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The fentanyl crisis has emerged as one of America’s most pressing public health emergencies, with devastating consequences that touch every corner of society. Only ‘layering’ up on the worst opioid addiction disaster (arguably) in US history. In a shocking revelation of the crisis’s scope, fatal drug poisonings reached a record 111,451 in the 12 months ending in August 2023, with fentanyl driving the majority of these deaths. Yet as the body count rises, America’s response remains fragmented, ineffective, and mired in political theatre.
A Perfect Storm
What makes fentanyl particularly dangerous is its unique nature as a synthetic drug. Unlike traditional narcotics such as heroin or cocaine that require crop cultivation, fentanyl is purely chemical-based. As DEA officials note, the only limitation on fentanyl production is access to precursor chemicals, making it potentially limitless in supply. This fundamental difference from traditional drugs has created an unprecedented challenge that our current drug control infrastructure seems woefully unprepared to address.
The crisis is further complicated by the cartels’ deceptive tactics. Drug traffickers are pressing fentanyl into counterfeit pills designed to look identical to legitimate medications like oxycodone, Percocet, or Adderall. This practice has led to countless deaths among users who had no intention of taking fentanyl, creating an unprecedented public health challenge that demands far more urgent attention than it’s receiving.
The Politics of Failure
As the crisis deepens, American politicians have reduced this complex challenge to simplistic campaign fodder. Republicans, led by former President Trump, hammer Democrats over border policies, while Vice President Kamala Harris responds by touting her prosecution record and promising more border agents. Lost in this rhetorical crossfire is any meaningful discussion of what primary prevention and demand reduction; or drug use exiting treatment and recovery – the very elements experts say are crucial to addressing the crisis.
It has been said by many a pundit… “we cannot arrest our way out of this mess”, but be rest assured, we cannot ‘treat our way out’ either, especially with treatment is but a ‘mop’ and the faucet of demand continues to flow unchecked, only driving supply.
A Global Criminal Enterprise
The fentanyl supply chain represents a complex international network that makes a mockery of traditional drug enforcement approaches. The DEA has identified two primary cartels responsible for most of the fentanyl entering the United States: the Sinaloa cartel and the Jalisco cartel. These organisations operate as sophisticated multinational corporations, with operations spanning more than 45 countries.
The supply chain typically begins in China, where precursor chemicals are purchased, before moving through Mexico, where the final product is synthesised. Last year alone, the DEA seized enough fentanyl to kill every American – approximately 410 million deadly doses. Yet, significant quantities continue to enter the country through various means: by air, land, and sea, often through the Southwest border. This stark reality raises serious questions about the effectiveness of our current enforcement-first approach.
The Social Media Scandal
Perhaps most damning is the role of social media companies in this crisis. These platforms have become what DEA officials call “the last mile” in the deadly supply chain, providing cartels with direct access to potential victims. Despite their own terms of service prohibiting drug sales, social media companies have provided what law enforcement describes as minimal cooperation in addressing the crisis. The result is a digital marketplace for death, operating in plain sight.
Institutional Inertia
The international response has been equally inadequate. China, the primary source of precursor chemicals, has effectively ceased cooperation with U.S. law enforcement over the past year. Mexico’s president has gone so far as to deny that fentanyl is even synthesised in his country, despite overwhelming evidence to the contrary. Meanwhile, U.S. authorities are left to combat what amounts to a multinational criminal enterprise with fragmented resources and inconsistent international support.
Again, the demand coming from not only a now ‘addicted’ cohort, but a demographic that wants to either party or medicate away everything from perceived ‘boredom’ and trauma’ to genuine cultural and psycho-social despair you have the incentive that addiction for profit actors love. When a society tacitly enables pleasure seeking as a ‘right’ and refuses to identify contributing factors to self-harming behaviours or celebrated unaccountability that needs to be called out and addressed, then those ‘supplying’ have a continuingly enabled ‘demand’ for the preferred ‘agent of symptom annihilation’.
Ground-Level Reality
The human cost of this institutional failure is stark. At DEA headquarters, a memorial wall now displays over 4,000 photographs of fentanyl victims, with hundreds more being added regularly. These images – showing victims as young as 12 or 13 – stand in silent rebuke to the political grandstanding and institutional paralysis that characterises the current response.
