Donald Trump last week announced he would declare the opioid crisis a national emergency, as his Commission on Combating Drug Addiction and the Opioid Crisis recommended late last month. The commission, led by New Jersey Gov. Chris Christie, stressed the importance of making addiction treatment and overdose-reversal drugs available to more Americans—policies to alleviate the demand side of the problem.
These actions will help, but the commission won’t succeed in reducing opioid deaths if it doesn’t make suppressing the supply of drugs its leading priority. The report contains no recommendations for reducing the largest supplies of opioids at their sources in Mexico and Asia. Cracking down on doctors who prescribe excessive amounts of legal pain medications is already having an effect, but the surging supply of illegal drugs like heroin and fentanyl has negated a lot of the gains.
The rise and decline of the cocaine epidemic shows how attacking the supply is essential to saving lives amid a drug crisis. Cocaine from Peru led to the crack epidemic of the 1980s, until the supply chain was disrupted by U.S.-Peruvian antidrug operations. Coca cultivation dropped by 75% between 1992 and 2001.
After a brief remission in the 1990s, cocaine from Colombia began to flood U.S. streets. Some six million Americans used cocaine in 2006, according to the National Survey on Drug Use and Health. Then something unprecedented happened. Between 2006 and 2011, cocaine users dropped rapidly, to under four million. This decline registered in multiple data sets. During this time cocaine-positive workforce drug tests declined more than 60%. Meantime, cocaine treatment admissions fell from about 268,525 a year in 2005 to 143,827 in 2011. Cocaine-related drug overdose deaths fell 44% between 2006 and 2010.
Treatment rescued many, and prevention slowed initiation. Yet during this time demand-reduction policy didn’t change, nor did funding increase. The driving factor was the decline of cocaine production in Colombia. Military progress against cocaine-producing rebel groups and crop-eradication programs, joined with development efforts, led supply to shrink from an estimated 700 metric tons in 2001 to 210 metric tons by 2012. Data showed a decline in cocaine purity on U.S. streets, and a corresponding surge in price.
Reducing supply proved the key catalyst for progress. Unfortunately, the Obama administration, fearful of waging a “drug war” and hesitant to influence another country’s internal politics, undermined these achievements. Worst of all, Colombian coca eradication dropped dramatically in 2013. By 2016 Colombian production exceeded its previous peak in 2001. The most recent data show cocaine overdose deaths are rising again, while college students’ annual cocaine use, after falling 50% from 2007-13, rose 60% through 2015.
When cocaine flow was rising, abuse rose and its consequences got worse. When the flow of cocaine was cut, demand reduction—e.g., recovery programs—gained traction. But when flow returned, such demand-based programs couldn’t hold back the wave of easily available poisons.
This is the crucial lesson for stanching the opioid epidemic. As the U.S. shuts down overprescribing of opioid medications, it needs a comparable effort against the availability of illicit opioids like heroin and fentanyl. The U.S. should offer Mexico a partnership similar to our previous arrangement with Colombia, contingent on whether the country cuts its opium and fentanyl production and trafficking. The Trump administration should insist on similar enforcement in the Asian nations sending illicit fentanyl into the U.S. and fentanyl precursors to Mexico. Federal law enforcement also needs a strategic plan to dismantle domestic trafficking networks. Hopefully Mr. Christie’s commission makes this clearer to the president than its initial report did.