This week, Michael is joined by the Cato Institute's Director of Immigration Studies David Bier and Senior Fellow Dr. Jeffrey Singer to break down the false narrative that ties illegal immigration to the fentanyl crisis. They say the real source of fentanyl comes from US citizens at ports of entry, and argue that harder drug prohibition leads directly to harder drugs being manufactured.

Episode Transcript

Michael Pope  

I'm Michael Pope. And this is Pod Virginia. A podcast that's taking a look at the opioid crisis and wondering how immigration might influence overdose deaths. Now, you may have heard the narrative out on the campaign trail that President Biden's immigration policy is letting fentanyl pour across the border. But is that really true? We'll take a look at that issue. Today we got two great guests here from the Cato Institute to help us understand the interaction between the opioid crisis and immigration policy. We are joined by the director for Immigration Studies at the Cato Institute, David Bier; thanks for joining us.

David Bier  

Thanks for having me on.

Michael Pope  

We are also joined by a surgeon who practices in Phoenix and is also a senior fellow at the Cato Institute. Jeffrey Singer, thanks for joining us.

Jeffrey Singer  

Thank you for having me.

Michael Pope  

I'm really looking forward to this discussion. I appreciate both of you coming on Pod Virginia. I want to start with a simple proposition that our listeners have probably heard so many times that many of them have probably internalized it. It's a narrative that essentially says fentanyl would disappear if illegal immigration would disappear. Is that really accurate? David Bier, I’ll start with you.

David Bier  

Certainly not. If you look at fentanyl trafficking trends at the US-Mexico border, which is the primary entry point for fentanyl into the United States, it turns out that over 80% of the people who are interdicted crossing with fentanyl are actually US citizens. That would indicate that this is not an issue that can be solved by getting rid of immigration. US citizens, because they're demanding these drugs, are willing to go and pay someone to get it or get it themselves. And so it's ultimately about the demand for drugs, as opposed to this idea that we can just shut off our borders and prevent immigration. That's not what's driving or leading to fentanyl being brought into the United States. 

Michael Pope  

Jeffrey Singer, you were part of a white paper with the headline, Cops Practicing Medicine, which you know, the origins of the first drug war date all the way back to 1914. Explain how the war on drugs has evolved over the years. 

Jeffrey Singer  

Up until 1914, all of the currently illicit drugs were legal. People would commonly purchase them through the Sears catalog in the mail. But the Harrison Narcotics Act made what they call narcotics. Obviously, cocaine is one of them, and that's not a narcotic; it's a stimulant. But they listed cocaine and opium derivatives as illegal unless. Well, first of all, you had to pay a tax on it. That was the way of making it comport with the Constitution, because Congress has the authority of tax, and the only exception for using it was if you had a doctor's prescription for it. At the time that bill was being considered, the American Medical Association was protesting against it, saying that we use these drugs routinely, and how are we going to be able to take care of our patients? So, they gave that an exception. But what started happening was the Treasury Department was tasked with enforcing it, and at the time, Treasury agents would enforce it because it was supposedly tax-related. In the early 1920s, many doctors were being arrested because people had commonly used morphine or other opium derivatives, either for pain or even for pleasure; it was actually common for some people to relax at night and help them fall asleep. They found themselves going into withdrawal symptoms because they had grown dependent on it, which, by the way, is not the same thing as being addicted. There are a lot of drugs that can cause dependency, and when they would go to their doctors with these symptoms, the doctors would diagnose that they're withdrawing from the opioid, and they’d prescribe it for them. Then the Treasury agents would arrest them because the law said the doctors could prescribe it only for appropriate medical use, and in those days, it was the view of the Treasury Department, and it held up in court, that treating dependency or addiction is not a medical use, because addiction is a vice, not a medical problem in those days. That's why they thought of it. That's how Drug War One started. Then, eventually, as things sort of leveled off, President Nixon basically started Drug War Two with the war on drugs in 1970 and the passage of the Controlled Substances Act. Up until 1972, for example, methadone which is a very effective way to treat opioid addiction. You can go to your doctor, and if the doctor is interested in getting involved with treating it because it's complicated, it's not simple. They could prescribe methadone for you and follow up with you in their office. They've been doing this for decades in Canada, the UK, and Australia. Still, the Controlled Substance Act took that out of the doctors' office's hands and set up these methadone clinics, what's called opioid treatment programs, which the Drug Enforcement Administration regulates. There are all sorts of nimbyism and zoning laws that make it very hard to even see these. They're not nearly enough of them. People have to show up every day in the presence of the clinic staff and take the methadone in front of clinic staff because, since they're addicts, they quote, unquote, can't be trusted. As a result, something like less than 40% of people who want help for opioid use disorder can get into methadone programs. Of course, the Drug Enforcement Administration has cracked down on doctors prescribing pain medications to their patients who need them. According to the latest numbers, prescription levels are at the 1992 level. Yet, of course, overdose rates are soaring because non-medical users stopped using diverted prescription pain pills long ago. They first used heroin, and now fentanyl, and now other drugs are coming on the scene.

