Although President Donald Trump frequently decries the threat that fentanyl poses to Americans, his comments about the drug reveal several misconceptions about it. He thinks Canada is an important source of illicit fentanyl, which it isn’t. He thinks the boats targeted by his deadly military campaign against suspected cocaine couriers in the Caribbean and the eastern Pacific are carrying fentanyl, which they aren’t. Even if they were, his oft-repeated claim that he saves “25,000 American lives” each time he blows up one of those boats—which implies that he has already prevented nine times more drug-related deaths than were recorded in the United States last year—would be patently preposterous.
Trump’s fentanyl fantasies reached a new level of absurdity this week, when he issued an executive order “designating fentanyl as a weapon of mass destruction.” As relevant here, federal law defines a “weapon of mass destruction” (WMD) to include “any weapon that is designed or intended to cause death or serious bodily injury through the release, dissemination, or impact of toxic or poisonous chemicals.”
The fentanyl implicated in U.S. drug deaths is not a “weapon.” It is a psychoactive substance that Americans voluntarily consume, either knowingly or because they thought they were buying a different drug. Nor is that fentanyl “designed or intended” to “cause death or serious bodily injury.” It is designed or intended to get people high, and to make drug traffickers rich in the process.
Trump nevertheless claims “illicit fentanyl is closer to a chemical weapon than a narcotic.” How so? “Two milligrams, an almost undetectable trace amount equivalent to 10 to 15 grains of table salt, constitutes a lethal dose,” he says. But that observation also applies to licit fentanyl, which medical practitioners routinely and safely use as an analgesic or sedative.
Dentists, for example, frequently use fentanyl combined with a benzodiazepine such as diazepam (Valium) or midazolam (Versed) for “conscious sedation.” On a couple of occasions, I have received that combo during dental surgery. I was not at all worried that I would die of a drug overdose, and I certainly did not think my dental surgeon was attacking me with a weapon, let alone a weapon of mass destruction.
Contrary to what Trump implies, the danger posed by fentanyl in illicit drug markets is only partly a function of its potency. The core problem is that the introduction of fentanyl—initially as a heroin booster or replacement, later as an adulterant in stimulants or as pills passed off as legally produced pharmaceuticals—made potency, which was already highly variable, even harder to predict. It therefore compounded a perennial problem with black-market drugs: Consumers generally don’t know exactly what they are getting.
That is not true in legal drug markets, whether you are buying booze at a liquor store or taking narcotic pain relievers prescribed by your doctor. The difference was dramatically illustrated by what happened after the government responded to rising opioid-related deaths by discouraging and restricting opioid prescriptions. Although those prescriptions fell dramatically, the upward trend in opioid-related deaths not only continued but accelerated. That result was not surprising, since the crackdown predictably pushed nonmedical users toward black-market substitutes that were much more dangerous because their composition was uncertain and unpredictable.
The concomitant rise of illicit fentanyl compounded that hazard, and that development likewise was driven by the prohibition policy that Trump is so keen to enforce. Prohibition favors especially potent drugs, which are easier to conceal and smuggle. Stepped-up enforcement of prohibition tends to magnify that effect. From the perspective of traffickers, fentanyl had additional advantages: As a synthetic drug, it did not require growing and processing of crops, making its production less conspicuous and much cheaper.
Hellbound and Down 