Dr. Mahmut Cengiz: Fentanyl in Virginia and the USA
Dr. Mahmut Cengiz, Assistant Professor at George Mason's Schar School, joins Thomas and Michael to discuss the causes and effects of the fentanyl crisis in Virginia, how Glenn Youngkin's has handled the crisis, and how Virginia could move forward to help the lives of those affected.
Episode Transcript
Michael Pope
I'm Michael Pope.
Thomas Bowman
I'm Tom Bowman.
Michael Pope
This is Pod Virginia, a podcast that is taking a look today at the Fentanyl crisis.
Thomas Bowman
How did it happen? What can we do about it?
Michael Pope
And we've got a really amazing guest here today to help us understand this. He's one of the leading authorities on the Fentanyl crisis, including research into money laundering, corrupt politicians, and human trafficking. He's an associate professor and research faculty at George Mason University's Schar school. Mahmut Cengiz, thanks for joining us.
Mahmut Cengiz
Thanks for having me.
Michael Pope
Let's start with an overview of this crisis. What exactly is fentanyl? And how do we find ourselves in this crisis where overdoses are now claiming more lives and automobile accidents and guns combined.
Mahmut Cengiz
Fentanyl is a type of painkiller, and it is in the category of opioids. And recently, what we have seen is that it's ripping through American society; it is hitting all segments of society. And then fentanyl, in the last couple of years, became an epidemic and has ramped up. Also, it is very devastating, and it is now the most deadly drug in the world. It is highly potent, even 50 times more potent than heroin. And also 100 times stronger than morphine. People are exposed to fentanyl because they don't know, in most cases, what they are using. And also, what we have seen recently, in 2021 and 2022, is more than 60,000 people died from overdoses. In 2019 and 2020, overdose deaths among 10 to 9-year-olds more than doubled. Oftentimes, two milligrams is enough to deliver a fatal loss, and in the US, dependents and accidental overdoses are skyrocketing as well.
Thomas Bowman
All right, I wonder if you can bring it home for us. What's the situation specifically in Virginia regarding fentanyl overdoses and the crisis here
Mahmut Cengiz
In Virginia, if I look at some data, Disease Control and Prevention Center data, I think between 2016 and 2019, the percentage change was 5% to 10%. So there were some slight increases in those years. But in 2020, from 2019, we saw a 70% increase in in Virginia. So, Around 1,700 people lost their lives because of overdoses in 2020. So, in 2021, it was much worse. Virginia has been reported as one of the states reporting increases in the number of fentanyl overdoses. Even though there have been some slight decreases, there is some good news in 2022. But then, look at the most recent trends; I can tell you that in Virginia, we are facing one of the most difficult and the most threatening types of drugs in Virginia as well.
Michael Pope
How did we get here? I'm just trying to get a sense that this is not a situation that we were facing 10 years ago. How did we get into this situation where this has become such a huge crisis and relatively fast?
Mahmut Cengiz
I think it was 20 years ago; it was more cracks and a hurry. But I think there are three waves of the fentanyl epidemic: from 2000 to 2010 and 2012. I think we should pay more, blaming the drug companies that were aggressively promoting the use of this fentanyl. And also just promoting for prescribers and to use this. This fentanyl. But then, fentanyl pills became less available in 2011 - 2012. Then we saw that these people were addicts; they just transitioned to heroin because it was much cheaper, but it was much easier to get access to heroin. But again, we saw these people's addicts transitioning to fentanyl because of its availability, because it's much cheaper than heroin.
Thomas Bowman
Alright, so Glenn Youngkin sent the Virginia National Guard to the southern border. Why did he do that? What's the rationale as far as fentanyl trafficking goes for that?
