Harsh New Fentanyl Laws Ignite Debate Over How to Combat Overdose Crisis (2023)


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Critics say a fierce law-and-order approach could undermine public health goals and advances in addiction treatment.

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Harsh New Fentanyl Laws Ignite Debate Over How to Combat Overdose Crisis (1)

By Jan Hoffman

Three teenage girls were found slumped in a car in the parking lot of a rural Tennessee high school last month, hours before graduation ceremonies. Two were dead from fentanyl overdoses. The third, a 17-year-old, was rushed to the hospital in critical condition. Two days later, she was charged with the girls’ murders.

Prosecutors cited a Tennessee law that permits homicide charges to be brought against someone who gives fentanyl to a person who dies from it.

“We have this law to punish drug dealers who poison and kill people,” said Mark E. Davidson, the district attorney who is prosecuting the case in Fayette County, Tenn. “And we also want it to be a deterrent to those who continue to do these drugs.”

Dozens of states, devastated by unrelenting overdose deaths, have been enacting similar legislation and other laws to severely ratchet up penalties for a drug that can kill with just a few milligrams.

In the 2023 legislative session alone, hundreds of fentanyl crime bills were introduced in at least 46 states, according to the National Conference on State Legislatures. Virginia lawmakers codified fentanyl as “a weapon of terrorism.” An Iowa law makes the sale or manufacture of less than five grams of fentanyl — roughly the weight of five paper clips — punishable by up to 10 years in prison. Arkansas and Texas recently joined some 30 states, including Pennsylvania, Colorado and Wyoming, that have a drug-induced homicide statute on the books, allowing murder prosecutions even of people who share drugs socially that contain lethal fentanyl doses.

The bills are intended to beat back a deadly substance that has infiltrated much of the illicit drug supply in the United States. But they are renewing a debate over whether unsparing law enforcement can be effective and equitable in addressing a public health crisis.


“We are falling back on these really comfy, straightforward law-and-order solutions in spite of the fact that they didn’t work before, they’re not working now, and there’s growing evidence telling us they’re making things worse,” said Jennifer Carroll, a medical anthropologist at North Carolina State University. She is an author of a recentstudy that found that in one large Indiana county, 911 calls and overdose fatalities jumped as people who relied on dealers who were swept up in drug busts frantically sought fresh sources.

Approaches to drug addiction have evolved in recent years, with both states and the federal government allocating more funds for treatment and prevention. The Biden administration has embraced the concept of “harm reduction” — the short-range goal of making drugs less dangerous for users. The Food and Drug Administration has approved an overdose reversal medication, Narcan, for purchase over the counter.

But to many public health experts, the tough new fentanyl laws seem like a replay of the war-on-drugs sentencing era of the 1980s and ’90s that responded to crack and powder cocaine. They worry the result will be similar: The incarcerated will be mostly low-level dealers, particularly people of color, who may be selling to support their addictions.

Already, there are signspointing to a reoccurrence of the bitter legacy of the crack cocaine laws. Last year, the average federal trafficking prison sentence for a fentanyl-related substance was about six and a half years, with 56 percent of those convicted Black, 25 percent Hispanic and 17 percent white, according to the U.S. Sentencing Commission. Such disparities are poised to become even more extreme, argue critics including Senator Cory Booker, Democrat of New Jersey, pointing to a federal fentanyl crime bill that passed last month in the House of Representatives with bipartisan support.

Fentanyl, a highly addictive synthetic opioid that is 50 times more powerful than heroin, was linked to more than two-thirds of the nearly 110,000 overdose deaths in the United States last year. In small, tightly regulated doses, it can be legally prescribed to patients with relentlesspain. But over the past five years, illicit versions have exploded.

They are frequently mixed into counterfeit prescription pills and other street drugs such as cocaine as a cheap bulking agent. Many victims who succumb are not even aware they have been taking fentanyl.


In a deeply divided country, many of the fentanyl crime laws are notable for attracting bipartisan support. This year, the Democratic-controlled legislatures in Nevada and New Jersey advanced strict fentanyl bills. Oregon lawmakers, who in 2021 passed the country’s most lenient drug possession law, have been weighing a tough new one.

This may be partly because many laws have been publicly championed by families who have lost children to fentanyl. Mourners often stand alongside governors at bill-signing ceremonies.

“The victims’ families are being promised that these bills will save lives,” said Lt. Diane Goldstein, the executive director of the Law Enforcement Action Partnership, a group pressing for criminal justice reform. “But what’s missing in all the discussions about legislation is that no one really is asking, How do we actually save lives?” Lieutenant Goldstein, who used to supervise a narcotics squad in Redondo Beach, Calif., lost a brother to an overdose.

