Tim Steller's column: Look beyond the border for fentanyl-addiction fixes

It’s always nice to blame our problems on someone else.

It means the solutions are simpler and don’t take as much work from us.

This is something worth thinking about when you hear candidates talk about how the “open border” is causing one of Arizona’s worst problems — the fentanyl addiction epidemic.

It isn’t. At least not the way they say it is.

But that doesn’t mean the problem isn’t severe and doesn’t deserve careful attention from the candidates. It’s just that “filling the gaps between the different categories of behavioral health care,” and “ensuring people get care for underlying mental health issues upon successful drug treatment” — things like that can’t be made into rousing political slogans.

Instead you hear things like this faulty description of a solution to a real problem from Republican nominee for governor Kari Lake.

“We’ve got a fentanyl crisis going on. I’ll bet everybody in this room knows somebody who has been affected,” she said at an event last week. “This is happening because Joe Biden took away a great policy that was protecting us, and he opened our border to the drugs and the cartels.”

“The governor is the commander in chief of the Arizona National Guard. We’re going to enact and invoke our Article 1 Section 10 powers in the United States Constitution to secure that border.”

Now, I credit Lake for emphasizing the addiction issue in her campaign. But overdose deaths started accelerating in Arizona in late 2019, under Donald Trump, and reached an intolerable peak under Biden, CDC data show. In Pima County, there were at least 498 overdose deaths in 2021, of which at least 71% were from opioids, predominantly fentanyl.

So yes, it’s a big problem that we all can see in our families, our neighborhoods or out on the streets. But indulge me a prediction: If Kari Lake is elected governor and deploys the National Guard to the Arizona-Mexico border, it will not have a significant impact on our fentanyl addiction problem. Fifty years of Drug War experience tell us that.

Supply and demand problems

All over the country, politicians such as Lake are conflating two phenomena that are only indirectly related. One is the issue of migrants arriving at the Mexican border and crossing between ports of entry. That’s the “open border” people talk about, though many of the people crossing make legal asylum claims. Rarely do they smuggle drugs.

The other phenomenon is the smuggling of pills containing highly addictive fentanyl — largely through the border’s ports of entry. Over the last three years, 87 percent of the seizures of fentanyl by Customs and Border Protection officials have taken place at ports of entry — 25,100 pounds out of 28,800 total.

Even if you believe Joe Biden “opened the border” to migrants, he did not open the ports of entry to pills. That’s clear from the fact that seizures of fentanyl at the ports have more than doubled in the first two years of Biden’s administration, rising beyond 10,000 pounds per year compared to the 4,000 pounds seized during Trump’s last year in office.

The problem isn’t just supply — the pills pouring in from Mexico are made of chemicals from China or elsewhere. The supply of these cheap, powerful pills was necessary to accelerate the addiction crisis we’re in, and likely helped create its own market. Now that there is a market, the pills will find a way, whether it’s through Mexico or in shipping containers or some other way.

But the problem is demand, too. Despite all the deaths, and all the risks associated with pills that are sold as, say, Oxycontin, but are laced with fentanyl — despite all that, we as a society still have a deep longing for them.

Cutting that demand — getting people not to take one of these pills in the first place, or to stop consuming them once they’re hooked — that’s the hard work on ourselves as a society. It’s more mundane and complicated than the symbolic deployment of soldiers to fight a drug problem that, at base, can’t be shot or arrested.

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System failures ongoing

Lots of people around Tucson are deeply involved in the hard work of addressing demand, from first responders to health care providers to officeholders, agencies and activists.

Naomi Vega became deeply involved in the issue after her son, Jesus Gutierrez, died of a drug exposure in 2020. Vega formed a group called Enlightening Hope Project that tries to help the family members of people with addictions to navigate treatment and services.

One might think that, after Gov. Doug Ducey called a special session to deal with the opioid epidemic in 2018, our systems would make it easy for someone who is addicted to get treatment. Not necessarily so.

When we talked Friday, Vega told me the nitty-gritty details of how the system can still fail people who want help. She followed up the conversation with a detailed email including spreadsheets of fee-for-service rates and provider information. Among the ongoing problems Vega has identified:

There aren’t enough beds for detoxification, leading to people who are addicted to methamphetamine or other stimulants being rejected, because opioid addictions take priority. But some of those methamphetamine pills are also laced with fentanyl, which contributes to the addiction.

The transitions from a detox facility to the next stage of treatment, such as a sober-living facility, and then out from that often lead to a patient falling through the cracks and dropping out of treatment

Once treatment for an addiction is complete, underlying mental-health conditions often go untreated, leading people to end up back in the same problems.

“There is not enough ‘filler’ to cover the areas where people are falling through the cracks,” Vega said by email. “There has to be something that catches the person between the different levels of care until the person is ready and able to be independent and a productive member of the community.”

Addressing demand lacking

Now, Lake does delve into some details of addiction treatment in her policy on homelessness. Overall, that policy uses a carrot-and-stick approach, banning people from “urban camping” but offering them services either voluntarily or involuntarily as diversion from crimes.

This sort of coercion is controversial in the addiction field, but it has been shown to work for some people. Chris Chavez, a program manager for Hope Inc. who does outreach in homeless communities, told me he got sober as a result of a diversion program when he was charged with felony crimes. He didn’t want to go, but it worked, he told me.

Lake’s Democratic opponent, Katie Hobbs, hasn’t posted a specific policy on addiction or spoken of it as frequently as Lake has. But her campaign told me via email this is a priority for Hobbs, a former social worker, as evidenced by her previously working with Republicans in the Legislature to address the opioid epidemic.

“As governor, I’ll ensure we do more to address this crisis that has been so deeply impactful across urban, rural, and tribal communities,” she said in an email. “That’s why I’ll work to secure our border to stop drug trafficking and work to provide critical resources that help those struggling with addiction, such as expanding access to medication-assisted treatment and working to ensure prescribers comply with standards that prevent the overprescribing of opioids.”

Again, the border.

Yes, supply matters. But we’re not going to get a grip on the problem unless we make it as easy as possible for users to get help and reduce their demand.