Prescription for Pain:

The 2020 Rx Drug

Abuse & Heroin

Summit

Chair: Claire Low

Assistant Chairs: Ananya Prayagai,

Jahnavi Bhatt, Seth Merryman

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Table of Contents

History of the American Opioid Crisis…………………………………………………………3

Current Domestic Situation……………………………………………………………………..6

International Issues……………………………………………………………………………..11

Issues to Consider………………………………………………………………………………17

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“America is awash in opioids; urgent action is critical.

What was a slow stream of illicit fentanyl...is now a flood.”

-Dr. Tom Frieden, Director of the CDC1

Dearest Delegates,

Welcome to Prescription for Pain: The 2020 Rx Drug Abuse & Heroin Summit, a

specialized committee focused on finding solutions toward ending the worst drug crisis in

American history: the opioid epidemic. My name is Claire Low and I am positively delighted to

be your Chair this year as we discuss both the domestic and international aspects of this crisis. I

am a senior here at Michigan State University, and I am currently pursuing a double major in

International Relations and Political Theory & Constitutional Democracy. Drug-related policies

are an interest that I hold close to my heart, and I hope that my committee will help you better

understand this issue and what actions you can take toward improving it.

Allow me to introduce the wonderful staffers that will be assisting me on the dias:

Ananya Prayagai is a freshman from Novi, Michigan. Ananya is majoring in Human Biology as

well as International relations, and pursuing minors in Public Policy and Bioethics. She has 4

years of Model UN experience, including 2 consecutive MSUMUN conferences. Ananya loves

to dance, travel, and try new things. She is ecstatic to see the delegates interact and come up with

innovative solutions to an uprising issue that impacts the public heavily.

Jahnavi Bhatt is a freshman from Troy, Michigan. Jahnavi is majoring in Chemical

Engineering. She has 3 years of Model UN experience, including 3 consecutive MSUMUN

conferences. Jahnavi loves the environment, engineering, and energy bars. She is excited to see

the committee collaborate on issues surrounding the opioid epidemic, a topic she feels strongly

about.

Seth Merryman is a freshman from Oakmont, Pennsylvania. Seth is majoring in International

Relations as well as Political Theory & Constitutional Democracy, and pursuing a minor in

Religious Studies. Seth has four years on Model UN experience, including being the president of

his highschool team, entering his freshman year of college. He is interested in sports, video

games, travelling, and politics. He is looking forward to seeing this committee having a thougtful

discussion on this very important topic.

1 Tom Frieden, M.D. “EXCLUSIVE: CDC Chief Frieden: How to End America's Growing Opioid Epidemic.” Fox

News. FOX News Network, December 17, 2016. https://www.foxnews.com/opinion/exclusive-cdc-chief-frieden-

how-to-end-americas-growing-opioid-epidemic

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I. History of the American Opioid Crisis

America’s experience with opiate and opioid2 abuse has been a longstanding issue, dating

all the way back to 1775, when opium first made its way to the shores of the United States.

During the Civil War (1861-1865), morphine, which was then extracted from opium, was widely

used to treat wounded soldiers and the Union Army issued nearly 10 million opium pills to their

men -- 400,000 of which later became addicted to opioids. In the following years, morphine

would come to be prescribed by male doctors to female patients for menstrual cramps, morning

sickness, and other physical discomforts, leaving over 60% of American women struggling with

opiate addiction.3 In 1898, Bayer Co.4 began to commercially produce heroin, marketing it as a

morphine substitute and cough suppressant for adults, and a cough and cold medicine for

children.5 By 1910, Americans were crushing opioid pills and inhaling them for recreational

use.6 In 1914, the Harrison Narcotics Act was passed to ensure that opioid prescriptions were

written for medical treatment purposes only, limiting recreational use and use of opioids to treat

opioid addictions.7 In 1934, the U.S. Bureau of Social Hygiene found that hydrocodone (an

opiate painkiller) was an excellent painkiller and cough suppressant, but led to addiction because

users would eventually build a tolerance to the drug.8 By the mid-1900s, more policies were

passed to ensure that opioid prescriptions were being written only for patients who were dying

and in acute pain, and the practice of using opioids to treat chronic pain was now widely seen as

high-risk.

2 “Opiate” refers to natural substances that come from opium, while “opioid” refers to substances that are semi-

synthetic or fully synthetic (as defined by www.recoverycentersofamerica.com). 3 Trickey, Erick. “Inside the Story of Americas 19th-Century Opiate Addiction.” Smithsonian.com. Smithsonian

Institution, January 4, 2018. https://www.smithsonianmag.com/history/inside-story-americas-19th-century-opiate-

addiction-180967673/. 4 Bayer Co. today is known as Bayer AG, and is a German multinational pharmaceutical and life sciences company.

