From the U.S. Government Accountability Office, www.gao.gov Transcript for: Combating Synthetic Opioids Description: Illegal opioids have been around for a long time. So what's different about the rise of illicit synthetic opioid use, and what can be done about it? Related GAO Work: GAO-18-205: Illicit Opioids: While Greater Attention Given to Combating Synthetic Opioids, Agencies Need to Better Assess their Efforts Released: April 2018 [ Background Music ] [ Diana Maurer: ] Tens of thousands of Americans are dying every year of drug overdoses. [ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. Federal agencies have been responding to the increase of illicit synthetic opioid use by doing things like working with foreign governments, sharing trending information or changing approaches to prevention and treatment. I sat down with Diana Maurer the director who led GAO's recent report on combating synthetic opioids, and I wanted to know since there are legitimate uses with many opioids, what harms did the report focus on? [ Diana Maurer: ] Sure, well there are legitimate uses for opioids. A lot of people in this country take opioids for legitimate pain relief and that's been a widespread practice in this country. That industry is heavily regulated and there is a legitimate regulated distribution chain to get opioids in the hands of people who truly need them. The problem is that many of those people become addicted to those pain medications. That creates a tremendous demand for opioids and synthetic opioids through illicit channels and that's where the drug cartels and the drug trafficking organizations come into it. The harm from this comes from the fact that many of the synthetic opioids are much more powerful than the medically provided opioids, things like morphine and oxycodone, fentanyl for example is 20 to 30 times more powerful than morphine. That means that it takes a much smaller dose of fentanyl to be lethal to someone. That's definitely contributed to the dramatic increase in the number of deaths as a result. [ Matt Oldham: ] Can we call where we're at right now an epidemic? [ Diana Maurer: ] Absolutely. And unfortunately, we can call it an epidemic and many people have done that. You know, in 2016 over 60,000 Americans died of drug overdoses and about 20,000 of those were due to synthetic opioids and to put that first number in perspective, 60,000 people is more than died in the entire Vietnam War. So, if you think about the Vietnam War Memorial here in Washington D.C., you'd have to construct a bigger memorial just to capture all the people who died from overdoses in 2016. In addition, the number of people who've died from synthetic opioids increased more than 500 percent from 2013 to 2016, so we are definitely in the grips of an epidemic and unfortunately, all indications are, it's still getting worse. [ Matt Oldham: ] So, what are federal agencies doing about this epidemic? [ Diana Maurer: ] Federal agencies are working on a number of different fronts to try to confront and minimize the impact and hopefully as a result have fewer people die. There's been a lot of effort on the public health side of the House to get naloxone into the hands of local law enforcement and first responders. That's a medication that allows paramedics, for example, to revive someone who's suffering from a drug overdose. So, they don't die. Public health officials are also working very closely with law enforcement to get real time, or close to real time information into the hands of law enforcement so they can track drug overdoses in the prevalence and location of those overdoses. Law enforcement at the federal level is working more closely with state and local partners to more aggressively seek out, investigate and prosecute drug trafficking organizations. On the international scene, the State Department and other federal agencies are working with our counterparts in places like China and Mexico and Canada to stem the flow of synthetic opioids and the precursor chemicals used to make those substances before they get into the United States. So, there's a lot going on. [ Matt Oldham: ] And do we know how effective these efforts are? [ Diana Maurer: ] Well, I wish that I could say that we did know. But unfortunately, we really don't. There certainly has been no lack of effort, there's definitely been more attention, there's been more focus, there's been more resources, there are a number of strategies across different parts of the federal government. Our report identified five of them. Unfortunately, most of those strategies don't have a clear way of determining whether or not they're succeeding. And that was one of the main recommendations in our report, was that yeah, it's great that we have these strategies, but the agencies and the organizations that are implementing them, need to have some yardstick, some measure to know whether or not they're on track, to achieving success. [ Matt Oldham: ] Since we first started talking about doing a podcast on this issue a few weeks ago, opioid use has been in the news. You have the Department of Justice urging Congress to relook at regulation and laws. And the CDC just released a report saying that opioid overdoses have jumped 30 percent from 2016 to 2017. Can you give me anything, any bit of optimism on this issue? [ Diana Maurer: ] It's difficult to be optimistic about an issue like this when so many people are dying. And so many indicators point to the fact that this is only getting worse. But I think one of the main things to be optimistic about, is the increased level of attention, the increased level of focus that exists to address this problem at the federal level, at the state level, as well as the local level. There are many different federal agencies that are paying much more attention to this issue than they were three, four years ago. They're devoting more attention, they're devoting more resources. It's being confronted as a multifaceted problem. Which is encouraging, because it is a multifaceted problem. So that means public health is engaged, that means federal law enforcement and local law enforcement is engaged, U.S. government is engaged diplomatically to try to address the problems. There are a lot of things going on, there are a lot of efforts underway to try to address it. The real challenge is that millions of Americans are addicted to opioids and there is a multibillion dollar, multinational sophisticated series of drug trafficking organizations that exist in part to help meet that demand. That makes this an extremely difficult problem to try to address. [ Background Music ] [ Matt Oldham: ] While federal law enforcement agencies are tackling the growing epidemic of illicit synthetic opioid use, they may not be able to truly know how effective they are. I asked Diana to walk me through her team's recommendations. [ Diana Maurer: ] First and foremost, we recommended that the different federal agencies that have strategies develop ways, in some cases better ways, of measuring whether or not they're making progress. That's important for the agencies that are implementing these efforts. But it's also important for the American public and Congress to understand whether or not we're actually making progress. Whether things are getting better or not. And a little more focused basis, we recommended that the Agency Customs and Border Protection, which screens international mail, do a better job of determining where to prioritize its resources. Where should they put people? Where should they have labs for example, to screen whether packages or substances taken from packages, are actually illicit opioids. We think that these things can help address this problem. We also had a recommendation that the Office of National Drug Control Policy, which is the leading federal organization, to coordinate all the other agencies, work across the spectrum of law enforcement, of public health organizations, to help get better information, more real time information, on the prevalence and location of drug overdoses. This helps for the public health side of this issue, it also helps federal law enforcement know where to target their resources and focus their attention. [ Matt Oldham: ] Diana what would you say is the bottom line of your report? [ Diana Maurer: ] The bottom line of our report, that this is a tragedy facing this country right now. Tens of thousands of Americans are dying every year of drug overdoses. Many different federal agencies are very focused on this. They are taking a number of actions, they're working more closely with each other, they're working more closely with their state and local partners, to try to address this problem. However, we think that they should do a better job and can do a better job assessing whether or not their making progress. One of the strategies that's in place right now, has a good set of metrics that allows the agencies to know whether or not they're making progress. We would like to see a similar approach taken in all the federal strategies that are helping to address this national epidemic. [ Background Music ] [ Matt Oldham: ] Thanks for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Matt Oldham: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.