Michael Pope  

All right, so because this is Pod Virginia, I want to focus our attention here on Virginia Governor Glenn Youngkin, who surprised a lot of people last year by deploying 100 Virginia National Guard troops to the Texas border for an operation he called Joint Task Force Cardinal; that costs Virginia taxpayers more than $3 million, David Bier, was that worth it?

David Bier  

Well, I don't know why he did it, but it certainly doesn't make sense from a drug interdiction perspective or even an illegal immigration perspective. They don't have the authority to arrest people for crossing the border anyway. And if you look at it, just on the drug smuggling front, people crossing the border illegally are not the origin of fentanyl trafficking in the United States. If you look at the numbers from Customs and Border Protection, about 90% of all the fentanyl that they seize from people crossing the border are people entering legally. These are, mainly, US citizens coming through lawful crossing points with their vehicles, and it's stashed in the glove compartments and trunks, or other forms of baggage, and the back of trucks and so forth. It's much easier to conceal fentanyl, which is a very potent drug, 50 times more powerful than heroin, in legal luggage and baggage or even in your pockets than it is to conceal a human being crossing the border illegally. And so, the Customs and Border Protection estimates that they intercept maybe about 2% or 3% of hard drugs entering the United States through ports of entry. They intercept about 75% of the people who cross the border illegally, which is based on surveillance of the border. We have drones, cameras, and other things that film the people who are crossing the border illegally. They can get a good idea of what's getting passed. Then, of course, consumption in the United States, they can estimate how much hard drugs are being consumed and produced. These estimates show that the vast majority of it is getting through these ports of entry, and that is where, ultimately, the origin for most of the hard drugs that come in; they are coming through these ports of entry. The idea that you're going to stop the Fentanyl crisis by deploying people to try and intercept people who cross illegally it's just irrelevant to the issue. 

Michael Pope  

Governor Youngkin was not alone. Several states sent National Guard troops to the Texas border, including Tennessee, Idaho, and Nebraska, Governor Ron DeSantis in Florida sent 800 of his National Guard troops to the Texas border. Jeffrey Singer, did any of that amount to anything? I mean, that's a lot of manpower, effort, and money. Was any of that worth the cost and expense? 

Jeffrey Singer   

I don't think so. As we've been mentioning, I don't think you're going to be able to interdict drug smuggling that way. It's also important to mention that while most of the fentanyl right now is coming across the southern border, because it's the most practical way, it comes through several other routes. A big report less than a year ago, I think, in The Washington Post talked about super fentanyl, super labs being busted in Canada because that's another route across the northern border. And you know, up until 2018, fentanyl-related overdoses were only seen primarily in 28 states east of the Mississippi. It was gradually making its way from east to west. That's because, on the East Coast, most of the heroin was what they call white powder heroin, which often comes from South America or South Asia and was smuggled in through Eastern ports. And fentanyl is easier to mix in with white powder heroin than with black tar heroin, which is from Mexico. So there's evidence right here that this drug and the drug problem are coming in from several different directions. I’d like to say this has never been an immigration issue. This is a prohibition issue.