It was established in 1863. 5 History.com Editors. “Heroin, Morphine and Opiates.” History.com. A&E Television Networks, June 12, 2017.

https://www.history.com/topics/crime/history-of-heroin-morphine-and-opiates. 6 “The Opioid Crisis in America: An Overview: Calvary Healing Center: Phoenix Drug and Alcohol Rehab.”

Calvary Healing Center, July 29, 2019. https://calvarycenter.com/opioid-crisis-america-overview/. 7 Terry, C. E. “The Harrison Anti-Narcotic Act.” American Journal of Public Health 5, no. 6 (1915): 518–18.

https://doi.org/10.2105/ajph.5.6.518. 8 “A History of Vicodin -- New York Magazine - Nymag.” New York Magazine. New York Magazine, July 2,

2009. http://nymag.com/news/intelligencer/topic/57770/.

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In 1970, President Richad Nixon signed off on a federal statute known as the Controlled

Substances Act, which combined the previous 200-something mix of laws that attempted to

regulate drugs in the United States. The Controlled Substances Act regulates the manufacturing

and distribution processes of controlled substances such as hallucinogens, narcotics, depressants,

and stimulants.9 As defined by the United States Drug Enforcement Administration, the

scheduling of drugs are as follows:

1. Schedule I drugs have no currently accepted medical use and a high potential for abuse.

Examples include heroin and peyote.

2. Schedule II drugs have a high potential for abuse, with use potentially leading to severe

psychological or physical dependence, and are also considered dangerous. Examples

include Vicodin (hydrocodone), cocaine, methamphetamine, Dilaudid (hydromorphone),

OxyContin (oxycodone), and Ritalin (methylphenidate).

3. Schedule III drugs have a moderate to low potential for physical and psychological

dependence. Examples include Tylenol with codeine.

9 “The Controlled Substances Act: Overview.” Findlaw. Accessed November 24, 2019.

https://criminal.findlaw.com/criminal-charges/controlled-substances-act-csa-overview.html.

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4. Schedule IV drugs have a low potential for abuse and low risk of dependence. Examples

include Xanax, Valium, and Tramadol.

5. Schedule V drugs have a lower potential for abuse than Schedule IV drugs and have

limited quantities of certain narcotics. Examples of drugs in this class include over-the-

counter cough syrups with very small amounts of codeine.10

In 1995, the Food and Drug Administration approved Purdue Pharma’s OxyContin (a

sustain-release formulation of oxycodone), and allowed the company to legally claim that their

drug would be less appealing to drug abusers than Percocet and Vicodin. This became Purdue

Pharma’s biggest selling point for OxyContin and the company stretched the F.D.A.’s approval

to their benefit, telling doctors across the country -- primarily targeting suburban and rural white

communities -- that OxyContin was safe, less addictive, and less prone to abuse than other

opioids on the market.11 In reality, prescription opioids were discovered to gradually increase

tolerance and pain sensitivity in patients who experienced chronic pain. And despite Purdue

Pharma’s claims that OxyContin had a lower potential for abuse and addiction than other opioid

drugs, OxyContin was actually booming in popularity on the streets because of its higher

narcotic levels. Purdue Pharma’s company officials were receiving numerous reports about

users illegally altering the drug, breaking and entering into pharmacies that stocked OxyContin,

doctors illegally selling prescriptions, and people attempting to purchase the drug online.12

Despite these reports, Purdue Pharma continued to market OxyContin nationwide, and opioid

addiction rates continued to rise.

By 2002, the amount of opioid prescriptions had shot through the roof. Morphine

prescriptions had gone up by 73%, fentanyl prescriptions by 226%, and oxycodone (OxyContin)

prescriptions by 402%. And this trend wasn’t age-limited; even people as young as teenagers

were going through their parents’ cabinets to access prescription drugs. Efforts began to

decrease opioid prescriptions, and they had some impact but failed to fully control the opioid

epidemic. The years leading up to and following 2002 are now what is referred to as the first

wave in the opioid crisis.

The second wave, which started in around 2010, began with a rapid increase in deaths

from heroin abuse. In 2010 alone, there were 16,651 deaths from drug-induced overdose, and

heroin was involved in 3,036 deaths.13 People were switching from prescription opioids, which

10 “Drug Scheduling.” DEA. Accessed November 24, 2019. https://www.dea.gov/drug-scheduling. 11 Meier, Barry. “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused.” The New York

Times. The New York Times, May 29, 2018. https://www.nytimes.com/2018/05/29/health/purdue-opioids-

oxycontin.html. 12 Meier, Barry. “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused.” The New York

Times. The New York Times, May 29, 2018. https://www.nytimes.com/2018/05/29/health/purdue-opioids-

oxycontin.html. 13 “The Opioid Epidemic: America's Biggest Drug Crisis - Rehab Spot.” RehabSpot. Accessed November 24, 2019.

https://www.rehabspot.com/opioids/opioid-epidemic/.

