Drug Historian Challenges Trump’s War on Fentanyl

BIANNA GOLODRYGA: Well, while the U.S. battles a fentanyl crisis at home, the Trump administration is taking its fight against drugs to the Caribbean. Dozens have been killed since President Trump announced military operations against what the administration says are drug boats used by Venezuelan traffickers. The move is facing a lot of criticism over its legality and whether it’s actually reducing the spread of drugs in the U.S. Drug historian David Herzberg argues this strategy is falling short and he joins Hari Sreenivasan to explain why.

 

HARI SREENIVASAN: Bianna, thanks. David Herzberg, thanks so much for joining us. You wrote an op-ed in the New York Times recently that was titled, “I am a Drug Historian. Trump is Wrong about Fentanyl in Almost Every Way.” I guess, what’s the biggest way that the administration is wrong about this new kind of war on drugs that we seem to be prosecuting?

 

DAVID HERZBERG: Well, first thanks for having me on to talk about this. And I guess the biggest way is the idea that there is a drug-free America in the past that we can return to if we just stop this foreign supply of fentanyl. That’s the story, the idea that these open borders have undermined America’s traditional communities. And that if we could just get back to that before state, everything could begin to recover. And we could have that traditional America again. But as a drug historian, I can tell you that there have always been drugs in America, even in suburbs and rural areas and small towns. There’s always been quite a lot of drugs, in fact. It’s not always been in crisis. But there isn’t a drug-free place we can return to if we just stop this.

 

SREENIVASAN: So David, according to the CDC, there were 53,000 drug overdose deaths in 2024. That’s down from 75,000 in 2023. And illegally-made fentanyl were involved in 65.1% of those overdose deaths. Now, even though the numbers are down you know, more than 50,000 deaths a year is still a staggering number. That sounds like a crisis. Doesn’t the president have a point that this is a crisis?

 

HERZBERG: We should absolutely be taking more significant actions to try to stem this drug. The question is, we want those actions to work, right? We want our goal to be less death, less harm, and the — if we aim our policies at a goal that is kind of a mirage or a fantasy, they can’t succeed. What we want is policies that can actually achieve something that’ll improve people’s lives. And, you know, fentanyl is not a good…is not a good product for consumer use. It’s very potent. It’s hard to package for safe use. And so you know, we saw a shift in illegal markets from heroin to fentanyl, in the 2010s. And this was a shift that didn’t occur because consumers were asking for it. They weren’t saying, We want a more powerful opioid. It happened because of policy changes that changed the incentives in supply chains away from providing heroin. Which had its own problems, of course, right? It’s not a perfect product either. But they shifted to fentanyl, and, and we can, we can do that in reverse. We can shift away from the drugs that are killing so many people and reduce that harm.

 

SREENIVASAN: Help us kind of put this in perspective for us. I think most people are familiar with kind of the opioid crisis that America had started to deal with — and still deals with, especially in rural parts of the country. But how did we get from something that was, you know, pill mills over-prescribing, people getting addicted to painkillers through heroin to fentanyl now?

 

HERZBERG: The problem with fentanyl began in what I call white markets. White markets are those legal markets that sell psychoactive drugs. They’re the ones in your medicine cabinet prescribed by doctors and sold by pharmacists. And when those markets, as they sometimes do, spiraled out of control in the opioid crisis, when authorities responded to try to fix that problem, they were, their actions were in keeping with the pharmaceutical industry argument that it’s, the problem is not with the products. The problem is with the abusers who are diverting them and misusing them. And so the steps they took to fix the problem were to exclude those buyers — people with addiction — exclude them from buying in white markets. Those are people very strongly committed to continuing to buy and use opioids. So they wanted to continue to do that, but there was a mismatch between supply and demand here because they did not live in the places where heroin was sold, right?

 

The heroin markets were a, like a 20th century thing. They involved farms, they went to central markets in major cities, and the opioid crisis, as you mentioned, began in the suburban rural areas. So you had this mismatch. There were people who wanted to buy opioids, but there weren’t enough people selling to them. And that meant somebody could make a lot of money. And so new suppliers stepped in, and these new suppliers were modernizers. They said, We don’t need farms and farmers and goo coming from the sap of flowers. This is all so complicated. We’re in the 21st century. Let’s have a synthetic product. It’ll be even be more powerful, so it’s more profitable. And instead of sending it to just a few major markets in New York and Chicago and Los Angeles, let’s send it to where the consumers are, just like every other product does in the 21st century. 

 

And we have plenty of evidence once again, that consumers at this time did not like fentanyl when it first appeared. They preferred other drugs: Oxycontin, if they could get it, or those other pharmaceuticals or heroin. But the supply chain had shifted and it actually became quite difficult to get those. And so that’s how we saw that shift from pharmaceutical opioids to briefly heroin and then into fentanyl.