David Bier

Suppose I could just jump in and add one point to that. The whole concept of interdiction is we interdict a certain amount of drugs that cross the border. Then politicians issue a press release saying we've saved this many lives because this many people could overdose on the drugs that we intercepted. The assumption there, of course, is that the traffickers are just sitting on their hands and not replacing the drugs that have been intercepted, which is totally untrue. We have a great idea about how this works because marijuana smuggling from Mexico, which was the primary origin for much of the Marijuana in the United States for decades, trafficked at an incredibly high level across the border, not even mainly through ports of entry. That was so bulky it had to be carried across the border illegally. The border patrol was radically expanded and increased fourfold from 1990 to 2010, and it had no effect on marijuana availability in the United States whatsoever. They just smuggled more of it in response to increasing seizures. So the idea that seizures we're going to somehow seize our way out of fentanyl use or overdoses is just really fanciful thinking. 

Michael Pope  

What I'm hearing both of you say is if you really want to crack down on the smuggling of illegal opioids, you would do yourself a favor by focusing on legal crossings, not illegal crossings. Because the cartels have an incentive here to hire US Citizens as smugglers because they're subject to less scrutiny, and you can fit a whole lot of drugs into a tiny, microscopic little area. It's really the legal crossings, where you find a lot of these drugs moving in, versus the illegal crossings. That's the proposition that you guys are both putting out there. But David Bier, you take this a little bit further by saying the border crackdowns actually exacerbate the problem. Why do you say that?

David Bier

If you look at the issue as it evolved, the drug market in the United States favored heroin for many years, even up until the pandemic. Where most of the drugs being seized, if you look at it by the pound, a majority, about 70% of the seizures were heroin, as opposed to fentanyl. Then, they closed the ports of entry down; other issues prevented traffickers in Mexico from getting the precursor chemicals they needed to make heroin. During that period, you saw the month-over-month increase in the share of fentanyl being trafficked, as opposed to heroin. Ultimately, heroin got pushed out, in part because of the restrictions on these legal entry points. They were able to radically increase the percentage of individuals who were being searched by essentially shutting down much of the legal migration that was happening. Each individual crosser was subject to much more scrutiny, which led to a lot more seizures. The reaction from the traffickers, again, wasn't let's sit on our hands and not traffic heroin. It was, let's traffic, fentanyl because fentanyl is 50 times more potent. We can supply 50 times the market by weight than heroin. There were rational incentives to favor switching over to fentanyl. You saw that play out throughout 2020 and into 2021 when the legal crossing points were so restricted, so the idea that you're going to seize your way out of this problem is disproven by history. We talked about marijuana, but also this episode with heroin, we actually forced more of the consumption into the more lethal drug by focusing on seizures at ports of entry and really reduced heroin consumption in favor of the more deadly fentanyl drug.

Jeffrey Singer

If I could just jump in and add something to that. First of all, at the border, very few dogs have been trained to be able to detect fentanyl. Again, another reason why it's easier to get it through the border. But there's a term that people in the drug policy world use called the iron law prohibition, which,h in shorthand, is, the harder the enforcement, the harder the drug. David was just illustrating that it incentivizes the drug traffickers to come up with more potent forms of the drug. Because they're more potent, you could get more sales out of them, which helps compensate for the risk you're taking. But in addition to that, it's usually easier to smuggle, because you could smuggle it in smaller sizes. During alcohol prohibition, they weren't smuggling beer and wine. They were smuggling the hard stuff like whiskey, and in a real-life example, at football games, at tailgating parties, people are consuming beer and wine, but you're not allowed to bring any alcohol into the stadium. So people are usually smuggling in the hard stuff in flasks. They're not smuggling in beer and wine.