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had become limited by the earlier efforts to reduce opioid abuse, to a new, cheap, and widely

available illegal drug known as heroin. Medical centers were now required to examine pain

levels in patients to determine whether prescription opioids were actually needed, and it became

much easier to go the illegal route to obtain opioids. The attempts to reduce prescription opioid

abuse had led users to turn to newer and more dangerous drugs, namely heroin. From 2002 to

2013, deaths related to heroin overdose increased by a staggering 286%, and around 80% of

heroin users admitted to abusing prescription opioids before heroin. Additionally, most usage of

heroin requires injection into the veins, and the sharing of hypodermic needles fueled the spread

of injection-related diseases such as HIV/AIDS, hepatitis B and C, skin infections, blood

infections, and heart infections.14 In 2013, there were over 27,000 babies born with Neonatal

Abstinence Syndrome, meaning that they were born drug-dependent.15

2014 marked the beginning of the third and current wave in the opioid crisis. While the

first wave was centered around prescription opioids, and the second on heroin, this wave is

centered around the abuse of fentanyl and other illegally supplied synthetic opioids. In 2016,

deaths occurring from synthetic opioids rose by 100%, and a total of 19,413 deaths were the

result of a synthetic opioid. In order to increase the side effects and addictiveness of drugs,

illegally manufactured synthetic opioids are also being added to counterfeit pills and other street

drugs like heroin, cocaine, and marijuana.

II. Current Domestic Situation

As of 2018, there were 192 deaths everyday due to a drug overdose in the United States16.

Despite efforts by governmental and medical organizations to drive this number down, the

statistic continues to rise. In addition to facing the drastic human cost of this opioid crisis, the

United States must also tackle significant economic setback that comes as a consequence of this

emergency. In a 2017 Executive Summary report published by the White House, officials stated

that the nation incurred a loss of $504.0 billion USD or 2.8% of gross domestic product for the

year due to the opioid crisis17.

14 Liu, Lindsy. “History of the Opioid Epidemic.” History of the Opioid Epidemic: How Did We Get Here?

National Capital Poison Center, November 13, 2019. https://www.poison.org/articles/opioid-epidemic-history-and-

prescribing-patterns-182. 15 “History of the Opioid Epidemic.” Dual Diagnosis. Accessed November 24, 2019.

https://www.dualdiagnosis.org/infographics/history-of-the-opioid-epidemic/. 16 “Drug Overdose Deaths.” Centers for Disease Control and Prevention. Centers for Disease Control and

Prevention, June 27, 2019. https://www.cdc.gov/drugoverdose/data/statedeaths.html.

17 “The Underestimated Cost of the Opioid Crisis.” Accessed November 19, 2019.

https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The Underestimated Cost of the Opioid Crisis.pdf

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Despite many individuals being aware of the dangers of recreational drug use,

communities across the nation are seeing unprecedented increases in drug-related deaths and

medical emergencies. One of the primary reasons for this occurrence is the illegal usage of

prescription drugs such as hydrocodone, morphine, codeine, and fentanyl18. These prescription

painkillers are safest when used for up to three days in order to treat acute afflictions. Any time

longer than this puts patients at major risk for developing an addiction. As opioids are prescribed

to patients in the United States without severe regulations and their enforcement, individuals find

themselves developing a dependency that lasts even after their medical treatment is over. There

were 259 million opioid painkiller prescriptions written in 2012, and an estimated 2 million

people developed an addiction later that year. Anyone who takes opioids - irrespective of his/her

age, gender, or race -- is at risk of developing an addiction. While certain genetic factors may

make some individuals more susceptible to an opioid dependency, there is no surefire way of

knowing who will be at risk19.

Certain medications, known in the scientific field as “antagonists” can undo the effects of

an opioid overdose when injected into an individual: one such medication is Naloxone (also

referred to as Narcan). Naloxone binds itself to the brain’s opioid receptors before heroin (or

other drugs) can, preventing the activation of detrimental substances within the body20. Due to

Narcan’s essential function and its cost effectiveness, the government has permitted non-medical

personnel to legally carry the medication in case of emergency. In addition to preventing opioid

overdose, US organizations are also working on developing treatments using sedatives,

psychological counseling, inpatient and outpatient treatment centers, as well as rehabilitation

groups. Unfortunately, there is no uniform procedure that allows all victims of opioid addiction

to be treated effectively, and much medical and neurological research is still being conducted to

solve this dilemma.