The stories of survivors paint an equally damning picture. Crystal Long, who survived multiple overdoses before finding recovery, describes fentanyl’s overwhelming pull: “All of your problems go away… it’s like this tingling feeling from head to toe that just you’re calm, nothing else matters.” Her survival, thanks to a drug court program, represents the exception rather than the rule in a system that prioritises enforcement over treatment.
We see here again a perception in, arguably, the world’s most affluent and ‘free’ nation that every form of positive emotional disruption is viewed as trauma, and the faux right to comfort as all costs drives self-soothing behaviours in some many of the population who are not genuinely traumatised or suffering privation.
A Glimmer of Hope?
Recent CDC data showing a 13 percent decline in overdose deaths between May 2023 and May 2024 offers some encouragement. This improvement is attributed to expanded treatment access, over-the-counter naloxone availability, and increased border seizures. However, with deaths still hovering near 100,000 annually, celebrating such marginal improvement seems premature at best.
The Path Forward
The solution to the fentanyl crisis requires more than campaign promises and border security theatre. It demands a three-pronged approach that has thus far been largely absent from the national conversation: demand reduction, supply reduction, and recovery support.
Demand Reduction: The most glaring oversight in current policy is the lack of comprehensive demand reduction strategies. While politicians focus on border security, they largely ignore the factors driving Americans to seek out opioids in the first place. Effective demand reduction requires:
- Expanded access to mental health services, particularly in underserved communities where fentanyl use often takes root
- Prevention programs that address the root causes of addiction, including trauma, poverty, and lack of economic opportunity
- Educational initiatives that go beyond by include the “just say no” messaging, as this powerful protective factor now seems to have been erased (if not eroded) in our first world entitled culture. Not uptake, No problem! No, is powerful and needs to be empowered and equipped, not undermined by throw away and evidence-deprived ideology that saying no doesn’t work.
- Early intervention programs in schools and communities, with particular focus on the vulnerable 12-25 age group that’s increasingly falling victim to fentanyl. This must include sound anthropologically anchored resilience building factors in the individual, family and the community.
Supply Reduction: While current supply reduction efforts focus almost exclusively on border interdiction, a truly effective strategy must be more comprehensive:
- International cooperation agreements with real enforcement mechanisms, particularly with China and Mexico
- Regulatory reform to better track and control precursor chemicals
- Enhanced prosecution of social media platforms that fail to adequately police drug sales
- Targeted disruption of cartel financial networks through enhanced cooperation between law enforcement and financial institutions
- Investment in advanced detection technologies at all points of entry, not just the Southwest border
Recovery Support: Of course, for those caught in the tyranny of this addiction, we need a fundamental shift in how we approach recovery, particularly in light of recent scientific evidence. A 2024 study in the Journal of Addiction Medicine has conclusively demonstrated that Medications for Opioid Use Disorder (MOUD) remain highly effective even against highly potent synthetic opioids like fentanyl. Whilst this can be a good start, it can also be an ongoing addiction trap, as much lived experience and earned resiliency has made clear. The healthcare system should not place bureaucratic barriers in the way of these proven treatments but should also harness them to other proven drug use exiting protocols that empower the substance use to live substance free. That is what recovery has always meant.
The evidence is clear:
- Both buprenorphine and methadone have proven effective in preventing death and opioid overdose – This, again, is a great start, but the Gold standard for treatment isn’t ‘death prevention’, it is the exiting of practices that facilitate the near death experiences.
- Higher daily buprenorphine doses (>16mg per day) show increased effectiveness
- Low-dose buprenorphine initiation protocols have demonstrated feasibility even with ongoing opioid use
- These Medically Assisted Treatments (MAT) must be part of a more holistic approach for recovery to not only be lifesaving, but also life affirming, developing and recalibrating – thus ensuring the very thing causing all this grief is no longer in play.
Despite this compelling evidence, we continue to underutilise these life-saving treatments. A comprehensive recovery support system must include:
- Creation of robust aftercare programs to prevent relapse and support long-term recovery
- Investment in job training and educational programs for recovering addicts to break the cycle of addiction and poverty.
- Immediate expansion of medication-assisted treatment programs, with particular attention to optimal dosing strategies that research shows are most effective
- Removal of bureaucratic barriers that prevent addiction specialists from prescribing treatment medications, especially given the proven effectiveness of MOUD against synthetic opioids
- Insurance reform to ensure that recovery programs are covered at the same level as other medical conditions, including coverage for higher-dose treatment protocols that research shows are more effective
The tools and knowledge to implement these solutions exist. What’s lacking is the political will to move beyond simplistic enforcement narratives and invest in comprehensive solutions. The success stories – like Crystal Long’s journey through drug court to recovery – demonstrate what’s possible when we implement evidence-based solutions. But these success stories remain the exception rather than the rule.