Michael Pope  

In the military context, you often hear generals talking about the dangers of fighting the last war. The pandemic really did change things for the opioid epidemic because, before the pandemic, there might have been an issue with heroin being smuggled in illegal crossings. Now I'm hearing you guys say that the issue is fentanyl because of its size and how easily you can smuggle it in small amounts. It's really the legal crossings that you want to look at with US citizens being involved with the cartels in smuggling. David Bier, you have a proposition that I think is probably going to surprise a lot of our listeners, which is that legal travelers smuggle almost all of the fentanyl into this country. Is that right?

David Bier

That's right. If you look at the statistics on seizures, you can see the percentage of people who cross the border illegally and are apprehended by border patrol. Obviously, they don't arrest everyone who makes it across illegally, but we have a very large sample, millions of individuals who've been arrested after crossing the border illegally. This huge sample gives you a good idea of who the people are avoiding detection. It's something like 1 out of every 12,000 people who cross the border had any fentanyl at all, usually a very small quantity. Because they can't carry as much as the individuals who are crossing through legal ports of entry, that's where, as I said, 90% of the fentanyl is being seized at those legal crossing points. Because it’s so much easier to conceal it in your luggage than it is to try to sneak across the border and get past the Border Patrol and the drones and the border wall and all the other stuff that's there, and it's safer, too. And of course, if you're a US citizen, you have the right to enter the United States at any time, and the border patrol or the Customs and Border Protection have to acknowledge that. You're not subject to the presumption against your admission like a non-citizen would be who doesn't have permanent residence here. There's a huge incentive for the cartels to favor that in the case of hard drugs, including heroin, but also fentanyl. That's the pattern we've seen in the Drug Enforcement Administration and the Federal Bureau of Investigation, who sort of backtracked the origin of these drugs, confirmed that as well. You can also see it confirmed on the Mexican side of the border, where the Mexican cartels are waging war over ownership of these legal crossing points, which are so valuable precisely because of their ability to bring drugs through those corridors. In contrast, the illegal crossing points are less valuable for drug smuggling, though, of course, human smuggling happens there.

Jeffrey Singer 

On that note, again, about the iron law prohibition, there's another drug that people should kind of put on their radar screen, called a category is called nitrazine, Isotonitazene (aka nitazene or "ISO”) is what the drug users call it. It's another completely different type of synthetic opioid that started making its appearance around 2019 in parts of Europe and the United States, mostly in the Midwest, and now in some southeastern states. Again, that's not following the Mexican border. It's 10 to 20 times the strength of fentanyl, and that's a new drug now appearing on the scene because of incentives.

Michael Pope  

Do all of the existing circumstances involving fentanyl apply here? For example, if you really want to crack down on it, focus on the legal crossings, not the illegal crossings. Focus on the US citizens, not the illegal immigrants crossing the border.

Jeffrey Singer

Well, that would make sense. That's a much safer way to smuggle it in and get it in. But to this day, even some is coming in through the mail. As you know, there was a story in July in Detroit that the US Post Office seized six pounds of fentanyl that was coming in through the mail. So, there are many different legal routes for these illicit substances to find their way to American consumers.

David Bier

In terms of how the government classifies these things, they often don't even necessarily say fentanyl versus another synthetic opioid. They might not even be distinguishing in every case between nitazenes or fentanyl. But at the end of the day, anything that can be made synthetically is going to be at an advantage from a drug trafficking standpoint because it can be made anywhere. It's not dependent on seasons or having swaths of land that you need to take up for growing. There are some distinct advantages that are likely to persist in the future. And, you know, nitazenes, that's the next thing on the horizon, or it's already here in some cases. But there's going to be something after that. The black market is not constrained by, well, we have to supply this particular thing because this is what consumers want. It's whatever can get past the border. That's what counts. 