Once a dependency on opioids manifests into an addiction, victims find themselves

turning to illegal narcotics in order to satiate their fixation, mainly due to ease of availability.

Illegal opioids such as heroin and synthetic fentanyl are produced in underground labs and

smuggled around the nation amidst a vast network of drug traffickers. On a micro-level,

individuals obtain illegal opioids through two main methods, classified as “active” and “passive”

18 National Institute on Drug Abuse. “Prescription Opioids.” NIDA. Accessed November 20, 2019.

https://www.drugabuse.gov/publications/drugfacts/prescription-opioids.

19 “Am I Vulnerable to Opioid Addiction?” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 16,

2018. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-

20360372. 20 National Institute on Drug Abuse. “What Can Be Done for a Heroin Overdose?” NIDA. Accessed November 25, 2019.

https://www.drugabuse.gov/publications/research-reports/heroin/what-can-be-done-for-heroin-overdose.

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methods21. When victims of addiction seek out opioids by venturing into illegal drug trafficking

rings and pay for the painkillers with money, they are taking an active route. On the other hand,

if individuals only accept illegal opioids when they are offered to them at parties or on other

occasions, they said to be following a passive method of drug use. However, in recent years, the

availability of illegal narcotics has heightened due to sales on the dark web.

There are an estimated 30,000 online or “cyber” pharmacies, of which about 96% operate

illegally22. These pharmacies enable drug users to gain easy and undetectable access to

significant amount of illegal opioids such as heroin, vicodin, and fentanyl. Further studies

suggest that online drug-trafficking is now also finding its way to “clean” sites such as Facebook,

Instagram, and Linkedin. However, despite the prevalence of web-based drug sales, US

governmental bodies have been able to do little to curb the problem. Little to no effective

regulation exists to restrain the blatant misuse of technology and the internet when it comes to

illegal drug sales.

a. Pharmaceutical Companies

In the current stage of the opioid crisis, the epidemic has claimed more than 300,000 lives in the

United States since 2000 and could claim another half million over the next decade23.

Prescription painkillers are strong drugs that interfere with the transmission of nerve signals from

pain receptors in the nervous system24. During this time period, annual opioid deaths rose from

under 18,000 a year to more than 23,000, and prescription drugs were cited as factors in a

majority of the deaths25. Inappropriate distribution of opioids from pharmaceuticals contributes

to the increasing deaths in the United States. Pharmaceutical companies inappropriately prescribe

and dispense opioids excessively26.

Lawsuits commenced in the early 2000s, but have increased in frequency and profile in

recent years. The earliest suits against opioid manufacturers started with Purdue Pharma, who

21 Daniulaityte, Raminta, Russel Falck, and Robert G Carlson. “Sources of Pharmaceutical Opioids for Non-Medical Use among

Young Adults.” Journal of psychoactive drugs. U.S. National Library of Medicine, 2014.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112461/. 22 Mackey, Tim K. “Opioids and the Internet: Convergence of Technology and Policy to Address the Illicit Online Sales of

Opioids.” Health services insights. SAGE Publications, September 14, 2018.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144490/. 23 Haffajee, Rebecca L., Rebecca Haffajee, Rebecca Haffajee, P. J. Landrigan, J. Kapur, M. Shakya, and Department of Health

Management. “Drug Companies' Liability for the Opioid Epidemic: NEJM.” New England Journal of Medicine, December 4,

2019. https://www.nejm.org/doi/full/10.1056/NEJMp1710756. 24 Nazario, Brunilda. “Prescription Drug Abuse: Addiction, Types, and Treatment.” WebMD. WebMD, February 6, 2018.

https://www.webmd.com/mental-health/addiction/abuse-of-prescription-drugs#1. 25 Mulvihill, Geoff. “Data Show Many Companies Contributed to US Opioid Crisis.” AP NEWS. Associated Press, July 17,

2019. https://www.apnews.com/98963bb70e0f462295ccc02fe9c68e71. 26 “What Are Painkillers? OxyContin, Oxycodone & Hydrocodone - Drug-Free World.” Foundation for a Drug-Free World.

Accessed December 10, 2019. https://www.drugfreeworld.org/drugfacts/painkillers/what-are-painkillers.html.

