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download it for free today. your front row seat to washington anytime, anywhere. host: a discussion on efforts to battle the crisis of synthetic opioids. bryce pardo works at the drug policy research center at the rand corporation, serves as a staff member of the commission on combating opioid trafficking. some background on the

commission, when and why was it started? guest: it was passed into law in 2019 as part of the national defense reauthorization act. part of the duties were to look at the mounting overdose death crisis related to synthetic opioids, the supply mechanisms involved in how the drugs are arriving into the united states and how they are diffused domestically into drug markets, and trying to figure out solutions to resolve the issue. and one guiding point was to reduce the overdose death burden in the u.s., as well as to figure out ways to disrupt the flow of the drugs. host: it has reached a what levels? guest: in 2021,

what is happening today is these are illegally manufactured chemicals, in the case of fentanyl these are chemical inputs manufactured in china, imported illegally into mexico

and synthesized into fentanyl. the difference being fentanyl is very potent, a very small quantity can replace a large amount of heroin. fentanyl's potency is about 20 times more than heroin. you need less to have the desired effect. the drawback is the dosing margin of error is very tiny. if you are off by a few milligrams, that can result in an overdose that could be lethal. some of these are physiological effects of fentanyl. the reason why people are dying is because the potency is so great it is used to substitute for heroin and some dealers are cutting their heroin with fentanyl, resulting in greater overdose risks, not telling the users it contains fentanyl but also putting it into counterfeit tablets made to look like genuine pharmaceutical grade

medications. it is leading individuals into thinking they're taking something else when they're taking fentanyl. host: let me invite viewers to join in the conversation. phone lines are split regionally. if you're the eastern or central time zones, (202) 748-8000. mount up specific -- mountain or pacific time zones, (202) 748-8001. and a special line for those experienced with synthetic opioids, (202) 748-8003. a line for you to tell your stories or ask your questions. go ahead and start calling now. bryce pardo, you talked a little bit about the manufacturing, that less is needed of this to create more. why is this so hard to catch in

anti-trafficking efforts? guest: it has always been difficult to the availability of drugs. we have been doing that for decades. it may have effects but traffickers find routes around that. what is different about fentanyl in particular, the potency is what matters. prior to 2019, these chemicals were openly available online and some of the open surface webspace. you would find a vendor in china who would sell you a small quantity of fentanyl and have it shipped directly to your house. that is one reason this problem is different. the ability with which anybody can obtain a sizable amount of fentanyl and distribute that downstream is new. that is one factor. the other is because of its potency, you can replace a lot.

think about it being 25 times more potent than heroin, you need to increase her trafficking loads by a factor of 25. one kilogram can substitute for 25 kilograms of heroin. that reduces the costs and risks to traffickers. they can move smaller loads. it made the already difficult job much more difficult. host: we are talking about the opioid crisis. one million overdose deaths since 1999. 100,000 between june 2020 and may 2021. two thirds of those involved synthetic opioids. the commission trying to help fight that crisis. recommendations from the commission on combating synthetic opioid trafficking elevating the drugs are to a cabinet level position, increase target oversight and enforcement to disrupt the drug supply.

make a public health demand reduction approach. collaborate with other countries , and then improving surveillance and data analysis. run through a couple of those for us. approach. collaborate with otherguest: the inputs being used to manufacture synthetic opioids are coming from sectors in asia. these are legal sectors. china and india are the world's largest sources of many pharmaceuticals we consume. many other chemicals we consume in our day-to-day lives. the industry is spottily regulated. the enforcement mechanisms in china are limited. they do not do enough unannounced inspections. some of the recommendations be two ways in which the united states and other diplomatic efforts can be used to encourage china to do a better job in

overseeing the sectors to limit the availability of the necessary precursors used to manufacture fentanyl. other things the commission recognizes, this is going to be a more difficult challenge when it comes to looking at this through only a supply-side lens. that means we need to put greater efforts on demand reduction but also other public health intervention aimed at reducing overdoses or preventing overdoses. things like increasing the availability of medications we know work for the opioid use disorder, methadone is used in united states, but there are many barriers to access to those medications through traditional insurance policies or other regulations involved with dispensing administration of those drugs. trying to reduce those barriers and increase access to individuals who have a substance use disorder will be lifesaving. some of these people can leave the markets.