Michael Pope  

I want to turn our attention to solutions. Jeffrey Singer, you have a controversial solution to this, which would be to repeal prohibition. I think a lot of people in Virginia would react to that with some level of shock and horror. How could you possibly repeal prohibition? People would get hooked on drugs, and drugs would be everywhere, and we would have these huge societal problems. Explain how repealing prohibition would be a solution to the opioid epidemic. 

Jeffrey Singer

First of all, that's an ideal solution. I don't think it's a politically realistic one at this point. But it's been done before. When we repealed alcohol prohibition, everybody warned that we'd have a surge in people who had alcohol use disorder. There definitely was initially an uptick in alcohol consumption that sort of leveled off. But none of the harmful effects of making alcohol readily available and repealing prohibition. I'm talking, of course, for adults, not for minors. They were greatly outweighed by the harmful effects of the prohibition. I think that's obvious from the standpoint of law enforcement, from the standpoint of regulators, for the fact that police are engaging themselves in the practice of medicine and a patient doctor relationship. But more realistically, if lawmakers can't, at this time, get what I think will be the ideal solution done at least. What they should do is stop this focus on the interdiction side, which is actually, as we've been talking about, only stimulating and incentivizing the development of new, more potent drugs that are more deadly. Instead, make it easier for people to have access to addiction treatment or harm reduction strategies. There are numerous harm reduction strategies that don’t necessarily require any government funding. There are groups that want to help people, but laws prohibit them, whether we're talking about drug paraphernalia laws still in many states. If you wanted to hand the fentanyl test strip to someone so they could test to see if what they bought in a black market has fentanyl in it, you could get arrested for handing out drug paraphernalia in certain states; that's considered drug paraphernalia. Or syringe services programs that reduce the likelihood of the spread of HIV and hepatitis. Nowadays, when people are handing out clean syringes, they're also handing out Naloxone, the overdose antidote, and they're giving fentanyl test strips. In much of the developed world, since the 1980,s there have been what's called Overdose Prevention Centers. Some people call them Safe Consumption Sites. They're federally illegal in the United States because of what's called the Crack House Statute, but they're operating in 16 countries, at least 147 locations in 16 countries. There's not been one reported overdose death. This is when you people come in off the street. When people get upset about seeing people using drugs on the street, well, this is people who are brought inside. They're given good testing equipment to test what they have. They're given clean equipment to use. And somebody is standing right by with the overdose antidote, Naloxone, if necessary. Then, they even have them hang around for a while before they go back out in the streets. That way the initial effects subside a little bit. As a bonus, not only has this prevented the spread of disease and death, but it seems to an awful lot of people when they realize that they're being kind to unconditionally; people unconditionally care about them. They start opening up, and they seek help, and these overdose prevention centers connect them to treatment programs and other services. It's illegal in the United States, but since the end of 2021, two have been operating authorized by the city of New York. In New York City, by the summer of 2023, they'd already reversed 1,000 overdoses. There's one about to start in the state of Rhode Island, the state approved it, and it's getting ready to go online. About two months ago, Vermont lawmakers legalized one to begin in Burlington. Vermont hasn't gotten started yet. What we need to do is we need to allow more ways to reduce the harmful effects that are largely the consequences of drug prohibition. Because when you go to the black market, you can't be sure of what you're getting in the purity, the dosage, etc. 

Michael Pope  

Jeffrey Singer, you outlined a bunch of harm reduction strategies that would be things you’d try to accomplish if you did not have the ideal solution. But David Bier, I want to ask you about the ideal solution, which is to repeal prohibition. This is going to strike a lot of people as a pretty radical approach. What would you say to someone who felt it adds a danger of addicting a lot of people to drugs who are not currently addicted? Raising the rates of people using and raising problems? What would you say to people who say those things about repealing prohibition? Why would you do that?