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created and heavily produce OxyContin -- the brand name for oxycodone hydrochloride. Purdue

Pharma was targeted with personal injury claims brought on behalf of people with addiction who

overdosed. Purdue Pharma‘s opioid products, they alleged, were defectively designed because

companies failed to include safety mechanisms, such as an antagonist agent or tamper-resistant

formulation. Manufacturers also purportedly failed to adequately warn about addiction risks on

drug packaging and in promotional activities. Some claims alleged that opioid manufacturers

deliberately withheld information about their products’ dangers, misrepresenting them as safer

than alternatives. The amount of prescription painkillers being distributed has swelled by more

than 50 percent even as the body count climbed. The products started flowing faster even after

Purdue Pharma was fined $635 million for falsely marketing OxyContin as less addictive than

other opioids. Purdue tried to escape the fines through loopholes, for example, they claimed that

the company produced only a small fraction of the nation’s opioids - about 3% between 2006 and

201227.

b. Lawsuits

This lawsuit led to other companies being identified as also heavily flowing painkillers.

Three companies - SpecGX, Par Pharmaceutical and Activis Pharma - sold lower-priced generic

drugs, including version of OxyContin, to have a combined 90% of production of oxycodone

hydrochloride. Many companies have been using loopholes similar to Purdue Pharma to prove

their distribution of drugs as legal. It is increasingly harder to prove that a prescription drug is

defective if it’s approved by the FDA, which is why companies are able to bypass any attention

of illegal activity with the opioids. Four companies - McKesson Corp., Walgreens, Cardinal

Health, and AmerisourceBergen - each distributed more than 10% of the opioids to pharmacies.

Mckesson distributed more than 18% of the nation’s opioids from 2006 to 2012 - the most of any

company - but stated it didn’t push sales28.

c. Public Initiatives

The Trump Administration declared the opioid crisis a public health emergency and is

starting to put in more efforts to combat the crisis. President Trump’s Initiative to Stop Opioid

Abuse, unveiled in 2018, is confronting the driving forces behind the opioid crisis29. Part 1 is

reducing demand and over-prescription, including educating Americans about the dangers of

opioid misuse. Part 2 is cutting down on the supply of illicit drugs by cracking down on the

international and domestic drug supply chains that devastate American communities. Part 3 is

27 Brown, Dana. “The Case for a Public Option for the Drug Industry.” The New Republic. The New Republic, September 16,

2019. https://newrepublic.com/amp/article/155071/case-public-option-drug-industry-purdue-pharma-settlement-bankruptcy. 28 Mulvihill, Geoff. “Data Show Many Companies Contributed to US Opioid Crisis.” AP NEWS. Associated Press, July 17,

2019. https://www.apnews.com/98963bb70e0f462295ccc02fe9c68e71. 29 “Ending America's Opioid Crisis.” The White House. The United States Government. Accessed December 10, 2019.

https://www.whitehouse.gov/opioids/?utm_source=internal&utm_medium=web&utm_campaign=opioidsgov.

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helping those struggling with addiction through evidence-based treatment and recovery support

services. As of October 2018, the Trump Administration had secured $6 billion in new funding

over a two-year window to fight opioid abuse. To curb over-prescription, the President

implemented a Safer Prescribing Plan that will cut opioid prescription fills by one-third within

three years.

d. Waste Disposal

Another major issue in the epidemic is opioid waste disposal. There is heavily reported

cases of the waste disposal of opioids being misused. This can be due to opioids being

incorrectly checked during inventory or drugs not properly being disposed of. Improper disposal

of opioids can result in the increase of prescribed opioids in the wrong hands. It’s vital to dispose

of medications properly in order to protect our environment and to keep medications away from

drug abusers or curious children and pets. Medications should never be poured down the sink or

flushed down the toilet, except for a few medications identified as appropriate for flushing by the

U.S. Food and Drug Administration (FDA)30. For many, “in-home” disposal is the easiest option

to safely dispose of unused or expired medication.

Home disposal recommends unwanted medicines (not sharps) be removed from containers,

placed in a sealed plastic bag or container and discarded with normal household trash. To the

extent that children or pets are present in the household, consumers may wish to mix coffee

grounds, cat litter or other unpalatable home waste in with the unused medicines before sealing

the mixture in a plastic bag and discarding it with normal household waste. It’s vital to dispose of

medications properly in order to protect our environment and to keep medications away from

drug abusers or curious children and pets.

e. Heroin Assisted Treatment Trials

Meager efforts have been made in the past to control pharmaceutical and drug industries.

One of the biggest efforts that has been set in place was the HAT trials. The HAT trials stand for

Heroin Assisted Treatment. These trials have investigated the utility of medical heroin

prescribing for problematic opioid users31. They attempted this treatment study in Canada, The

Netherlands, Germany, Spain, Switzerland, and the United Kingdom. Throughout the study, the

researchers made frequent observations of increased mental and physical health for most of the

conducted trials, which showed signs of the treatment working. Results from the studies ran from

30 “Prescription Drug Misuse, Abuse & Disposal.” PhRMA Org. Accessed December 10, 2019.

https://www.phrma.org/en/Advocacy/Safety/Prescription-Misuse-Abuse.