those are policies we put forward. in addition to that, the other overdose prevention mechanisms like looking at some of the innovative harm reduction interventions other countries have put forward, test strips of something this administration has thought to expand and use more. these are a dollar a piece test strips that allow you to determine if fentanyl is present in your drugs. other things we were looking at have to do with increasing the surveillance and monitoring of drug markets. fentanyl caught a lot of us off guard. very few drug policy researchers have heard of fentanyl in the illegal market until recently. this was something that caught us off guard. we speak about synthetic

opioids, that is a broad term. these are chemicals that act on the brain that are not derived from poppy. these can raise from fennel to other families of drugs that are not fentanyl related. we need to do a better job of monitoring the markets. for the last 20 years we have had a difficult time trying to measure the actual population of heroin users. the national household surveys that try to capture those numbers underestimate that. ways in which we can improve our assessment of these markets and of the user base to better determine the capacity -- the scope of this problem as well as what chemicals are coming in or exiting these markets. ways in which we can use dated to give us a better idea for how to respond. there are 70 recommendations or

actions. things like governance and policy, supply reduction, demand reduction, data, and surveillance. host: let's take a few colors. richard out of minneapolis. good morning. caller: good morning. i heard on a recent news report that the seizure of fentanyl at the border is up 1066% and what is happening is the drug runners are getting the families across the border patrol is busy at the headquarters taking care of the families, so the drug runners are free to bring the fentanyl across without any objection. why doesn't the administration put sanctions on china for manufacturing this junk?

the need to put sanctions on mexico. this is another failure of the bided administration, failure after failure. guest: with regards to the increasing seizures on the border, that is true that the numbers have increased in terms of the frequency and the total weight. there are couple of things we need to be careful about. one is that the seizures from south of the border are highly them your. -- are highly impure. these are tablets that contain 1% to 2%. we have a kilogram seizure, talking about 1% to 2% of that. closer to the ballpark of 10 grams of pure fennel. it is not that high. both numbers have increased. to your point in terms of not being able to -- we only measure

what we sees. what is being reported on the border -- we only measure what we seize. to say this is a failure of interdiction would be counterintuitive because we are measuring what we are seizing, so we are doing a better job of seizing on the border but we notice the flows are increasing. some things have had some impact of what we think is closing those flows. the border restrictions are changing the way traffickers are moving things like cars, moving by pedestrians, moving strategies and tactics. with regard to sanctions, sanctions is something that is a bludgeon. these are large trading partners sewed be very difficult to put sanctions on some of this. the trump administration did work with china to encourage them to control fentanyl, to put a blanket generic control on all fentanyl structures in 2019. that was done and that may have shifted some of the market some

way. reducers no longer offer fentanyl but now they are moving to precursors that are uncontrolled and selling those to drug trafficking organizations in mexico. to say nothing has happened is limited, there have been some things. some policies have butted place to reduce access in china as well as in mexico. there are many complicating factors that limit the availability to stop the flow. at the end of the day it will be difficult to stop the flow of the stop. -- of the stuff. host: joan in texas. good morning. caller: are they making the connection between the human trafficking and the entry into this country by way of that with the fentanyl? the second part would be how would a layperson recognize how

it is packaged and what does it look like so it is spilled out, what does it look like? guest: i will start with the second question. that is interesting. it depends on what formulation it has been created. with regard to what is coming across the border from mexico, which is now the largest single source of fentanyl, these are tablets many times. to be able to tell the difference would be impossible. these look very much like the real thing, they have the same markings and coloring agents. they look almost like the real product. it is very hard to tell the difference. there also powder that comes across the border. that is being used to mix into other things. the concern about touching fentanyl, i know there is concern about that. some of that is legitimate but a lot of it is overblown. fentanyl, you cannot get a dose of fentanyl by touching it. you need to touch it and touch

your eye or your nose, membrane to get into your bloodstream. dutch -- just touching fentanyl will not kill you but you should wash your hands if you see white powder vining around. -- white powder lining around. the commission did not look into this, but this was something discussed by customs and border protection when we did interviews with them. it has to do with the fact there is limited availability of agents to juggle both competing challenges. it is not so much the traffickers are using the migrants themselves to smuggle, it that in some cases you of migrant populations that are moving and that creates the limited availability with which border patrol agents can deal with one problem and then traffickers will use that opportunity to move drugs across the border. they are somewhat linked but not directly. this bunts into other problems

and challenging with having to deal with the immigration policy. this is something the commission did not look at but was brought up in some of the interviews. it is not that they are using migrants, it is that it creates a competing challenge law enforcement has to respond to. host: steve on twitter saying you listed possible solutions. no mention of treatment. we've been focusing on the supply side. what about the demand-side question mark what about treatment on demand? guest: the commission does talk about recommendations towards reducing barriers to access. this is being able to plug people into a treatment provision will be crucial. some states are taking innovative approaches. when an individual shows up at an emergency department because of an overdose, they get basically inducted into a treatment then and there. in some cases they referred to treatment. those are ways in which people can get access to treatment