 

HERZBERG: If this is such a hard drug to handle and get correctly, why is it so prevalent? I mean, you also hear about fentanyl in other drugs or other drugs laced with fentanyl.

 

HERZBERG: Yeah. So the trouble is that fentanyl is a bad product for consumers, just objectively speaking. It’s hard to make safe. It doesn’t last very long, et cetera. But it’s a great product for smuggling. I call these illegal markets, prohibition markets because we think about them as there to eliminate the supply. But they don’t eliminate the supply, right? Fentanyl is still there. They’re just a different set of market incentives that are, we call prohibition. And those market incentives favor a very potent product, because you need less of it to make the same amount of doses. So that’s very…that can increase the chances for profit. And because fentanyl is such a good product for smuggling, it starts to outcompete other products. 

 

But also prohibition markets don’t incentivize safe production practices. You know, in white markets, pharmaceutical companies have to do all this expensive stuff to make sure that when you buy one of their products, it is exactly what it says it is on the label. And that’s way safer. But in prohibition markets, it’s just as illegal to sell fentanyl that is high quality, that is accurately labeled, as it is to sell fentanyl that is poorly mixed and therefore quite dangerous. Or to sell something that you claim is cocaine, but it’s laced with fentanyl because people didn’t clean the machines or what have you. So there’s no incentive to do this expensive, careful production process in a prohibition market. The incentive is to avoid the cops. So fentanyl kind of spreads out through there because it’s good for the people whose job it is to make money selling drugs.

 

SREENIVASAN: I think there’s also been some questioning of whether or not the boats that we have targeted and attacked. Are these boats coming from Venezuela carrying Fentanyl onto the shores of the United States?

 

HERZBERG: Nothing that I’ve seen suggests that they have fentanyl on board. The fentanyl supply chain doesn’t involve Venezuela. As far as I’m aware, Venezuela is not a significant source of any drugs to the United States. I went to the 2024 United Nation Office of Drugs and Crime Report, and I searched for country names. You search China, it comes up 130 times or what have you. You search Mexico, lots of times. You search Venezuela, and it literally comes up with zero. So I, there’s no evidence that I have that suggests that they are carrying those drugs. And that’s part of the problem with shooting first and asking questions later. These are essentially imposing the death penalty on people who, as far as I can tell, have never been committed — have never been even accused of a crime, much less convicted of one. 

 

SREENIVASAN: What’s interesting about not just the op-ed that you wrote, but really the books that you’ve written in the past are, is that you kind of have this much longer arc. And you’re looking at how the culture in the country that is America has had previous, you know, experience with drugs that we couldn’t contain that became socially acceptable, that might be legally questionable. I mean, we had, you know, President Nixon famously, you know, wanted to start this war on drugs. And we’ve had this kind of really difficult relationship back and forth on trying to figure this problem out.

 

HERZBERG: So while there has long been widespread drug use in America, starting with, in the years after the revolution, historians call this the alcoholic republic. Drinking rates shot up to a level that has never been matched since — eventually triggering a century long crusade against alcohol that culminated in literally a constitutional amendment to criminalize the sale and transport of alcohol. So the problem has been there. But there have also been, there have been times when widespread drug use has led to public health crises, and there have been times when there’s still widespread drug use, but there aren’t public health crises. And this is something that we can learn from history and say, well, what’s the difference between the two? 

 

And I’ve developed a little bit of a rule of thumb and trying to think about this, 150 year history and public health crises usually come in a situation where certain communities or lots of communities are flooded with a dangerous drug. Meaning that that drug is really, really easy to access. And I think about this in my own life. In the 1980s when I was in high school, kids knew how to get beer, they knew how to get cannabis. Out of all the illegal drugs that exist, those are the ones that kids in my high school used. Why? Because they were the ones that were easiest to get. So in a certain way, there was an informal harm reduction going on. In theory, the kids were supposed to be using no drugs, but in reality, the ones they had access to were the ones that were relatively safer than, let’s say, if I had been in high school in the 2000s. And at every high school party, there were a ton of opioid pills. So that flooding is really at the basis of a lot of the crises. 

 

SREENIVASAN: You know, do you see parallels like, you know, when in what, ‘71, when Nixon starts this sort of war on drugs. And then we’ve seen president after president in different ways kind of quote that or come up with their own slogan — “Just Say No,” famously with Nancy Reagan, right? And even now, I wonder whether you are seeing the kind of rhetoric politically that comes out in trying to stop fentanyl. Are there parallels going back in American history?

 

HERZBERG: Yeah, there are, there are a lot of parallels. And it, and it even goes before Nixon, the first federal anti-drug laws with mandatory minimum prison sentences were in the 1950s, in the so-called Boggs Act. So this is,  it’s easy to understand this reaction. Addiction is frightening. I’m a parent of three children myself, and it’s terrifying to imagine this kind of harms befalling your children. And the idea of someone saying, I’m gonna take a tough approach and really punish and scare the people who want to threaten your children. It’s an emotionally satisfying approach. And as a parent, I fully understand it. 