Each day we delay implementing this comprehensive approach, more faces appear on the DEA’s memorial wall. The choice is clear: we can continue with the current failed approach of political posturing and enforcement-only solutions, or we can implement the comprehensive strategy that evidence shows will work. The fentanyl crisis is not unsolvable – it’s simply unsolved because we’ve lacked the courage and commitment to implement real solutions.
Until we embrace this three-pronged approach and marshal the resources and political will to implement it effectively, Americans (and all other cultures wrestling with this nightmare) will continue to die needlessly. The question isn’t what needs to be done – we know what works. The question is whether we’re finally ready to do it.
Dalgarno Institute
Endnotes
- Everyone’s tough on drugs again
- DEA’S Faces of Fentanyl documents extent of drug crisis
- Full DEA head: ‘We don’t know the exact amount’ of fentanyl that gets through to the U.S.
- Recovering fentanyl addict speaks out about dangers of the drug
- Dramatic turnaround for fentanyl addict
- Medications for Opioid Use Disorder Remain Effective as Highly Potent Synthetic Opioids Permeate North American Illicit Drug Supplies
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While the carefree days of childhood are supposed to be a time of joy and wonder, the harsh reality is that too many young lives are marred by abuse, neglect, and exposure to toxic substances. A sobering new study from the University of Sydney has shed light on the long-lasting mental health consequences of such childhood trauma.
- 21% of depressive disorder cases
- 24% of anxiety disorder cases
- 32% of drug use disorder cases
- 39% of self-harm cases and 41% of suicide attempts
- 27% of alcohol use disorder cases
In other words, the wounds inflicted on these vulnerable young minds don’t just heal with time – they fester, leading to a lifetime of emotional turmoil and anguish.
The culprits behind this mental health crisis are all too familiar: physical, sexual, and emotional abuse, as well as emotional and physical neglect. And let’s not forget the insidious impact of exposure to drugs and alcohol, which can further compound the trauma. It’s a veritable perfect storm of factors that rob children of their innocence and saddle them with invisible scars.
But what’s most alarming is that these issues aren’t just limited to the individual. The researchers estimate that eradicating childhood maltreatment could prevent over 1.8 million cases of mental illness in Australia alone. That’s a staggering societal cost, both in terms of human suffering and the strain on our healthcare system.
Yet, despite these sobering statistics, the conversation around childhood trauma and its mental health implications often remains hushed and stigmatised. It’s time to shed light on this silent epidemic and demand better support systems for vulnerable children and their families.
After all, the mind is a precious thing, and no child should have to navigate its darkest corners alone. It’s high time we prioritise prevention, intervention, and holistic healing – because the alternative is a generation haunted by the demons of their past, condemned to a lifetime of mental health struggles.
Source (WRD News)
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Research spanning over three decades has consistently highlighted how the frequency, severity, and impact of violence escalate in the presence of alcohol and drugs.
Unified Care for Safer Lives
It’s all too common for domestic violence and substance use to be treated as separate issues, which often leads to patchy solutions. We really need to start looking at these problems together, creating strategies that keep victims and children safe. By focusing on comprehensive policies, we can tackle these complex challenges head-on.
When we truly grasp how substance use and domestic violence are linked, we can advocate more effectively for solutions that protect families and foster a healthier society. It’s crucial to break the silence that many victims endure. By having open conversations and building supportive networks, we can provide those in need with the resources to rebuild their lives and make our communities safer.
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World Mental Health Day 2024.
It’s Time to fully apply the COMPREHENSIVE MENTAL HEALTH ACTION PLAN 2013-2030 (W.H.O) Drug use has not place in the effective plan.
Summary and its Application to Alcohol & Other Drug Issues - Dalgarno Institute
From the Conclusion: Any attempt to normalize, and thus embrace drug use as part of everyday life, is antithetical to the entire World Health Organisation’s Mental Health Plan.
That substance use may be a subset of behaviours in a culture is not in question.
However, what is in question, is its status. A status that is historically and wisely utterly unacceptable for all and more of the reasons outlined in attached document. However, it has been gradually shifting, due to addiction for profit protagonists and the emergence (particularly in first world economies) of rabid individualism which sees ‘rights’ as only enshrined in the egocentric, with little to no regard for the ‘neighbour’.