David Bier

Well, I would point to the reality on the ground. Right now, we have a policy of drug prohibition, and it has manifestly failed to produce better outcomes. Obviously, Jeffrey Singer is going to be much better at speaking to the reality of and alternatives to the system that we have now. But the system we have is failing people. It's resulting in people's deaths. We know that it's driving people to harder and harder drugs, more dangerous drugs. I can see it at the border. I can see it in the data. I can see the spike in opioid deaths that happened in 2020 when immigration was eliminated. These alternative solutions, supposedly where we drastically reduced immigration, had no effect. It had the opposite effect of producing even more dangerous drugs and,d ultimately, more deaths. The current situation is an absolute failure, and everyone needs to start with that premise. Then, you look at some of the countries that have made progress on this issue. Still, none of them have made progress by sealing their borders and ending immigration, and all of these ideas get floated around as a list of options for resolving the Fentanyl crisis. It's all about addressing the people who are using these drugs and helping them with their needs. Whether it's pain management or weaning them off the products that they're addicted to, whatever the case is, we need a rights-focused approach. This approach recognizes the rights of the user to live a life that is dignified and not thrown into a situation where they might kill themselves. Alongside that, we have these policies that say maybe it is US citizens trafficking these drugs. Well, we need the death penalty for drug trafficking. If you read the stories of so many of these Americans who are crossing the border with drugs, they are the users in many of the cases. These are people who are in desperate conditions and are coerced into this position where they feel like they have to do this to support their habit or otherwise they need help. And I don't think the idea of killing Americans in order to save Americans is the answer. We need to focus on, like I said, a rights based approach that cares about the individual's needs and empowering physicians to help them, as opposed to criminalizing all these different ways of helping them that Jeff was talking about.

Jeffrey Singer 

I also think it's important to mention that everybody is assuming that everybody who's consuming these illicit drugs is addicted. The evidence shows that roughly 80% to 90% of people who use illicit drugs begin when they're adults, when the frontal cortex is fully developed, say around 25 or so, 80% to 90% don't become addicted and are occasional weekend users. The great majority of people who are addicted began using when they were adolescents, and one of the best ways to keep illicit drugs out of the hands of adolescents is to legalize them. You could always get fake IDs and such, but it's much more difficult to get tobacco or alcohol; it's much more difficult for minors to get it when they have to go through a legal retailer who's going to check their ID and verify their age. You're not going to have a perfect world, but you're going to have something closer to it by making it legal. 

Michael Pope  

One more topic. I want to get your final thoughts on this issue, and that is treatment. So, Jeffrey Singer, this is a question for you. There are two parts to this, from the perspective of the patient. You say that the patients need to take home methadone. They don't need to go to a methadone clinic where they're watched and treated like a criminal; they need to be able to take home methadone. That's reform one. But then also the doctors frequently have quotas that limit how many patients they can treat. Talk a bit about solutions here in terms of treatment.

Jeffrey Signer

Yeah, well, the quote refers to the two drugs that comparative effectiveness studies show are effective in reducing and treating addiction. They have the lowest recidivism rate, and that is methadone and buprenorphine. Some people call it Suboxone. Now, the government has loosened up on that so doctors can prescribe buprenorphine in their office, But they do have quotas on how many patients they can treat. If this is an area that you're interested in as a doctor, not every doctor is interested in this because it takes a commitment. But I don't think you should have a quota. I think we should let doctors treat as many patients as they feel they can properly handle methadone. On the other hand, as I mentioned, up until 1972, doctors were prescribing methadone to treat addiction, but now they can't, even though they've been doing so in the UK, Canada, and Australia since the 60s. There's actually legislation in Congress right now called the Modernizing Opioid Treatment Access Act. It's not my ideal situation, but it's a step in that direction. It would allow board-certified addiction specialists to prescribe methadone to patients in their offices. There aren't nearly enough in the country to meet the need, but at least it's moving away from making people have to find and go every morning to a methadone clinic. But even recently, the Substance Abuse and Mental Health Services Administration, which also teams up with the DEA, to regulate these OTPs, has recently allowed these methadone clinics to give people take-home methadone at an earlier stage in their treatment process than they used to. That's because during the pandemic, and a lot of these places were closed during the lockdown phase, people were given take-home methadone, and follow-up studies found that it didn't get abused, misused, or sold on the black market. In fact, most research shows that methadone that people acquire on a black market is not for recreational use. It's because they can't get into a methadone clinic, so they're trying to buy it to treat themselves, to self-medicate with methadone. One more irony is, as a doctor, I could prescribe methadone to treat pain. That's been around since the 1930s, and occasionally, we surgeons do prescribe it for people in very severe pain, or cancer patients, or whatever. It's a class two drug, but I can't prescribe it to treat addiction, which is interesting. It's not like I don't know how to prescribe it because I'm allowed to. I just can't prescribe it if it's a person's addiction. They have to go to a methadone clinic.