31 Fischer, Benedikt, Eugenia Oviedo-Joekes, Peter Blanken, Christian Haasen, Jürgen Rehm, Martin T Schechter, John Strang,

and Wim van den Brink. “Heroin-Assisted Treatment (HAT) a Decade Later: a Brief Update on Science and Politics.” Journal of

urban health : bulletin of the New York Academy of Medicine. Kluwer Academic Publishers-Plenum Publishers, July 2007.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219559/.

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these trials have shown that the implementation of HAT is feasible, effective, and safe as a

therapeutic intervention.

III. International Issues

a. Current International Situation

As of 2016, roughly 275 million people (about 5.6% of the global population aged 15 to

64 years old), used drugs during 2016 at least once32. The international trade of drugs is making

it easier for all members of the population to acquire illegal drugs, such as opioids and

amphetamines. The cause for this increase of drugs being able to be shipped is the massive trade

wars between countries such as the United States and China, who are two of the world’s largest

markets. During these trade wars individuals, who are in charge of checking shipments, are

allowing drugs to slip under their noses. Due to this we saw increases in opium poppy

cultivation, global cocaine manufacture, the quantity of heroin seized globally, and global

cocaine manufacturing coming from countries such as Afghanistan, Colombia, and those within

the African continent and the Middle East3. Countries such as the United States have lead drug

efforts that have failed.

During the year of 2016, alone, we saw 318 million drug users, with the highest numbers

of users coming from cannabis with 192 million users and opioids and amphetamines and

prescription stimulants at 34 million users3. The failing of the international drug control efforts

still have seen drug production, trafficking and consumption remaining consistently steady.33

This steadiness has lead to death tolls being roughly 450,000 people in 2015, with 167,750 of

those deaths being from drugs being misused; while the rest coming from other drug related

issues such as HIV and Hepatitis C3.

The deaths caused by the international drug trade are unneeded and unjustified. The illegal drug

trade has led to tons of drugs to be seized in 2016 alone. Throughout the year 8,607 tons of

illegal drugs were taken in by authorities, with cannabis being the highest at 6,313 tons and

cocaine at second 1,129 tons. Productions of drugs, such as cocaine, are at an all time high

making it easier for people to access these illicit drugs. The international drug trade is coming

from all parts of the world and it shows now sign of slowing down. Even in countries such as the

United States that are starting to see drops in drug related deaths, with only 68,557 thousand

people dying in 201834, the trade is still causing issues. With tons of money being put into efforts

32 UNODC. "Executive Summary Conclusions and Policy Implications." United Nations Office on Drugs and

Crime. Last modified June 2018. Accessed November 20, 2019. https://www.unodc.org/wdr2018/

prelaunch/WDR18_Booklet_1_EXSUM.pdf.

33 Drug Policy Alliance. "The International Drug War." We are the Drug Policy Alliance. Accessed

November 22, 2019. http://www.drugpolicy.org/issues/international-drug-war. 34 Goodnough, Abby, Josh Katz, and Margot Sanger-Katz. "Drugs Overdose Deaths Drop in U.S. for First

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to try to slow down the trade of these illicit drugs and people still dying from overdoses. This

issue needs to be brought to the eyes of the world before it is too late.

b. Issues prosecuting drug trafficking

Drug traffickers come from all places in the world such as American and the Asian

Continent. The trafficking of drugs within the international community is, to a lot of countries, a

serious offence. It is an issue that destroys families and causes harsh punishments. Each country

has its own way of prosecuting international drug dealers.

Countries, such as Malaysia and China in the Pacific and Iran and Saudi Arabia in the

Middle East, if caught drug trafficking drugs into the countries borders is punished with death35.

Their reasoning for killing of these dealers is a pretty simple reasoning: that the drugs they bring

in are considered to lead to family destruction and death, and since there is death we should treat

these individuals as murderers. Due to how laws are enforced in certain nations, the exact

number of people who have been executed for this crime is not known. However, in 2017 China,

Iran, and Saudi Arabia executed over a thousand people combined with China being the

highest^20.

Time since 1990." The New York Times. Last modified July 17, 2019. Accessed November 23, 2019.

https://www.nytimes.com/interactive/2019/07/17/upshot/drug-overdose-deaths-fall.html.

