Biden talks fentanyl crisis in Mexico: What experts say should be done to stop overdose deaths

President Joe Biden will meet with Mexican officials Monday to discuss how to stop illicit drugs from coming through the southern border, a problem that continues to fuel a new wave of the deadly fentanyl crisis across the United States. 

CONTEXT: There were 107,622 drug overdose deaths in 2021, according to the Centers for Disease Control and Prevention, and two-thirds of those deaths were caused by fentanyl, a synthetic opioid. 

Most illicit fentanyl is mass-produced in "secret factories" in Mexico with chemicals obtained from China, according to the Drug Enforcement Administration.

Fentanyl is highly addictive, 50 times more potent than heroin, and only a tiny amount – enough to rest on a pencil tip – can be fatal.

Here's what health researchers and overdose prevention workers say are the top solutions to curb fentanyl addiction and overdose deaths in the United States:

More medications needed to treat opioid addiction

People who use opioids need different “exits points” and “off ramps” to get off the drugs, said Susan Sherman, a health behavior professor at the John Hopkins Bloomberg School of Public Health in Maryland.

Whether illicit fentanyl is "sourced from Mexico or whether it’s sourced from China, the issue is here with consumption, with lack of scaled-up evidence-based medication-assisted drug treatment," Sherman said.

Only a small fraction — roughly 10% — of people with an opioid addiction are on medication to treat it, according to Joseph Friedman, a substance use researcher at the University of California, Los Angeles.

"So there's just this huge unmet need, and that's an uncontroversial point of failure of our drug policy," he said.

Unequal access to health care means many people have no way to get the life-saving medication, unlike more widely available, government-funded treatment programs for other epidemics, like HIV, he said.

Friedman said the government and the health care system should especially work to make Buprenorphine, which has "historically been prescribed to middle and upper class white people," more accessible and affordable. Unlike other treatments that must be administered at a clinic each day, Buprenorphine is the first opioid addiction treatment that can be dispensed by family doctors and everyday pharmacies, according to the Substance Abuse and Mental Health Services Administration.

It's not hard to accidentally consume fentanyl. 

Illicit drug tablets laced with fentanyl are often being disguised to look like prescription pain-relief pills. Many non-opioid drugs including marijuana and cocaine can contain fentanyl, unbeknownst to people who use it.

Recent research has pointed to overwhelming racial disparities in synthetic opioid deaths, with mortality rates for Black people more than tripling from 2010-2019, compared to an increase of 58% for non-Hispanic whites.

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More tests are needed to check for fentanyl

Across the country, people with opioid addictions who use illicit drugs rely on fentanyl test strips to know if the substance they're about to take contains fentanyl.

"Imagine you went to a bar and ordered a drink and you don't know if they made your cocktail with a tenth of a shot of alcohol or ten shots of alcohol, and the only way you can figure that out is by starting to drink and see how you feel," Friedman said.

The strips use the same technology as workplace drug tests, they're cheap and they prevent overdoses because the fentanyl they detect is so potent.

"There's all these things that would be great to avoid, so drug checking is a very common sense way to reduce the harm of a really, really toxic drug market," Friedman said.

But the paper test strips, which are considered drug paraphernalia, are illegal according to laws on the books in nearly every state intended to crack down on illicit drugs.

Drug paraphernalia laws make people who use illicit drugs fearful of seeking help to do so safely because "they’re viewed as criminals," said Alex Kral, an epidemiologist and drug policy expert at the non-profit Research Triangle Institute in North Carolina.

Besides test strips, a small number of U.S. harm reduction programs have machines called Fourier-transform infrared spectrometers that can test a drug and detect every substance it contains and its concentration.

If more places in the United States could access the machines, Kral said, they could serve as a surveillance system to alert the community when dangerous substances enter the supply of drugs.

“If you’re continually testing people’s drugs, you get a sense about what’s in the drug supply in general in the city, or neighborhood or town," Kral said. 

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What are overdose prevention centers?

Vulnerable people's lives are at risk every day, Kral said, because opioid addiction and overdoses stem from poverty, poor mental health and the availability of contaminated drugs. It's important people on the margins of society have a "trusted" place they can go to use drugs more safely, he said.

In New York City, two sanctioned safe consumption sites allow people who use drugs to test them for fentanyl without worrying about getting arrested. The sites, run by OnPoint NYC, prevented almost 700 overdoses in the past year, executive director Sam Rivera told USA TODAY.

The sanctioned sites in New York City were the first of their kind in the United States, according to the Drug Policy Alliance.

"Imagine — we’ve had 700 overdose preventions in a little over a year," Rivera said. "What if we have 5 sites, 10 sites? That’s 7,000, right?”

Contributing: Kevin Johnson, Ken Alltucker