Michael Pope  

All right, I want to close out the podcast by giving our listeners something that they could do or at least some solutions here. Looking forward a little bit. David Bier, I want to start with you. I think a lot of people with probably good intentions are looking at this crisis and saying, Gosh, we've got to do something. There's the impulse to do something. So I think for a lot of people that became close to the border. We have a big crisis; let's do something, lets close the border. What would you say to those people in terms of the effectiveness of using immigration as a solution to this problem, and what should they be doing instead?

David Bier 

Look, it's a total distraction from what is happening on the ground. Obviously, US citizens are heavily involved in the trafficking. Over 80% of the fentanyl trafficking convictions are of US citizens in the last year. That's not the answer that won't ever be the answer, even if we sealed off the United States and no one could enter or leave. Obviously, that wouldn't be a free country, but we would still have the demand for these products. There's nothing that would prevent someone from manufacturing here in the United States; we've seen that happen with other drugs in other circumstances. I don't think the answer is focused on immigration or the border. Seizures are totally ineffective. These cartels replace the drugs that are seized. We need a different approach. I think forcing politicians and commentators to get back on topic and focus the attention on how we address the people we're trying to help. Because these seizures and this crackdown approach aren't helping them, it's manifestly not helping them. It's leading to more deaths, harder drugs, and more overdoses. I think holding the feet of politicians to the fire and saying you have to come up with an actual plan that is going to do something. As opposed to yet another press release about so many drugs getting seized or whatever. That's not helping anyone who's ignoring the problem that Americans are having to live with every day, and some, unfortunately, are dying with.

Michael Pope  

Jeffrey Singer, same question for you. I want you to look ahead. Give our listeners a look ahead to potential solutions. Something I heard you say earlier, which got my attention, is that in some states, fentanyl test strips are considered drug paraphernalia, and you could get arrested for having them. That sounds like the world is totally upside down. I would imagine there this is a target-rich environment of solutions that you could do for harm reduction strategies and treatment, right?

Jeffrey Singer

Yeah, that's low-hanging fruit. Still to this day, I don't know the exact number. But probably close to 20 states. Many states have amended their drug paraphernalia laws to exempt handing out fentanyl test strips. My state did in 2021 [Airzona]. I'm sure everybody's heard about the veterinary tranquilizers, xylazine, getting mixed in with fentanyl. Now they call it tranq. There are also xylazine test strips, but they're still drug paraphernalia. Recently, the governor of Texas endorsed allowing fentanyl test strips to be handed out in that state. But it didn't pass the Texas Legislature, so it's illegal in Texas. If you got caught handing fentanyl test strips to people who happen to use illicit drugs, you could get arrested.

Michael Pope  

All right, you have been listening to the director of Immigration Services at the Cato Institute, David Bier. And a surgeon who practices in Phoenix, who's also a senior fellow at the Cato Institute, Jeffrey Singer. Thanks for joining Pod Virginia.

David Bier

Thanks for having me.

Jeffrey Singer

Thank you.