Mr. Davidson, who is prosecuting the Fayette County teenage murder case, has seen up close the anxiety and desperation of families as he makes the rounds to rotary clubs and churches to educate the community about fentanyl. After these sessions, frightened parents keep demanding: What are you doing about it?

Until about two years ago, drug fatalities were unheard-of in Fayette County, a rural bedroom community outside of Memphis with about 40,000 people. But since May 2021, the county sheriff’s department has recorded 212 overdoses, including 27 fatalities, overwhelmingly because of fentanyl.

Mr. Davidson said his decision to charge the 17-year-old girl with fentanyl-related murder initially resonated with the public.

“Some folks are saying, Well, we have two dead kids here, so somebody needs to be charged,” he said.


But within days, authorities discovered drugs in the family’s home and charged an uncle with child neglect. Then the girl’s mother died of an overdose.

The tenor of comments on social media began to reflect differing viewpoints on the case, Mr. Davidson said.“Someone else will say, Well, that poor girl, her mom died and there’s drugs in the house, and she’s probably had a troubled childhood.”

So-called drug-induced homicide laws, like the one Mr. Davidson relied on, usually do not require prosecutors to prove that the person who provided the drug intended to kill the victim; the law presumes that if someone knowingly distributed fentanyl, death was foreseeable. Many prosecutors believe such laws are essential, given the crisis in their communities.

“If you are distributing this poison, our goal is to charge you with murder when there is an overdose out there,” Robert Luna, the Los Angeles County sheriff, said during a news conference about fentanyl last month. “Plain and simple, you’re distributing this poison, you’re going to go to prison for a long time for committing murder.”

John J. Flynn, the district attorney for Erie County, N.Y., and the president of the National District Attorneys Association, said prosecutors saw these laws as a valuable tool, especially for pursuing large-scale dealers.

Critics say the laws clash with the principles of Good Samaritan laws, which are typically exceptions to drug crimes for possession or distribution. These carve-outs offer immunity from prosecution to a drug user who calls 911 to save an overdosing companion. But critics say that if the charge could be murder, people might be reluctant to summon help.


A more common type of fentanyl crime law focuses on the kind of drug and weight at the time of seizure. Federal laws and, increasingly, state ones are attaching higher mandatory minimum sentences for ever-smaller amounts.

Mandatory minimums are seen as the most restrictive form of sentencing because they generally prevent judges from exercising discretion. At least six states established them in their fentanyl laws this year, according to the Addiction and Public Policy Initiative at the Georgetown University Law Center.

“Drug type and weight quantity are never the whole picture of a person who is committing a drug offense,” said Molly Gill, a former prosecutor who is now a vice president of policy for FAMM, a nonpartisan group formerly known as Families Against Mandatory Minimums. “It’s just one factor of many that should be considered, even when the drug is fentanyl.”

That framework largely ignores the context for a drug crime, she said, such as whether the defendant was addicted, coerced into trafficking by an abuser or even knew the drugs contained fentanyl.

Ultimately, many drug crime experts say, these laws do not meaningfully disrupt the vast sources of the drug supplies: synthetic drugsfrequently ordered on the internet and processed in Mexico, often with chemicals from China and India.

“These are international drug-trafficking networks,” saidRegina LaBelle, a former top drug policy official in the Obama and Biden administrations who is now the director of the Addiction and Public Policy Initiative at Georgetown.The drug supply is no longer about poppy farmers but chemists, she added. “This is about illicit finance,” she said.“So what do we need to do strategically, from a policy standpoint?”

Audio produced by Jack D’Isidoro.

Jan Hoffman writes about behavioral health and health law. Her wide-ranging subjects include opioids, tribes, reproductive rights, adolescent mental health and vaccine hesitancy. @JanHoffmanNYT

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What is love in the age of fentanyl? ›

Love in the Time of Fentanyl is an intimate, observational look beyond the stigma of people who use drugs, revealing the courage of those facing tragedy in a neighborhood often referred to as ground zero of the overdose crisis.

What is the Ondcp overdose response strategy? ›

The Overdose Response Strategy (ORS) is an initiative designed to enhance public health public safety collaboration and to strengthen and improve efforts to reduce drug overdoses within 21 High Intensity Drug Trafficking Areas (HIDTAs) across 34 states.

How do you fight fentanyl? ›

Naloxone is a medication that can reverse an overdose from opioids, including fentanyl. Keeping it on hand could mean the difference between life and death — for you or someone else.

