With the nation in the throes of an agonizing opioid abuse crisis, the federal government must do all that it can to save lives and help heal individuals, their families, and communities. With lives on the line every day, federal policy and resources should be urgently directed where they can do the most good quickly. There is absolutely no time to waste on gimmicks and costly strategies that we know are doomed to fail.
Key Trump administration officials—notably Health and Human Services Secretary Tom Price—have already spelled out what some of those urgent priorities should be. Topping the list are improving access to treatment and recovery services, and promoting use of overdose-reversing drugs. Congress and the administration should act quickly to fully fund and implement those priorities.
Such an effort should enjoy broad bipartisan support. Dramatically expanding treatment and overdose reversal is the correct course of action, both in terms of compassion and real-world impacts. Indeed, beyond the direct benefits for those struggling with drug addiction, treatment also delivers significant reductions in crime, largely or totally offsetting the costs of treatment itself.
Unfortunately, President Trump himself remains fixated on precisely the kind of doomed-to-fail gimmicks that we cannot afford, namely a border wall. With key federal government funding deadlines looming, Trump has taken to Twitter to press for his promised wall as “a very important tool in stopping drugs from pouring into our country and poisoning our youth (and many others)!”
Perhaps the president believes his own rhetoric about the wonders of a “big, beautiful wall.” But the reality is that investing in a border wall would do virtually nothing to stem the flow of illegal drugs into the United States. Even setting aside the simple fact that a 30-foot wall can be breached by a 31-foot ladder (or more realistically, underground tunnels), the majority of heroin smuggled into the country crosses through the official ports of entry. Heroin is so compact and valuable that it can be smuggled in very small amounts—even in shoes—and still be lucrative.
A look at the sheer scale of legal commerce at the border demonstrates the futility of a wall in blocking the flow of drugs. The total annual market for heroin in the United States is estimated to range from 40 to 50 tons. One standard shipping container can carry 20 to 25 tons of cargo, meaning the entire U.S. market could be supplied by just two containers full of heroin. In 2016, according to the Bureau of Transportation Statistics, over 4.5 million loaded cargo containers entered the United States via trucks and freight trains over the U.S.-Mexico border. That’s in addition to more than 181,000 passenger buses, 75 million personal vehicles, and 42 million pedestrians. With such massive legal flows of people and goods, the wall—even if it could be built—is essentially beside the point. If Americans are looking to buy heroin, the supply will be forthcoming, and no wall—no matter how grandiose—will stop it.
A border wall would do even less to alleviate the broader opioid crisis, which is still driven by prescribed opioids such as hydrocodone and oxycodone, with more than 200 million prescriptions and 12 billion dosage units dispensed per year. From 2011-2015, opioid pain relievers were implicated in more than 90,000 overdose deaths, compared to 45,000 heroin-related deaths. Beyond the glaring need for more effective regulation of the manufacturing and distribution of prescription opioids, the overdose crisis underscores the need for safer drugs and therapies to relieve and manage pain, especially chronic pain.
The policy response to the opioid crisis must be on the demand side, starting with effective treatment for everyone in need. As it stands, hundreds of thousands of Americans who should receive treatment for opioid disorders do not receive it—either because the required services simply do not exist, or because the people in need cannot access the services that do exist. The $12 billion that Trump has claimed the wall would cost—an impossibly low figure, as our colleague Adam Isacson has pointed out—is more than three times the annual budget of the federal Substance Abuse and Mental Health Services administration (SAMHSA). With that much money, the United States could more than cover one full year of methadone maintenance (a proven treatment for opioid dependence that carries an average cost per person of $4,700, according to the National Institute on Drug Abuse) for each of the 2.5 million Americans suffering from opioid use disorders.
The truth is that, in drug policy terms, it’s nearly impossible to conceive of a worse investment than Trump’s wall. As a supposed remedy for America’s opioid crisis, the wall is a case of all cost, no benefit. Congress and the administration have far more effective policies at hand, and time is of the essence. To waste money on a wall in the name of controlling drugs would be a betrayal of the millions of Americans and their families desperate for relief now.