fact, at the end of 2023 in the UK, they were reporting that there was a huge amount of nitazine showing up in the black market there.
And it's been reported in toxicology studies here as well.
It's just not a lot of labs are aware of it, so they're not all testing for it.
So if it gets too difficult to make fentanyl, the cartels will then move over to nitazine.
There's always going to be something else.
So my answer would be the ideal solution would be to end the war on drugs, treat these.
These are randomly decided to be illegal.
Cocaine was legal.
It was put in Coca-Cola and Moxie up until 1914.
Starting in 1914, we decided to make certain types of drugs federally illegal, and that's when the problems began.
And if we'd only learned the lessons that we learned with alcohol prohibition and make it legal and regulated, That would put the cartels, they'll have to go in.
Well, they're already in multiple other lines of work anyway, including money laundering and selling DVDs and smuggling humans.
So they'll just have to concentrate on those other industries, just like when alcohol prohibition ended in the United States, the organized crime of the United States moved over to things like drugs.
So that's the real answer.
In the short run, if that's not politically feasible right now, at least remove government obstacles to harm reduction strategies.
There are many states, in five states in this country, including Texas, which is a huge population.
If you wanted to hand out fentanyl test strips to people in an area where you know there was a lot of drug use, so they could test what they bought to see if there's fentanyl in it, you can get arrested because that's considered distributing illegal drug paraphernalia.
So, and in New York City, since the end of 2021, they've had the city has permitted two overdose prevention centers to operate where people come inside, they use their drugs in a clean, safe environment, and they get to test it first.
And there are people standing nearby to rescue them in case if they overdose.
Well, that's actually against the law federally.
There's a thing called the Krack House Statute that doesn't allow that, but it's been operating, these two organizations have been operating since the end of 2021, beginning of 2022, and they've already reversed more than 1,300 overdoses.
These are people who would be dead.
Now one is opening up.
It's just opened actually in the state of Rhode Island that the state government approved.
And the state legislature just approved one that they're working on getting online in Vermont.
But that's federally against the law.
In the previous administration, the Justice Department exercised prosecutorial discretion and chose not to prosecute.
But there's no telling what will happen in this administration.
So if you can't make this legal and learn the lessons of alcohol prohibition, then at least let organizations that want to help people minimize the risk of overdose death and the spread of disease like HIV and hepatitis from shared needles and that kind of thing.
At least get out of the way of people who want to do that by removing the laws that don't allow that.
tammy thueringer ▲ ● ▼
Dr. Singer, to your point, you're talking about possible solutions.
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