providers that can be lifesaving. there are other limitations. some of these populations are very hard to reach so reducing the stigma is crucial in trying to -- these populations -- trying to reach some of these populations that have been using opioids chronically. counterfeit tablets, some individuals may not have an opioid use disorder, they may be casual drug users who may obtain what they think is a legitimate divergent medication when it contains no oxycodone, three milligrams of fentanyl, they take it thinking it is a medication, it is regulated. they take it and they die because it does not contain the active ingredient, it contains fentanyl. that population does not treatment, they do not want treatment. we will need to apply some policies directed at those

individuals as well because they are coming into contact with bagnall and overdosing and dying. that is something we also need to consider. host: keith in travelers rest, south carolina. you are on. caller: good morning. can you hear me ok? consider. host:i am a physician and i tral six states in the southeast. when i go to west virginia, it is a beautiful place, but they are suffering tremendously. i like the question about treatment. i will go further. 180 degrees away from interdiction and about jobs and giving people hope and faith so we do not have this problem. we fought alcoholism in the 1920's and all we did was create i am a physiciancorruption. mexico and those other states and central america are destroyed by our drug needs. we have to focus on giving people hope and faith. we need jobs and jobs and jobs.

is that something you can push with your agenda? guest: i like the way you are framing this. the report does talk about this problem being a problem that is very much a national security problem, but at the same time it is more than that. we have had a long-standing problem with addiction in the united states. that has to deal with things like lack of purpose, joblessness, homelessness. it is a confluence of all these different problems. i think covid-19 has shown us that things have gotten worse with drug use. many people who've had an opioid use disorder that were in and out of treatment, were in recovery, covid comes along and knocks them off their game, they no longer have a job to go to

where they may no longer have the day-to-day routine. covid taking that away from them puts higher stress demands on them, induces more in zaidi, you hear stories -- induces more anxiety, you hear people about -- you hear stories about people who relapse during covid, they buy a counterfeit fentanyl tablet, they take it and they take it in the overdose and die. that has to deal with what you are talking about. the social pressure, the lack of a future, the lack of meaningfulness in one's life, these are all important things we do hear about the despair. west virginia is case in point. high unemployment. nothing to do so people just consume drugs. the story is a compelling story and are ways in which we can do more. the report we talk about, the report does make some recommendations unemployment recovery workforces, so making sure employers are aware of

individuals coming back to the workforce that may have a substance use disorder that are in recovery, giving them the time in the state in which to be a part of that kind of workforce community while allowing them to go to their meetings, allowing them to get the methadone, being aware and mindful of those things is an important component of this. reducing stigma is also important thing. stigma does kill. getting people recognize that, maybe i'm having anxiety, instead of going on and buying what i think is a divergent medication that is actually a counterfeit, may be to somebody about it, these are things we need to start discussing in society. i like the way you frame it. it is much more than a surprise i'd problem. there are there social drivers that make a complex issue. host: important to talk about elevated the drugs are to our cabinet level position.

-- the drug czar to a cabinet level position. what difference would that make? guest: it used to be a cabinet level position in the late 1980's and the late 1990's and will remain there until the obama administration. the report goes into some of the limitations of not having it in the cabinet level position. the office has the clout of being in the white house -- seeing the problem with the executive level capacity that needs to be done. there are some challenges with the way in which our drug policy apparatus is developed and designed. we have competing agencies -- having ondcp sit on top of that to direct traffic would be helpful, and giving it more with

elevating its status so people realize this is a serious problem. after covid this is the number one public health issue facing americans today. it is the number one driver of deaths for those individuals age 18 to 45. it is now the number one cause up her venable injury deaths in the united states. it is an important problem we need to resolve. elevating from where it is now to a cabinet level but help direct some of the largest federal agencies that deal with this issues. host: we have a line for those web experience with synthetic opioids, family member, friend, themselves, it is (202) 748-80 2 3. wade calling in from south carolina on that line. guest: -- caller: my experience has not been the illegal drugs, the legal drugs.

my wife has had two hip surgeries in the last eight months and they put her on oxycontin and something else. my problem is trying to get her off of it once they put her on it. they put her on it, they do not try to get her off of it they are continuing to give it to her because she is asking for it. she has become addicted to this stuff. i tried to get them to take her off it and i had to call her doctor and plead with him and he said she is not going to like it, i said i do not care if she does not like it. the alternative is will never get her off the stuff if we do not try. he did cut her back on it. she came out of the hospital and had to go to rehab for her hip and wind up being there seven weeks, most of it because they would not take her off the rest of the pain medicine, which was some other kind of oxycontin. iweeks, most was telling them tr off of it.