How many people have died from fentanyl in Carrollton? ›

Three students in Carrollton-Farmers Branch ISD died last school year and others were hospitalized in a string of suspected fentanyl poisonings. Some students overdosed on school grounds after consuming pills laced with fentanyl, district officials said. “Four young lives, lost in an instant.

How many years can you do for fentanyl? ›

What's the Punishment for Possessing Fentanyl in Texas?
Amount of FentanylSentencePrison term
1 gram–4 gramsSecond Degree Felony2-20 years
4 grams–200 gramsFirst Degree Felony5-99 years
200 grams–400 gramsLife Felony10-99 years
>400 gramsLife Felony15-99 years
1 more row

Do people sleep on fentanyl? ›

When someone overdoses on fentanyl they first become sleepy, and it is hard to wake them. Their breathing becomes slow and shallow, they may snore, and they may pass out. The person's body may become limp, their face pale or clammy, and their pulse weak or slow.

What are the six Rs of managing high risk opioid prescribing? ›

The six 'Rs' approach to managing high-risk opioid prescribing (Rotation of opioids; Reduction; Replacement pharmacotherapy; Reversal with naloxone; Referral; Restriction of supply) is discussed. The six Rs is an aide-memoire that summarises the management options available to mitigate the risk of high OMEDDs.

What are the three waves of the opioid overdose epidemic? ›

The opioid epidemic can be broken down into three waves, prescription opioids, heroin, and synthetic opioids.

What is the opioid crisis response plan? ›

The Opioid Rapid Response Program (ORRP) is an interagency, coordinated federal effort to help mitigate overdose risks among patients who lose access to a prescriber of opioids, medications for opioid use disorder, or other controlled substances, such as benzodiazepines.

What is the one pill fighting fentanyl? ›

Naloxone is a life-saving medication that can reverse an overdose from opioids, including fentanyl.

How do you push fentanyl? ›

Fentanyl is typically administered intravenously (IV), intramuscularly (IM), transdermally (TD) as skin patches, intranasally (IN) in the form of a volatile nasal spray, and intrathecally (IT). It is also available as a buccal soluble thin film, which can dissolve in the mouth, similar to the sublingual tablets.

What reduces fentanyl? ›

Naloxone is a medicine that can be given to a person to reverse a fentanyl overdose.

How many recent fentanyl deaths in Los Angeles? ›

The LA county public health department released data on Tuesday revealing that 1,504 people suffered fatal fentanyl overdoses in 2021, nearly 14 times as many deaths as in 2016 when 109 people died. Last year's death toll also marks a 31% increase from 2020.

What are fentanyl pills prescribed for? ›

Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. However, most recent cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl, which is distributed through illegal drug markets for its heroin-like effect.

How many people have died from fentanyl in Dallas? ›

Last year over 260 people who fentanyl caused or contributed to the death in Dallas County. This epidemic does not distinguish between age, sex, race or income. People who have had at least one overdose are more likely to have another.

Who invented fentanyl? ›

Fentanyl was created in 1959 by Dr. Paul Janssen as an intravenous surgical analgesic. The drug is 50–100 times more potent than morphine. Because of its strength, the drug was rarely used except in hospital operating rooms or on large animals.

What is a long half life for fentanyl? ›

Fentanyl has been used in anesthesiology since 1960. Different routes of administration make fentanyl a good choice in emergency situations. [7] Its onset of action is less than 60 seconds with a half-life of 90 minures and duration of action near 30–60 minutes. Its peak effect is 2–5 minutes.

When do the feds pick up a drug case? ›

If police officers find you have crossed state borders with a controlled substance in your possession, you could face federal drug trafficking charges. The potential penalties for federal drug trafficking vary based on the offender's prior record, the type of drug involved, and the amount of the drug found.

Where does fentanyl come from? ›

The majority of fentanyl is mass-produced in Mexico using chemicals from China before being pressed into pills or mixed with other counterfeit pills made to look like Xanax, Adderall, or oxycodone. The counterfeit drugs are then sold to unaware buyers.

What is the warning on fentanyl candy? ›

In August, 2022 the Drug Enforcement Agency issued a warning about the emergence of fentanyl pills that are brightly colored. Cartels may be using these candy-like colors to sell more of the potentially deadly drug to children and teens.

Is oxycodone the same as Percocet? ›

What's the difference between Percocet and oxycodone-CR products? Both Percocet and oxycodone-CR products relieve pain, but while Percocet gives relief for about five hours, the effects of oxycodone-CR last for about 12 hours, when taken as prescribed.