Mahmut Cengiz
There are some troubling numbers because every year, we are worried about seeing increasing numbers of fentanyl overdoses. As always, there are different types of solutions on the table. Also, some states, including Virginia's Governor, believe that we should be sending more troops to the border just to secure the southern border. I think the justification for deploying the reservist troops is that the leadership solutions at the Federal level fall short. States are answering the call to secure our southern border, reduce the flow of fentanyl, and combat human trafficking. But then there have been some questions because it is costing $3.1 billion for Virginia taxpayers. I think that it's important that you are focused on what's going on on the southern border. But here the question is, how much fentanyl has been trafficked through the border in Texas? Or are they these traffickers using some other routes at the border. Although it's been a while since these traffickers are very resourceful, they are always constantly looking for some of the best routes to traffic. According to some data again, this pattern of trafficking has been mostly made through the Havana and the San Diego border. So, growth relative, there is very small size, fentanyl trafficking in Texas and Texas border. I think we can also use analogies just to understand our expectations when we are deploying troops on the southern border. I think I call it a balloon effect. Where you're pushing down drug trafficking in one region. It may cause us to bulge somewhere else. Also known as the cockroach effect, where you are turning on the lights, I think these cockroaches are just escaping to darker areas. So, when you focus on the Texas border, even though there are some small fentanyl seizures in the Texas border, I think it is likely to see these fentanyl traffickers moving to other borders.
Michael Pope
You know, after the governor sent the 100 troops to the southern border, there was a lot of pushback, a lot of people saying it was a cheap political stunt. Is this an actually effective way of dealing with this crisis, sending troops to the southern border?
Mahmut Cengiz
I think it can make a little impact because of the resourcefulness of these traffickers. So they can find some new ways and have some alternative routes just with traffic. So maybe in the short term, we can see some decreases for the traffickers, Federal traffickers using the Texas border. And then mostly just moving to other other routes. But I can say in the short term, yes, it's some little impact. But in the long term, I don't think that it will make a big impact on the fight against fentanyl trafficking.
Thomas Bowman
Alright, so you've given us a nice overlay of the problem as we understand it. What are some long-term strategies that will address this crisis?
Mahmut Cengiz
I think some long-term strategies, and what we need to do is first we need to understand the business. I think if you can understand the business, we can just target it. I think also we should be focusing on how we can reduce the size of the user population through prevention, treatment, and recovery support services. Another important tool here is as part of long-term strategies to bring together different elements of the community: health education, awareness, health resources, and law. I think also it is really critical for us to incorporate the private sector and develop public-private partnerships. That is involved, for example, financial institutions, shipping logistics, and express consignment operators. And, of course, pharmaceutical companies also are another one. I also think as a long-term strategy, we should take a holistic approach; we should develop a comprehensive national strategy to combat the opioid crisis, incorporating the perspectives of law enforcement, academia, government agencies, and the healthcare sector, as well as schools. I think another important one here is that we should tackle the global dimension. We should be following the money because there are resourceful traffickers who make huge amounts of money. As far as I know, just 400 pounds of fentanyl in Mexico. It is half a million US dollars. So, they will generate a huge amount of amount of revenue from this type of trafficking. I think, additionally, we should be fostering innovative research and using some data methods. Of course, the more important division is promoting law enforcement innovation.
Thomas Bowman
On the other side of the equation, of course, is the users themselves. And one thing that often drives people to use drugs in the first place is things like childhood trauma, hardships, and lack of access to medical care or mental health care. If we can balance the equation, what are some policy initiatives that would be useful to tackling the Fentanyl crisis from that side?
Mahmut Cengiz
I think, yeah, we should have a balanced approach. Because there are families here. Also the government is another one. Of course, the academia and the the police as well. I think that's why I see that we need this holistic approach. And also for the kids in the schools, or for younger generations, we need to raise awareness. Not only them but also at the fore, I think, for the families. Also, there is another problem: this fentanyl is laced with other types of drugs. In most cases, these addicts, these individuals do not know what they are using. So that's why we are recording these high numbers of overdoses every year, because it is cut into other types of drugs, in some cases, heroin, cocaine, methamphetamine, or even marijuana.
Thomas Bowman
Alright, so what's a reasonable expectation for policymakers to have moving forward?
Mahmut Cengiz
I think for policymaking. This is a complicated issue. Because there are transnational criminal organizations involved in this type of trafficking. Of course, China is a source country for these chemicals. So, I don't think that we can be effectively preventing fentanyl trafficking. If we cannot find some ways to stop the transfer of these chemicals from China to Mexico. I don't think that we can, again, be effective at stopping the transfer of this fentanyl from Mexico to Turkey if you don't have cooperation, strong cooperation with the Mexican government. As far as I know, the Mexican government is denying that Mexico is not a production country. So they're just blaming American culture, like individualism, or like the disintegration of families. So we are not on the same page with our other partners, who are actually part of this, this trafficking. So I think for policymaking, we should be really involving other partners, stakeholders, and more specifically in the US, starting from some measures in the border. So every state, I think, should do its own research and then just focus on finding the best model just to prevent this printout trafficking.