finally after five weeks of being there i said take her off of it or i'm coming to get her. if i have to come get her to get her off of it and bring her home i will do it. finally that day i said you can get her off of it i am coming to get her. they call the doctor and said we will take her off of it, we will give her tylenol if she asks for pain medicine. i said that is because she became addicted to it. the doctor is prescribing it and it was trying to help her get off. i finally got her off a bit. she stayed in rehab about four more weeks. i have had to take off work and be with her night and day. now what i am suffering is her cognitively, she is losing touch with reality although she has been off of it for six weeks. not all the time but it is periodically throughout the week this happens. this morning she got up and thought she was somewhere else,

did not have an idea where she was at. it is not only the legal drugs, it is the way the doctors prescribed these things during surgeries and after surgery they offer no help once they get addicted to it to get them off. that needs to be addressed. host: thanks for sharing your story. guest: this is one of these typical stories. i am sorry to hear that. as i mentioned earlier we aggressively treat pain. pain became a fifth vital sign around paul's -- around pulse. pain, you cannot measure it like a pulse. when we allow for paid to be treated as a fifth vital sign it reoriented the way health systems dealt with pain. because of the health care system we have, viz. largely for-profit, private, everything was how to address pain.

everything focused on that, which resulted in individuals that should not have been exposed to prescription opioids being exposed to them because doctors were treating pain -- ways we can reorient our health system so we treat pain on the incentive and the outset. when they have pain, offering that individual other non-formal logical ways to address the pain would be better, other things like reducing access to prescription opioids for certain therapeutic aims. postoperative surgery, it is fine. for chronic pain, chronic pain is tricky to treat using opioids. there are some patients who do benefit from opioids in perpetuity, that is fine.

what we care about is an individual can have a quality of life -- that is where they're going to become exposed to an unknown amount for some new chemical that could cause an overdose. in the case of wade and other patients who have lived through something similar, it has been unfortunate that we overexpose people and then we quickly turn off the tap. that is a gut reaction we did. we put into place too many restrictions when you already have these chronic pain patients, and when you do not taper that individual off, withdrawal is extremely painful, and then the motivating factor becomes had do i avoid withdrawal. individuals who have an opioid abuse disorder will go to great lengths to avoid withdrawal pains and they will trade down to the illicit market because they can find heroin there, they can find medications, now they are becoming exposed to vent all, that is the policy

considered cash exposed to fentanyl. that is the policy consideration we have. we have a large population of individuals who have an opioid use disorder because they were exposed to pharmaceutical grade medications, we need to slowly turn off that cap so we are not reflect that population and taking those individuals making sure they have quality care for treatment for those of an opioid use disorder so you're not pushing them to illegal markets because they're becoming exposed to fentanyl. the report does discuss some of the different mechanisms and the ways in which we can do this. to wade's point, it is challenging to address this from the onset because nobody should suffer. we need to think about this more holistically, more long-term as the doctors writing prescription after prescription to reduce availability for those who do not need prescription opioids.

at the same time, taking steps to avoid cutting somebody off such that they are motivated to go to the legal market. host: i should note this report we've been talking about is available at rand.org. the commissioners -- a bipartisan group of members of congress. what is your sense these recommendations from the commission are going to be taken up by congress into some sort of bill passed and signed by the president? guest: that is a good question. we provided the analytical backstop of research for the commission. this was a bipartisan commission. members from both houses of the legislative branch consisted of individuals from the executive agencies. the department of state, department of defense, dea, as well as other outside experts appointed by the legislative

leadership. we at rand served as the backdrop for the commission. we discussed some of the policy recommendations aimed at congress, so new legislation as well as executive agencies. this is a commission, there is no legal binding for agencies to take on these recommendations are for congress to pass a law, but we hope some of these things are actionable and we hope congress does take some of these recommendations into consideration and does issue legislation to put things forward. the commission was cochaired by very skilled legislators, senator cotton and david truax and from maryland, both of -- david trone from maryland, both of whom are interested in the issue and engaged on this. it is up to leadership and who can make things work and who can start to pull the levers in the

right places. there is generally bipartisan consensus on many of these things. this is a consensus document trying to agree to strategy going forward across these areas. it is going to be up to leadership to push this through. this is something that is largely bipartisan. host: about 10 minutes left in the segment. phone line split regionally in the special line set aside for those with experience in illegal synthetic opioids (202) 748-8002 is that number. eric from hopewell junction, new york. the morning. -- good morning. caller: good morning. we are talking about pain and the desire to stop pain. the universal desire to stop pain and how it is hard to measure somebody else's pain. the last guest talked about