 

Unfortunately, history shows it simply doesn’t reduce the risk. It simply is ineffective. We don’t have to debate whether it’s better or moral or this or that. If you want kids to be less harmed by drugs, that’s not the approach that you take.Because those prohibition markets, once again, they select for more dangerous drugs. They select for more danger to young people than less. And so, if we are switching now, if we are shifting back towards that rhetoric, that harsh anti-drug rhetoric, trying to deal with drug problems through war-like actions like blowing up boats in the Caribbean, that suggests another period of lengthened crisis, you know. Because those approaches don’t work. 

 

The way that approaches have been working to reduce the number of overdose deaths — you cited 50,000, there were over 100,000 recently — and there was nobody blowing up boats when that happened. It was because of a set of practical policies that had as their goal preventing deaths, preventing overdose deaths. So we’re talking about fentanyl test strips so that people can tell what’s in the drug they’re about to use. Syringe exchange programs that reduce the transmission of disease between injection drug users. Even safe injection sites, which kind of bring into prohibition markets a little bit of that white market safety to have a medical professional there. And those kind of things help reduce death. So everyone should agree that people should stay alive, and that should be a central goal of drug policy.

 

SREENIVASAN: When you kind of think of this sort of longer arc of how a country can tackle a problem like this, is there a country that’s done it well? 

 

HERZBERG: I think that there are those precedents in the United States. There are moments where the policies worked reasonably well. And I want to be clear, there is nowhere that has no drug problems. There’s nowhere that has no drug harms. But what had been happening in the 1950s and sixties were twin catastrophes. White markets were selling barbiturates, amphetamine, quaalude, Valium, hand and fist. As many as half of all Americans had used one of those products in the past year. And there was tons of addiction and harm in those white markets. So they were kind outta control. Meanwhile, waves of heroin addiction were washing through American major cities. And so all elements of American drug policy were failing dramatically and catastrophically by the late 1960s. And initially this, this war on drugs looked a lot different than what it eventually became. It initially involved tightening the screws on the pharmaceutical industry. In other words, regulating the sellers who are motivated by profit, so they will respond to incentives. And then they reduced many penalties for drug consumers and sort of trained their sites on those big sellers. And at the same time, they invested massively in the kinds of services and supports that people who had developed an addiction might need. This was the era that methadone maintenance became really widespread. 

 

So if you think about this combination of regulating suppliers and they regulate in a smart way. The more dangerous drugs like amphetamine got restricted really strongly and then less dangerous drugs — maybe like a codeine or in the sedative class Valium — they were in a they were less intensely regulated so that the market was steered towards products that were that were safer. And in the meantime, there was special recognition that people with addiction need different kind of response than everyone else.

 

SREENIVASAN: You know, we’ve had conversations with people who’ve run needle exchanges or safe injection sites on the program before. And if we know that the statistics back up that these programs work in different parts of the country where they’re tried, if we know that for sure. Why are there not larger scale policies if our interest should be in keeping people alive so that they can get help and perhaps get off these drugs?

 

HERZBERG: Yeah, I mean, I think a lot of it does have to do with cultural fears about drug use and about reducing the moral stigma of drug use, which people believe prevents people from using drugs. But it’s also that there’s a, there’s a degree of legitimacy to those fears that comes from a different angle. So I’ve been mostly talking about how prohibition markets select for dangerous drugs, but it’s also true that free markets like legalization and, you know, just open markets, those also lead to selecting for dangerous products. Look at the cigarette industry at mid-century, adding hundreds of chemicals to cigarettes to increase their addictiveness, even though it harmed consumer’s lungs. So it’s not irrational to be afraid that if you open up an inch that, you know, we live in a, in a commercial society. We live in a profit-driven society. Drugs are very profitable. And so if you, there could be a reasonable fear that if you open up an inch corporations will spread it out to a mile and there’ll be lots of harm and damage. And so you just want to keep the door all the way shut. 

 

To me, this is, this leads to catastrophic failure of policy creativity. You have prohibition and you have free markets. And if you aren’t willing to explore anything in the middle, then you’re stuck with the two worst options. And I think it’s a terrible tragedy that we’re not willing to try to apply that incredible expertise that we’ve developed over centuries in managing these markets. And I think we need to purchase legitimacy by showing willingness to regulate those markets really robustly. The goal isn’t that everybody should be using drugs. The goal is that people who use drugs should use safer ones, in safer ways, and that fewer people should experience addiction or other harms.

 

SREENIVASAN: Professor David Herzberg at the University at Buffalo. Thanks so much for joining us.

 

HERZBERG: Thank you.