35 Taylor, Adam. "At Least Four Countries Executed People for Drug-Related Crimes in 2017, Study

Finds." The Washington Post: Democracy Dies in Darkness. Last modified April 11, 2018. Accessed

November 24, 2019. https://www.washingtonpost.com/news/worldviews/wp/2018/04/11/

at-least-four-countries-executed-people-for-drug-related-crimes-in-2017-study-finds/.

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The United States prosecutes their drug dealers on what the drug is, how much was sold,

and how many people has the drug affected. In addition, if a person was not even intending to

sell the drug, they can still be charged as a criminal. The execution of drug dealers is not in the

terms of the US. However, that may be changing. President Donald Trump has praised countries

such as China for the “no tolerance” policy they have been in place. President Trump, at a

Pennsylvania Rally, said when it comes to why big countries, such as China, do not have

massive drug issues “I said what do you attribute that to? ‘Well, the death penalty.” and later said

that “You’re killing our kids.”36 The United States, if Trump wins his second term, could end up

using capital punishment as a way to deal with the issue at hand.

c. Countries of Distribution

Drug distribution can come from any country in the world. Countries such as Afghanistan

produced 9,000 tons of opium in the year of 2017, which was an 87% increase compared to

20163. Trends on where certain drugs are coming from are pretty clear and easy to see point out.

The trafficking of cocaine, which was the second most drug captured in 2016, has been generally

coming from one specific area of the world, South America. South America is not the only

36 Bowden, John. "Trump Praises Countries That Execute Drug Lords." The Hill. Last modified March 10,

2018. Accessed November 24, 2019. https://thehill.com/homenews/administration/

377792-trump-praises-countries-that-execute-drug-lords.

14

trafficker in this world37. Countries such as Spain, Portugal, Nigeria, South Africa, and The

United Arab Emirates are all collberates in this trade38. Cocaine, along with other drugs, is one of

the most addictive drugs in the world. It can lead to people’s brain to change the brain’s reward

system, which leads to the increasing risk of addiction39. The Pacific ocean is becoming an

increased supplier of cocaine. In 2017, a yacht was captured near New Caledonia with 1.464

tonnes of cocaine with a net price of $200 USD40. The amount of cocaine that was on this yacht

could easily have been bought by a victim only if it reached its destination. This leads to people

preferring to do anything else besides cocaine and could lead to them losing their homes and

families.

Global Cocaine trafficking (Map from United Nations)

In addition to cocaine, drugs like heroin/opioids, are leading the deaths when it comes to the

international drug crisis. The trafficking of heroin/opioids is coming, just like cocaine from a

specific point. Countries in Central Asia, South-East Asia, East Africa, and the Middle East are

37 Brazier, Yvette. "Everything You Need to Know about Cocaine." Medical News Today. Last modified May

15, 2017. Accessed November 23, 2019. https://www.medicalnewstoday.com/articles/

234239.php#risks. 38 Brazier, Yvette. "Everything You Need to Know about Cocaine." Medical News Today. Last modified May

15, 2017. Accessed November 23, 2019. https://www.medicalnewstoday.com/articles/

234239.php#risks. 39 Brazier, Yvette. "Everything You Need to Know about Cocaine." Medical News Today. Last modified May

15, 2017. Accessed November 23, 2019. https://www.medicalnewstoday.com/articles/

234239.php#risks. 40 Lyons, Kate. "The new drug highway: Pacific islands at centre of cocaine trafficking boom."

Guardian. Last modified June 23, 2019. Accessed November 24, 2019. https://www.theguardian.com/

world/2019/jun/24/the-new-drug-highway-pacific-islands-at-centre-of-cocaine-trafficking-boom.

15

leading in the international trade for Heroin41.It is being put into cocaine, heroin, and other

illegal drugs. Fentanyl is 50x more potent than Heroin and 100x potent than morphine42.

Fentanyl alone in 2017 killed 28,000 people in the US, more than any other synthetic opioid43.

This drug is just supposed to be a painkiller than is used in the proper medical terms, but it is

being abused and leading to the deaths of thousands.

Heroin Global Trade (Map from the United Nations)

Countries such as China are beginning to crack down on international drug shipments. In

November of 2019 China convicted a man who was trafficking Fentanyl into the United States44.

The United States work with the Chinese government to track down the dealers operation. This

cooperation is seen as a good sign for the future, especially after President Trump specifically

blamed China for the deaths in the American streets. The cooperation between nations is key to

stopping the issue at hand.