Which behavior is most suggestive of opioid use disorder? ›

The most suggestive behaviors are [48,54,55]:
  • Selling medications.
  • Prescription forgery or alteration.
  • Injecting medications meant for oral use.
  • Obtaining medications from nonmedical sources.
  • Resisting medication change despite worsening function or significant negative effects.
  • Loss of control over alcohol use.

What are the 4 A's of opioid prescribing? ›

The 4 A's—analgesia, activities of daily living, adverse events, and aberrant drug-taking behaviors—can structure assessment and serve as a means by which to record patient response to therapy.

What is the dire score for opiates? ›

The DIRE is a clinician-rated instrument designed for use by primary care physicians to predict the efficacy of analgesia and adherence with long-term opioid therapy. The DIRE score can range from 7 to 21, with a score of 13 or below suggesting that a patient is not a suitable candidate for long-term opioid therapy.

What is the fourth wave of opioid pandemic? ›

The fourth wave: Stimulants in combination

There has been a major rise in drug-related overdose deaths: a 3-fold increase for cocaine-related mortality (from 1.4 to 4.5/100,000 pop.) and a five-fold increase for psychostimulant-related (mostly methamphetamine) mortality (from 0.8 to 3.9/100,000), 2012–18 [1].

What is the wave 2 of the opioid crisis? ›

The second wave began in 2010 with the increased use of heroin, and the third wave started in 2013 as fentanyl use increased. A fourth wave of the crisis seems to be emerging, one characterized by the use of illegally man- ufactured opioids in combination with psychostimulants such as cocaine and methamphetamine. 2.

What happened in the first wave of opioid overdose deaths? ›

The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 19993. The second wave began in 2010, with rapid increases in overdose deaths involving heroin4.

What is the 5 point strategy to combat the opioid crisis? ›

The ultimate purpose for the HHS 5-Point Opioid Strategy is to provide better services in research, treatment, pain management, prevention and recovery to decrease the opioid crisis plaguing the United States. prevention, treatment, recovery and pain management.

What has Biden done to help the opioid crisis? ›

WASHINGTON, D.C. – To advance the Administration's plan to beat the opioid epidemic as part of his Unity Agenda, President Biden released his FY 2024 budget request to Congress, which calls for a historic investment of $46.1 billion for National Drug Control Program agencies.

What are the 5 A's of opioid response? ›

For this reason, we recommend Five A's of assessment: Analgesia, Activity, Adverse reactions, Aberrant behavior and Affect. Every person for whom opioids are prescribed has the potential to abuse their medication (Webster & Dove, 2007).

Is fentanyl 100 times potent than morphine? ›

What is fentanyl? Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States.

Is fentanyl 1000 times stronger than morphine? ›

Fentanyl is a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic. It is approximately 100 times more potent than morphine and 50 times more potent than heroin as an analgesic.

Is fentanyl 1000 times more powerful than opiates? ›

Fentanyl, an opioid that is practically and effectively 50 and 100 times more potent than heroin or prescription opioids, is often used to adulterate heroin, cocaine, methamphetamine and other “street drugs.” Overdose deaths often result from a user's unwitting purchase and use of fentanyl when believing he or she is ...

Can fentanyl be absorbed when touched? ›

Illicit fentanyl cannot be absorbed through the skin or by touching an item or surface where it is present. When in powder form, fentanyl and its analogs (including carfentanil and fluorofentanyl) cannot be absorbed through the skin. Dissolving the powder in a liquid does not change this property.

How fast should fentanyl be pushed? ›

IV direct administered slowly over 1-2 minutes. Although Fentanyl has been administered by subcutaneous or intramuscular routes, it is recommended that Fentanyl be given by direct IV only as it has a short half-life and multiple doses may be required.

How often can you push fentanyl? ›

Do not use fentanyl more than four times a day. Call your doctor if you experience more than four episodes of breakthrough pain per day. Your doctor may need to adjust the dose of your other pain medication(s) to better control your pain.

What happens if you give narcan to someone who doesn t need it? ›

Naloxone Will Not Harm Someone Who Does Not Have Opioids in Their System. If someone is having a medical emergency other than an opioid overdose – such as a diabetic coma or cardiac arrest – giving them naloxone will generally not have any effect or cause them additional harm.

How many people died from fentanyl in Florida? ›

In 2020, more than 6,150 people died from overdoses involving fentanyl and fentanyl analogs in Florida. For 2021, the latest provisional drug overdose death counts also indicate an increase in fatal overdoses caused by synthetic opioids.

