WASHINGTON — The Biden administration says it plans to cut the number of fatal overdoses in the United States by 13 percent by 2025, potentially saving tens of thousands of lives.
That would mean reversing a catastrophic four-fold rise in drug deaths that began in the late 1990s and accelerated again during the pandemic.
"We must approach this crisis with a sense of urgency that prioritizes saving lives as our North Star," said Dr. Rahul Gupta, head of the Office of National Drug Control Policy (ONDCP). He spoke Wednesday before a Senate oversight committee.
But some lawmakers questioned whether policies embraced by the White House go far enough to help people living with addiction survive.
There is also growing skepticism about the administration's ability to slow the supply of illicit fentanyl, a powerful and highly addictive opioid smuggled from Mexico.
A record 107,622 people in the United States died from overdoses in 2021, according to the Centers for Disease Control and Prevention. In his prepared remarks, Gupta said drug deaths are "unravelling the very social fabric of our nation."
Drug cartels are developing even more deadly street opioids
Gupta also acknowledged the growing power of Mexican drug cartels and other international narcotics gangs that "operate seamlessly across borders and cooperate with remarkable efficiency."
According to government officials, the cartels now contaminate much of the illicit drug supply in the United States with fentanyl, driving the latest surge of fatal overdoses.
Until recently, most street opioids — including heroin and black market pain pills — were made from chemicals extracted from poppy plants.
Fentanyl, by contrast, is produced using industrial chemicals, which means it's cheaper to make, far more potent and easier to smuggle.
Gupta noted drug gangs are continuing to develop new, even more powerful synthetic opioids that are now reaching cities and small towns across the country.
"A Pandora's box has been opened. We can expect to see much more potent substances [in the future]," he testified.
Sen. Sheldon Whitehouse, a Democrat from Rhode Island who chaired Wednesday's hearing, praised broad outlines of the Biden team drug strategy.
An ambitious plan, but will it work?
But Whitehouse questioned whether the plan does enough to reduce corruption and illicit drug production in countries such as China, Colombia, India and Mexico.
He also said the U.S. government lacks the tools to track whether this plan is succeeding.
"Right now, we don't have a timely reporting of fatal and non-fatal drug overdoses, or a reliable baseline for basic information, like how much money we have denied and seized from drug trafficking organizations," he said.
A report made public Wednesday by the General Accountability Office also found the ONDCP drug strategy document, unveiled in April, failed to detail resources needed to slow drug trafficking and reduce overdose deaths.
"We found that while the national drug control strategy outlines goals, it does not provide an estimate of the federal funding or other resources needed to achieve these goals," the analysis concluded.
Drug overdose deaths have emerged in recent years as a kind of shadow epidemic to the COVID-19 crisis. Disruptions caused by pandemic made it more difficult for many people experiencing addiction to find treatment and support.
Drug treatment experts say it also increased stress and isolation for many individuals, triggering a surge in drug and alcohol use.
Drug deaths spiked from roughly 185 per day in 2019 to nearly 300 per day now, according to the latest provisional data from the CDC.
A new focus on "harm reduction"
The Biden team hopes to boost spending on drug treatment and make medications that help reverse opioid overdoses far more widely available.
The strategy also aims to provide more treatment to prison inmates experiencing addiction.
It also sets a goal of sharply increasing active investigations of the biggest Mexican drug cartels
But critics say the White House has yet to embrace life-saving strategies popular in a growing number of other countries.
Those include as creation of "safe-consumption" sites where people with addiction can take street drugs under medical supervision.
For the first time in the United States, two such centers are operating in New York City. The non-profit On Point NYC said last month its program had "averted 314 drug overdoses since opening" in November.
In an interview in October 2021 with NPR, Xavier Becerra, head of the U.S. Health and Human Services Department, suggested the Biden administration might allow similar "harm reduction" programs nationwide.
"We're not going to say, 'But you can't do these other type of supervised consumption programs that you think work or that evidence shows work,' " Becerra said.
But his office quickly walked back those remarks, saying HHS "does not have a position on supervised consumption sites" and noting such programs are "a matter of ongoing litigation."
Drug war era still shapes policy debate
The policy response to the drug crisis in the United States has long been sharply divided. Public health advocates believe in a "harm reduction" model aimed at reducing stigma for those experiencing stigma and providing them with medical care.
Others back a "drug war" model, arguing tougher law enforcement and border security might eventually curb drug supply.
During Wednesday's hearing, Sen. Charles Grassley (R-Iowa) said harm-reduction efforts aimed at supporting people with addiction could go to far, encouraging dangerous drug use.
"I'm worried that making drugs more accessible is what this administration calls drug control," Grassley said.
But many drug treatment experts say the interdiction model, which led to waves of mass incarceration that often targeted Black and Hispanic men, hasn't worked to curb the supply of street drugs.
Falko Ernst with the International Crisis Group said the situation deteriorated further in recent years, after the Mexican government withdrew from efforts to target drug gangs and their profits.
"It's the norm for Mexican authorities to collude with criminal actors," Ernst said. "They form the same networks to the degree that you often don't have a distinction between the state and organized crime."
While debates over drug policy play out in Washington, fatal overdoses have continued to rise. Studies show high rates of addiction have devastated whole communities.
"The economic costs of the epidemic to be a staggering $1 trillion a year and up to 26% of the loss in U.S. labor force participation can be attributed to people suffering from addiction," Gupta told the Senate panel on Wednesday.
In a hopeful note, however, the CDC released data Wednesday suggesting drug overdose deaths may have plateaued after several years of sharp increases.