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The opioid overdose crisis has continued to accelerate in recent years because of the arrival of potent synthetic opioids, such as fentanyl and related substances. Although several synthetic opioids have legitimate medical applications, the majority of overdoses are due to illicitly manufactured imports. Researchers from the Homeland Security Operational Analysis Center evaluated publicly available data to better understand the dimensions of the consumption and supply of these substances. They performed four tasks designed to gain insight into this new and quickly evolving phenomenon: (1) They evaluated trends in overdoses across regions and over time. Understanding where overdoses due to synthetic opioids occur provides a rough proxy for where law enforcement should prioritize screening efforts for packages that enter the country destined for such markets. (2) They evaluated the supply of fentanyl and related substances using public data from state and local forensic laboratories that report to national systems. The authors note a relationship between lab exhibits and fatal overdoses across regions and over time. (3) They examined the online markets for synthetic opioids. The team collected quantitative and qualitative data from online marketplaces and vendors to better understand what supply and concealment mechanisms vendors use when shipping product to the United States. (4) They evaluated the adulterants and other bulking agents used in retail distribution. There are limitations to each of these approaches, and the authors provide caveats to interpreting their findings.

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Despite recent counternarcotics efforts by the Colombian and U.S. governments, coca cultivation and cocaine production in Colombia have risen to historic heights, making Colombia the leading global source of cocaine since 2014. However, the broad partnership between the governments of Colombia and the United States beginning in 2000 was instrumental in preventing Colombia from becoming a likely failed state and in ending the insurgency. The authors of this report examine the period in Colombia from 2000 to 2020 to assess the effectiveness of four key aspects of U.S. counternarcotics and security efforts in Colombia: eradication of coca; interdiction of cocaine, precursor chemicals, and destruction of facilities involved in drug production and trafficking; security and rule-of-law efforts to protect populations and support the development of institutions; and alternative development programs that discourage involvement in the drug trade by supporting viable, legal livelihoods. The authors find that although hard-power techniques can be effective in reducing coca cultivation and trafficking, broader issues — particularly in rural areas — need to be addressed, such as building licit economies, extending institutions and infrastructure, and promoting societal well-being. In addition, counterinsurgency and counternarcotics efforts are more likely to be successful and sustainable over longer periods if the four lines of effort are designed to complement and support each other. The limits of prioritizing eradication and interdiction over security and rule of law and development are especially noticeable in rural communities. Looking to the future, the authors recommend an approach that would synchronize the four lines of effort.

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Opioids play an outsized role in America's drug problems, but they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids (such as fentanyl) are involved in a majority of U.S. drug overdoses, but the problems are broader and deeper than drug fatalities. Depending on the drugs involved, there can be myriad physical and mental health consequences associated with having a substance use disorder. And it is not just those using drugs who suffer. Substance use and related behaviors can significantly affect individuals' families, friends, employers, and wider communities. Efforts to address problems related to opioids are insufficient and sometimes contradictory. In this 600-page report, researchers provide a nuanced assessment of America's opioid ecosystem, highlighting how leveraging system interactions can reduce addiction, overdose, suffering, and other harms. At the core of the opioid ecosystem are the individuals who use opioids and their families. Researchers also include chapters on ten major components of the opioid ecosystem: substance use disorder treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment, and education. The primary audience for this book is policymakers, but it should also be useful for foundations looking for opportunities to create change that have often been overlooked. This report can help researchers better consider the full consequences of policy changes and help members of the media identify the dynamics of interactions that deserve more attention.

Opioid abuse --- Opioid abuse --- Drug abuse --- Medication abuse --- Opioid abuse --- Opioids --- Prevention. --- Social aspects --- Government policy --- United States