What is the average age of overdose death? ›

The 35- to 44-year age group is experiencing the most opioid overdose deaths – 20,137 – a 20% increase from 2020, and a 73% increase since 2019. Currently, 71% of preventable opioid deaths occur among those ages 25 to 54, and the number of deaths among individuals 55 and older is growing rapidly.

What does naloxone do to the body? ›

Naloxone is a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone.

How many people have died from fentanyl? ›

The fentanyl category of opioids accounted for 67,325 preventable deaths in 2021, representing a 26% increase over the 53,480 total in 2020.

Is fentanyl in epidural? ›

Fentanyl is an opioid analgesic used to treat obstetrical pain in parturient women through epidural or intravenous route, and unfortunately can also be abused by pregnant women.

What is in a Narcan? ›

Naloxone is a medicine that is an antidote to opioid drugs. Opioids can slow or stop a person's breathing, leading to death. Naloxone helps a person who has opioids in his or her body wake up and keep breathing. Naloxone is also known by the brand name Narcan.

How many fentanyl overdoses in Texas? ›

Overdose deaths involving fentanyl in Texas rose nearly 400%, from 333 people dying in fiscal year 2019 to 1,662 dying in fiscal year 2021.

How many people overdose on fentanyl a year in the US? ›

Overall, drug overdose deaths rose from 2019 to 2021 with more than 106,000 drug overdose deaths reported in 2021. Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 70,601 overdose deaths reported in 2021.

What age is love and other drugs? ›

Rated R for strong sexual content, nudity, pervasive language and some drug material.

What is the documentary about fentanyl in Vancouver? ›

The award-winning documentary from director Colin Askey, “Love in the Time of Fentanyl,” takes viewers on an emotional, honest journey following the lives of those impacted by the ongoing opioid crisis.

What was fentanyl in 1960? ›

Fentanyl was first developed in 1959 and introduced in the 1960s as an intravenous anesthetic. It is legally manufactured and distributed in the United States. Licit fentanyl pharmaceutical products are diverted via theft, fraudulent prescriptions, and illicit distribution by patients, physicians, and pharmacists.

What was fentanyl in the 90s? ›

In the 1990s, a new transdermal skin patch for fentanyl was developed to treat chronic pain. The non-surgical delivery mechanism offered some unique advantages over other drugs, including quick onset of action, relatively few cardiovascular risks, and low histamine release.

What are the 4 love drugs? ›

The experience of love is underpinned by four neurochemicals: oxytocin, dopamine, beta-endorphin and serotonin.

What age does true love start? ›

And though for most people it happens young, it's certainly not true for everyone. They found 55 percent of people fall in love for the first time between the ages of 15 and 18.

Can love be as addictive as drugs? ›

Although romantic love and drug addiction are similar in the early stages, they are different in subsequent stages, as the addictive characteristics of love gradually disappear as the romantic relationships progresses. However, the addictive characteristics are gradually magnified with repeated use of drugs of abuse.

Where does most of the fentanyl in this country come from? ›

After being shipped to Mexico, the chemicals are produced into fentanyl-containing tablets and enters the United States via our southern border. It's estimated China is responsible for over 90 percent of illicit fentanyl found in the United States.

What country singer just overdosed on fentanyl? ›

Country singer Luke Bell died as a result of an accidental fentanyl overdose, the medical examiner said.

Where is the fentanyl capital of the world? ›

The Chinese city of Wuhan is known as the fentanyl capital of the world.

Were 500,000 fentanyl pills found in traffic stop? ›

Arizona police say two women were arrested after about 500,000 fentanyl pills were found in an SUV pulled over for speeding. CASA GRANDE, Ariz. (AP) — Two women were arrested after about 500,000 fentanyl pills were found in an SUV pulled over for speeding on Interstate 10 in Arizona, police said.

Was fentanyl used for execution? ›

Fentanyl also causes death by overdose, and in at least two states, Nebraska and Nevada, fentanyl is part of the lethal injection protocol. Since lawsuits have so far prevented Nevada from executing anyone with fentanyl, only Nebraska has used the opioid to carry out a death sentence.

Was fentanyl found in toy? ›

Oct 5 (Reuters) - U.S. authorities seized 15,000 rainbow-colored fentanyl pills hidden in a Lego toy box destined for distribution in New York City, the city's largest such seizure to date according to the U.S. Drug Enforcement Administration (DEA).

What is a pink pill with 10 on it? ›

Doses for Oxycodone

OxyContin, which is the brand name of oxycodone, comes in extended-release forms in the following doses: 10 mg.

What is the big deal about fentanyl? ›

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the U.S.


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