41 UNODC. "Drug Trafficking." UNODC: United Nations Office on Drugs and Crime. Accessed November 23,

2019. https://www.unodc.org/unodc/en/drug-trafficking/index.html. 42 U.S. Department of Health & Human Service. "Opioid Overdose." Centers for Disease Control and

Prevention. Accessed November 24, 2019. https://www.cdc.gov/drugoverdose/data/fentanyl.html. 43 U.S. Department of Health & Human Service. "Opioid Overdose." Centers for Disease Control and

Prevention. Accessed November 24, 2019. https://www.cdc.gov/drugoverdose/data/fentanyl.html. 44 Myers, Steven Lee. "China Sentences Man to Death for Trafficking Fentanyl to the U.S." The New York

Times. Last modified November 7, 2019. Accessed November 24, 2019. https://www.nytimes.com/2019/

11/07/world/asia/china-fentanyl-death-penalty.html.

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d. Activity in the US

The United States has been one of the biggest victims in the terms of the international

drug trade. In 2016 alone, 63,632 people died because of drug overdoses45, which was a 21%

increase from 2015. A large amount of these deaths were associated with pharmaceutical opioids

such as fentanyl. Even though the US has seen the number of overdose deaths drop since 199046,

the amount of people who died is still over 65,000 people. These are lives that did not deserve to

die. These were people with lives and families that struggled with drug addiction. Drugs are

getting into the country still at large rates.

Some of the most common areas where drugs get in from the southern border with Mexico and

the major ports. In 2016, Border Patrol agents confiscated 83,000 kg (183,000 lbs) of cocaine,

methamphetamines, heroin, and marijuana from Mexican border47. When asked a border patrol

agent said they only have 40 seconds to find any signs of possible signs of smuggling. Since

2001, the tunnel task force based in San Diego found over 60 smuggling tunnels coming into the

United States. Drugs that come into the United States, the amount that the drugs are worth is

about $200 to $700 billion. In places such as Miami, the coast guard seized more than $47

million of cocaine and about 50 lbs of marijuana48. These drugs are getting into the US and

causing massive amounts.

The current US policy in its current form has failed. The current US drug policy has

historically been known to be racist and imperialist. The drug policy in America has generally

been targeted towards Mexico, generally instead of including other nations that are part of the

problem. It has been written by political opportunism instead of seeing how effective the policy

might be or if it will bring any justice. Policy has not reduced deaths, drug abuse or its

availability. It has emphasized law enforcement instead of controlling drug flow. Since 1981, the

US has put more than $65 billion into drug law enforcement49. The money that has been put into

law enforcement, could have gone into fixing the issues that drug trafficking has brought.

45 Goodnough, Abby, Josh Katz, and Margot Sanger-Katz. "Drug Overdose Deaths Drop in U.S. for First

Time Since 1990." The New York Times. Last modified July 17, 2019. Accessed November 24, 2019.

https://www.nytimes.com/interactive/2019/07/17/upshot/drug-overdose-deaths-fall.html. 46 Goodnough, Abby, Josh Katz, and Margot Sanger-Katz. "Drug Overdose Deaths Drop in U.S. for First

Time Since 1990." The New York Times. Last modified July 17, 2019. Accessed November 24, 2019.

https://www.nytimes.com/interactive/2019/07/17/upshot/drug-overdose-deaths-fall.html. 47 Solis, Gustavo. "Drug Smuggling, and the Endless Battle to Stop It." The Wall. Accessed November 24,

2019. https://www.usatoday.com/border-wall/story/drug-trafficking-smuggling-cartels-tunnels/

559814001/. 48 A Forever Recovery. "Drug Trafficking Stats: Where Are All the Drugs Coming From?" A Forever

Recovery. Accessed November 24, 2019. https://aforeverrecovery.com/blog/drugs/

drug-trafficking-stats/. 49 Institute for Policy Studies. "U.S. Drug Control Policy." Institute for Policy Studies. Last

modified November 1, 1996. Accessed November 24, 2019. https://ips-dc.org/

us_drug_control_policy/.

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Issues to Consider

a. What actions has your character taken in regard to the opioid crisis in the past?

b. How should the US handle What are potential policies your character would support to

fight the opioid crisis?

c. the countries of origin that the opioids come from?

d. If the US were to decriminalize opioids, how would the demand be affected?

e. How does the education system help prevent drug use in young adults and children?

What to Include in a Resolution

● What is one way that you see doctors, pharmaceutical companies, and rehabilitation

centers coming together to address this crisis?

● How can the government take action in enforcing opioids-related policies?

● What policies would you work towards creating to limit the amount of illicit opioids

coming into the US from foreign countries?

● How should public education campaigns be structured to effectively reach those at risk?

● How should the US go about handling the countries where the drugs originating from?

● What can be done to make rehabilitation more accessible for those who have already

been impacted by opioids? How much does rehabilitation cost?