Biden’s position on fentanyl condemned by treatment advocates, Republicans

President Joe Biden’s calls in his State of the Union speech for strong criminal penalties in response to soaring deaths linked to the potent opioid fentanyl are being rebuked by harm reduction advocates who say that approach could make the problem worse, even as some in Congress jeered the comments and blamed the Democrat’s border policies for deepening the crisis.

The reactions laid bare how preventing drug deaths touches on deep political, practical and philosophical differences even in addressing an unrelenting U.S. overdose crisis connected to more than 100,000 deaths a year.

After introducing a New Hampshire father whose 20-year-old daughter died eight years ago from a fentanyl overdose, Biden laid out a grim statistic: “Fentanyl is killing more than 70,000 Americans a year.”

A few lawmakers called out “It’s the border.” The voice of one, Rep. Andy Ogles, a Tennessee Republican, rang out clearly: “It’s your fault!”

Biden paused, smirked and went on, laying out his approach for dealing with the crisis, including calling for inspecting more packages and cargo coming into the country.

One phrase in particular — “strong penalties to crack down on fentanyl trafficking” — drew applause in the House chamber but criticism from harm reduction advocates working to contain the crisis.

While such advocates support other aspects of Biden’s framework, their view is that handling the crisis largely as a law enforcement issue makes it worse, and that “strong penalties” could be linked to permanently listing fentanyl-related drugs in the highest tier of controlled substances. That brings higher penalties and make it harder for researchers to work with them. All fentanyl-related drugs are listed on that tier through 2024, but it’s up to Congress to decide whether to make it permanent.

“When you criminalize things, you create stigma around substances,” said Maritza Perez Medina, director of federal affairs at the Drug Policy Alliance. “If people know they’re going to get in trouble for using substances, they’re going to be reluctant to call for help.”

Harry Cullen, an organizer with the harm reduction advocacy group P.A.I.N., said efforts to control the fentanyl supply have led the emergence of other, even more dangerous substances in the drug supply, such as Xylazine, which is used as a veterinarian sedative, and nitazenes, another class of opioids.

“To double down on criminalization is not the way forward,” Cullen said.

Harm reduction advocates call for increasing availability of medicationassisted treatment and measures to prevent fatal overdoses through measures such as providing supplies to test drugs for fentanyl, and naloxone, a drug that reverses opioid overdoses.