Michael Pope
You mentioned Narcan. The Fairfax County School System recently had an initiative where they made it available to all of the schools and had training even for the students to help administer it. And there was some pushback among some parents who were concerned that not that it wouldn't save lives, but that it might be creating an atmosphere that would be there would be like a tacit approval or, kind of look the other way to kind of a deal, like how do people get over the kind of stigma attached with using drugs to help other drugs.
Mahmut Cengiz
Providing Narcan in the school system, like in Fairfax, I'd be in favor of first doing some pilot studies, like determining the hotspots. And then in the hotspots, just looking at where we are recording this high number of overdoses. I think you're looking at these hotspots; you can just provide this Narcan to families. But on the other hand, I'm not a big supporter of this approach of, like, providing Narcan in the school system. So, it can also create some drug conversations, like the one you have just mentioned. So some people, some families may believe that it can enable and create an atmosphere that also some other kids may be aware of what's going on. So they can just wander, and then they can they can just not accidentally be part of this issue.
Michael Pope
You say you're not a big fan of that approach. Why do you say that?
Mahmut Cengiz
I think it can enable, maybe kids, they can be aware of this fentanyl. So sometimes, you know, curiosity may push kids, you know, just to the hands of this atmosphere, to these traffickers.
Michael Pope
One other question I want to ask is about a new law recently passed by the General Assembly and signed by the governor that designated fentanyl as a weapon of terrorism, which I guess is a law enforcement approach, sort of increasing the prosecution and the penalties of people who traffic and this is that an effective strategy.
Mahmut Cengiz
I think, also, it is very common to always try to use the power of terrorism in the US, like we did during COVID. Also, COVID-19 was considered a biological weapon. I think sometimes, just to deter others from being part of this pattern of trafficking. We are using the power of terrorism. But of course, it's creating so many questions. Because if it is a weapon of terrorism, so are the traffickers terrorist organizations? Or are these individuals terrorist perpetrators? So there are some big questions for us. I think, rather than using the name of terrorism, I think we should find some other ways. Because it is very complicated, there is no agreement or consensus on the definition of terrorism, and worldwide, even in the US, there are, I think, more than 20,000 definitions, and they're using different tourism inclusion criteria. I think all the while even though there is this conversation on terrorism, I don't think that we should be pushing the fentanyl issue to the area of terrorism; it can just create more problems.
Michael Pope
We really appreciate your time. One last question, which is for the policymakers and people who work for policymakers who are listening to this; What should they be thinking about? What can they do? Obviously, we're in a crisis, and everyone's trying to figure out what the best way to handle it is. We talked about some short-term solutions, we talked about some potential long-term approaches. But in terms of specific actions that can be taken by the state government, what would you suggest?
Mahmut Cengiz
I think we should be in favor of this more balanced approach, approaches often giving our focus on the supply and demand side. I think for a specific state or country; first, we should understand the population of users or how many people are using because, according to some research, nothing can prevent or stop these individuals from getting access to this daily amount of fentanyl. So, for example, you can send your troops to the border or increase measures at the border, and they will build alternate routes just to bring more and more fentanyl or some other drug suppliers to the country. This way, I'm in favor of always doing some research to see. And that is a demand-side issue. After that, of course, we should find some ways to talk to the Mexican government. On the other side, on the side of the border, there are some very small amounts of fentanyl seized by the Mexican police. Of course, it is very complicated. It is a matter of corruption or cooperation issues. Of course, for the transnational issue, as I have just mentioned, China is a production country. I don't think that if you're not on the same page with our transnational or international partners, we will be more effective in fighting against fentanyl trafficking. But in the US, more specifically, what states need to do is, I think, in the first stage, they need to give their focus on the demand side, and they need to understand how many people or why people that people are using and how they can prevent it. Sometimes, they can focus on harm reduction, or they can focus on recovery policies.
Michael Pope
All right. George Mason, Professor Mahmut Cengiz, thanks for joining us.
Mahmut Cengiz
Thanks for inviting me.
