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Brief Description

= Introductory Paragraph =

Key to any strategy to reduce opioid misuse is preventing illicit opioids, including heroin and synthetic opioids, from ever reaching communities. This role is almost exclusively the role and responsibility&nbsp;of law enforcement at both the federal and state level, and requires cooperation between jurisdictions and federal partners to ensure success.

= Key Information =

<br/> In the United States, fentanyl is classified as a Schedule II controlled substance, meaning there is a potential for misuse and dependence, but it does have an accepted medical use and can be prescribed for restricted use. Although prescribed synthetic opioids are sometimes diverted to the illicit market, the main reason for the surge in high purity synthetic opioids are from the increase in manufacturing from clandestine labs, which are either pressed into pills or left in powder form and mixed with heroin.&nbsp;

Law Enforcement, State, and Federal Response<br/> Increasing seizures of synthetic opioid-laced heroin by law enforcement, calls from politicians to increase punishment for possession and/or sale of illicit fentanyl included escalating mandatory minimum sentencing, and even capital punishment for sale of heroin.There is no evidence that escalating criminal punishment will have any effect on reducing risk of overdose or use in general. Research has suggested that these policies will fail to address the issues involving fentanyl and will continue the harmful trend of mass incarceration in the US.&nbsp;<ref>https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>

Individual states and the federal government’s efforts are centered around placing individual synthetic opioids and opiate-like NPS into Schedule I of the Controlled Substances Act (CSA).&nbsp;

'''Perceived Dangers of Accidental Overdoses'''<br/> With the distribution of fentanyl, a powerful opioid that can be lethal in small amounts, overdoses have been reported by law enforment personnel as having occured through inhalation or absorption through the skin during routine encounters.<ref>http://www.cnn.com/2017/05/16/health/police-fentanyl-overdose-trnd/?iid=ob_article_footer_expansion]</ref>&nbsp; These instances, however, are more myth than reality,<ref> http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref>&nbsp;and can lead to misplaced fear when law enforement and emergency responders come upon a suspected overdose. Any delay in responding to an overdose could cause brain damage and even death.&nbsp;

'''National Programs<br/> <br/> ''DEA 360 Strategy<ref>http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref>'''''<br/> Target Drug Trafficking Organizations<br/> In the past, the DEA has targeted low-level, first time non-violent offenders who usually are selling to get high themselves.<ref>http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref>&nbsp;This new strategy will target all drug deals, but start from the top down.

"These drug trafficking organizations are predators. There's no other way to describe it. They look for the vulnerable, they exploit them by finding them while they are trying to get treatment; that's how severe, how bad these drug trafficking organizations are to find their customer and peddle their poison. We're going to put together a task force and this task force is going to put together building federal cases based on these overdoses, and there is significant sentencing around and this is a way to impact straight into the organization and take out upper level members of an organization that directly impact the flow of drugs.”<ref>https://www.justice.gov/usao/file/895091/download</ref>

-Thomas Gorman, Assistant Special Agent in Charge, DEA

'''''Organized Crime Drug Enforcement Task Force<ref>https://www.dea.gov/operations/ocdetf</ref>'''''<br/> Organized Crime Drug Enforcement Task Force (OCTDEF) National Heroin/Fentanyl and Opioid Initiative<br/> Since its inception in December of 2014, the ultimate goal of this initiative has been to develop multi-agency, multi-jurisdictional cases against criminal organizations. The Initiative leverages the national structure, resources and information sharing capabilities to identify the local street level distributors who are responsible for overdose deaths, as well as their network of suppliers at the local and regional level. In the last several years, OCDETF investigators and prosecutors attacked the opioid epidemic by prosecuting rogue physicians, pharmacists, internet sales, and pill mill operations. Their traditional diversion investigations involved overwriting of oxycodone by doctors, and misuse of fentanyl patches by users who clipped the edges to consume the gel inside. Today, OCTDEF funds 60 Heroin/Fentanyl and Opioid Initiatives across the country.

'''''Working With China to Stop Export of Controlled Substances'''''

A large number of synthetic opioids, specifically fentanyl, come to the US from China.&nbsp;<ref>https://www.statnews.com/2016/09/03/us-china-fentanyl/</ref><br/> China has agreed to crack down on the exports of substances that are controlled in the US, but not in China.<br/> The US and China will work together to exchange more law enforcement and scientific information to coordinate actions.<br/> Cooperation between the U.S. Drug Enforcement Agency (DEA) and the China Ministry of Public Security (MPS) and recognized China’s actions toward combating global synthetic drug trafficking.<br/> <br/> On October 1, 2015, China took an important step in international coordination by controlling a list of 116 synthetic drugs that were widely abused in the U.S.<br/> When evaluating a substance for control, the new provision also allows China to consider harm to the public in countries other than China.<br/> DEA continues to share information with Chinese officials to secure scheduling of additional fentanyl-class substances in China due to the wave of recent deaths in the United States from these synthetic opioids.&nbsp;<br/> <br/> At a time of massive growth in postal shipments from China due to e-commerce, the investigators found that the postal system received the electronic data on just over a third of all international packages, making more than 300 million packages in 2017 much harder to screen. Data in the Senate report shows no significant improvement during 2017 despite the urgency.&nbsp; The U.S. Postal Service said it has made dramatic progress in the last year in total packages with opioids seized by U.S. Customs and Border Protection... implementing the use of electronic data is slowed by the need to negotiate with international partners, but the service is making progress.&nbsp;<br/> <br/> '''General Strategies'''<br/> Better Addiction Prevention, Treatment, and Recovery Services<br/> Improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid misuse and addiction, and to enable individuals to achieve long-term recovery.<ref> https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

<br/> '''Better Data'''<br/> Strengthen public health data reporting and collection to improve the timeliness and specificity of data, and to inform a real-time public health response as the epidemic evolves.

<br/> '''Better Pain Management'''<br/> Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.<ref> https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

'''Better Targeting of Overdose Reversing Drugs'''<br/> Target the availability and distribution of overdose-reversing medications to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations.

'''Better Research'''<br/> Support cutting-edge research that advances our understanding of pain, overdose and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms.

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

= Promising Practices =

Please link to any best practice models or case studies that highlight creative/innovative or successful efforts in support of this strategy. Is there a community that does a really good job in this area that other communities should replicate? Please write a brief description and provide a link.

= Sources =