china's ascension, and you picked up on china's role in fentanyl being shipped to mexico and made into counterfeit tablets. and shoveled across the border. if you've known anybody with addiction, and by the way thank you for devoting yourself to this field, because it is an insidious thing in our country. i think everyone knows someone who is struggling with addiction problems. what it does to the families, even if the person does not die. it is hobbling. it takes a lot of energy that could be devoted to more productive things and worrying

about where is your son tonight and wondering where the money went, etc. etc. it strikes me that if 100,000 people died from overdoses last year in china is what proportion of that? that is a hell of a win for china. to expand a tiny bit -- guest: host: -- host: let me let bryce pardo pick up on that. guest: the report does mention this is a national security issue. when you have 100,000 people dying, people in the prime of their lives, 18 to 45 or 55, thinking about what effect that has not just on the 100,000 who lost lives, but we are talking about people with families, with

children, the so the second and third order effects of kids growing up without their parents , with parents growing up without their kids, that is going to have effects that are far-reaching and we fully have not recognized or really understood. the report does cite some of the economic impact this is having and some estimates are upwards of $700 billion a year in costs associated with opioid use disorder and early death. this is not a small issue. those costs are little bit -- those are less productivity over the expected years remaining at other premature deaths. this is something that is tearing at the well-being of our -- the social and economic well-being of this country. the report does look at what china's role is in this dust cloud china directly for doing a very bad job or not doing its

job when it comes to overseeing large industries. it is not like they are actively engaged in manufacturing this and sending it to the united states. what seems to be the case is they do not care about consumer product safety. we have heard about lead paint in children's toys, antifreeze and toothpaste manufactured in china. dog food killing american pets manufactured in china. this problem is related to that. it is now spilling into the american drug crisis. what seems to be happening as you have producers in china who are -- there is no oversight were very limited oversight. in some cases there in bed with local provincial administrators in local provinces. there is no incentive for everybody to crackdown and apply the rules. it seems to be the case that they are manufacturing these precursors, either knowingly or turning a blind eye, and then exporting it. they do not care what harm it is

doing or what damage it is doing. they do not care. that is the problem. we talked about ways of trying to get china to do a better job with larger industries to make sure people are not been in the rules or breaking the rules is key. china does not have this type of domestic drug problem. they have other drug problems that they take care of those more severely when they come up. trying to get trying to recognize that if it wants to be a global player and a steward of the international community it needs to do better job of making sure it is not a source of precursor chemicals being used to manufacture all sorts of drugs, not just synthetic opioids but methamphetamines, ketamine, some of the reagents used to manufacture cocaine. this is a large chemical and pharmaceutical industry that is unregulated and does not have the oversight capacity to make sure people are doing the right thing. china needs to do a better job

of cleaning up that act if it wants to be seen respectfully in the international community and not be a narco state. host: let me had back to california. this is john. good morning. caller: i wonder how much would it curtail the import of fennel if -- of fentanyl if we had a secure border, if we went back to the trump policy of state in mexico, if we completed the wall and the border was secure. i wonder how much difference does your person think that would make? would it not make any or you think it would make a lot? host: thanks for the question. guest: we do have some experiments to show. to answer it shortly would have very little effect. before 2019 fentanyl was coming into this country by mail from

china direct. to say we had a wall there would of had very little effects. the beginning of 2020 when covid was put into place, we did see a severe border asked -- quarter restriction. the amount of vehicles that pass from mexico to the united states dropped by 50%. if you have reduction by 50% in the same amount of agents, you double your divorcement capacity, imagine if we hire twice as many staff in the field . we did see a change in the volume affect no across the border -- we did see a change in the volume of fentanyl across the border, it continued to go up. we saw moving things by foot traffic. you do not need a lot of it. it will be easier to conceal fentanyl over a year, over vehicles or by pedestrians. there are other innovative ways

of getting stuff across the border. you can go under the border through tunnels, you can go over the border. to say the hard border -- it would have very little effect in terms of the overall amount. our appetite for opioids is announcer: next, president biden provides an update on russia and ukraine, then secretary of state antony blinken and the ukrainian foreign minister speak to recorders about the increasing tensions with russia. after that, the carnegie endowment for international peace holds a discussion about russian president vladimir putin. ♪ announcer: c-span is your unfiltered view of government. funded by these television companies and more, including sparklite. >> the greatest town on earth is the place you call home. at sparklite, it is our home, too, and now we are facing our

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