Subsequently, there has been a stronger emergence of ever ‘creative’ permission models, modes or mantras that give a tacit consent to these behaviours. These include the misuse of anti-stigma rhetoric to deny contestation of self and community harming activities – not least the mental health of a society and its members. This is completely unacceptable under the terms of this proposed plan.
The Dalgarno Institute, as part of the primary prevention sector, want to see this robust plan implemented with a strict eye to the absolute minimising, of not simply the potential harms of substance use, but more its capacity to even engage communities.
The upstream approach must look to ensure, as best as possible, that substance use gets no cultural leverage for normalization practices. Any approval in the public square of substance use behaviour, is only and always counter-productive to the best-practice outcomes of this mental health plan.
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The recently released report from the Australian Institute of Health and Welfare is an overview of statistics. As with previous reports its design is not to drill down into factors influencing protection orders or interventions, other than to refer to them as being subject to the following outcomes.
- having been seriously harmed.
- being at risk or significant risk of harm.
- having no other care options.
The following is an excerpt and very basic summary of the extensive statistical report. However, one does not have to imagine what are key elements of harm that facilitate the need for intervention. All one has to do is look at adjacent reported emergences in growing dysfunctional culture that has and is permitting greater and greater substance use.
Even though alcohol is being more closely monitored, it for over 150 years (Dalgarno Institute has the records), has been a community health, safety and well-being wrecking ball; but now we have the burgeoning illicit drug industry, that is being given greater tacit permission to operate – largely unchecked – in our current culture. The use of stimulants in particular, are at the very least correlated with some of these growing harms to children and families.
Of course, if one is able to spelunk the obfuscated data on drugs and violent crime the correlation soon tips into causal– but so very few will call it out in a now recreational drug use enamoured society. Aided and abetted by the continuing misuse of drug policy and a failure of an unequivocal public voice on this toxic conduct – The same voice we have on tobacco – a voice that worked. One Message, One Focus, One Voice – Quit!
This report provides an overview of children in the child protection system in 2022–23, including children subject to notifications, investigations, and substantiations of maltreatment, and the ways children were supported.
The child protection system aims to protect children from maltreatment in family settings. Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power (WHO, 2020).
Key findings:
- In 2022–23, about 180,000 children came into contact with the system, an increase from about 178,000 in 2021–22.
- Between 2018–19 and 2022–23, the rate of children who were subjects of notifications increased from 48 to 51 per 1,000.
- Between 2018–19 and 2022–23, the rate of children with substantiations remained relatively stable around 8.0 per 1,000.
- Between 30 June 2019 and 30 June 2023, the rate of children in out-of-home care remained stable around 8.0 per 1,000.
- As at 30 June 2023 45,300 children were in out-of-home care (7.9 per 1,000) (see Data table 5.1). Of these:19,700 were Aboriginal and Torres Strait Islander children (57 per 1,000 Indigenous children) 25,500 were non-Indigenous children (4.7 per 1,000 non-Indigenous children).
- For children who were in out-of-home care at 30 June 2023: about 89% (40,400) were in home-based care (foster care, relative/kinship care and other home-based care) (see Supplementary data table S5.3) About 3 in 5 (61% or 27,700) children were aged 5–14 years (see Supplementary data table S5.5) disability status was known for 72% (32,500) of children in care, of whom 21% (9,700) had a disability (see Supplementary data table S5.8) The rate of children living in inner and outer regional (12 per 1,000) and remote and very remote (14 per 1,000) areas were more than twice that of those living in major cities (6.0 per 1,000) (see Supplementary data table S5.9) most (94% or 42,300) were on a care and protection order (see Supplementary data table S5.13).(Source: Child protection Australia 2022–23, Supporting children - Australian Institute of Health and Welfare (aihw.gov.au)
It is vital that we keep joining the dots and putting this oft buried issues into the public square.
As it has been said, trying to fix familial, intimate partner and child abuse and neglect without addressing the alcohol and other drug issue is simply using a mop whilst leaving the tap running.
It is way past time to #preventdontpromote drug use and promote children’s and women’s rights over the drug using public recreational demands!
Dalgarno Institute
- Substance Use Incurring Violence Starts Here: Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood
- Asia-Pacific Prevention Hearing 2024 – The Declaration of Oviedo
- China’s Role in Synthetic Opioid Trafficking
- Substance Use & Family Violence: ‘Permission’ Policies vs the Rights of the Child