Washington must act to stop fentanyl deaths

Fentanyl has become the No. 1 cause of death for American adults under 50. It’s an indiscriminate killer, claiming the lives of quiet teens and young parents, Wall Street traders and celebrities alike. The synthetic opioid is now so cheap and ubiquitous that buying it has been compared to ordering a pizza. While addressing the fentanyl crisis has strong bipartisan support, lawmakers are currently getting pulled in too many directions. They need to establish priorities.

Fentanyl was developed in 1959 as a painkiller, primarily for cancer treatment. It’s up to 100 times more potent than morphine, and just a few milligrams can be deadly. Dealers can make large profits selling pills with infinitesimally small amounts of the substance, at just $4 or $5 each. Fentanyl is also getting cut into street drugs, such as cocaine, heroin and illicit painkillers. Last year, two Ohio college students died after taking what they thought was a generic form of Adderall, a prescription stimulant popular among exam-takers.

Congress, to its credit, has held multiple hearings on fentanyl’s toll. Yet confronting this challenge will be an immensely complex — and often controversial — undertaking. It will (among other things) require multi-year efforts to step up border surveillance, bolster law enforcement, work with foreign partners to disrupt supplies, and educate the public to curb demand.

One first step should be uncontroversial, however: preventing needless deaths. In particular, Congress should prioritize making naloxone, a lifesaving medication that can reverse an overdose, more widely available.

Last month, a government advisory committee voted unanimously to recommend that naloxone nasal spray be sold over the counter, a strong indicator that the Food and Drug Administration will allow it. But naloxone, commonly sold as Narcan, isn’t cheap, even with insurance: A two-pack of 4-milligram spray, typically enough to reverse one overdose, costs between $35 and $65. That figure can hit $250 or more for the uninsured.

The government can help. Congress should further subsidize bulk purchases by schools, community centers, hospitals and other local institutions, thereby broadening free, in-person distribution. (Some cities and states offer free naloxone by mail.) At the state level, laws governing who can dispense or administer naloxone vary widely. For example, many states allow schools to stock naloxone, but too few offer training for staff and students. Ensuring that enough medicine is available and can be properly administered should be a top priority.

President Joe Biden’s administration has taken several steps to expand access to naloxone, from distributing kits to helping states draft legislation governing its use. But it, too, can do more. Biden should start by re-elevating the director of the Office of National Drug Control Policy to a cabinet position. Such status would hold federal drug-control programs accountable, ensure drug policy remains a top budget priority, and facilitate greater coordination across agencies, which will become critical as new drugs like xylazine enter the supply. As part of the White House’s broader response, Biden should also ensure funding flows to equip law enforcement and other emergency workers with naloxone as a matter of routine.

Naloxone alone won’t solve America’s fentanyl crisis. It will save lives. That’s a good start.