The Fentanyl Epidemic, With Vanda Felbab-Brown

LINDSAY:
Welcome to The President's Inbox, a CFR podcast about the foreign policy challenges facing the United States. I'm Jim Lindsay, director of Studies at the Council on Foreign Relations. This week's topic is the fentanyl epidemic. 

With me to discuss why the United States is struggling to stop the flood of fentanyl from coming across the border is Vanda Felbab-Brown. Vanda is a senior fellow in the Strobe Talbott Center for Security, Strategy and Technology in the Foreign Policy program at the Brookings Institution. There she directs the initiative on non-state armed actors. She also co-directs the Africa Security Initiative and the Brookings Series on opioids, "The Opioid Crisis in America: Domestic and International Dimensions." She recently wrote a piece for Foreign Affairs titled, "Why America Is Struggling to Stop the Fentanyl Epidemic." Vanda, thanks for joining me.

FELBAB-BROWN:
My pleasure.

LINDSAY:
If we may, I'd like to begin by identifying the scope of the problem, Vanda. Something on the order of 100,000 Americans died last year from preventable drug overdoses, a number that is up nearly 60 percent in just the past four years and up nearly 800 percent over twenty-five years. The statistics show that the vast majority of those preventable overdoses involve fentanyl. Indeed, the head of the drug enforcement agency has called it the single deadliest drug threat our nation has ever encountered. What exactly is fentanyl?

FELBAB-BROWN:
Fentanyl is a synthetic opioid that has important legal medical uses. It is an anesthetic that's used in surgeries, and Jim, you or your listeners really don't want to have a surgery without anesthetics. Fentanyl is also used when people have to be put on ventilators. For example, during the most intense days of the COVID pandemic, people who had to be placed on ventilators to keep them alive and breathing would be given fentanyl. Nonetheless, fentanyl is also a drug that is being used in the illegal market that has very high addictive properties and that is enormously potent. Its potency is multiple times that of heroin, on the order of fifty times as potent than heroin, perhaps 100 times as opium. Because it is so potent that, the potency per weight ratio makes the drug ideal to smuggle. It is the dream drug for traffickers because very small amounts are sufficient to supply very large markets, but it is a nightmare for users and from public health perspectives.

On the one hand, it can give very intense highs because of the potency, but the chance that overdose will result is enormous. Now, you know mentioned those really devastating statistics, 100,000 Americans dying, but fentanyl today in the United States and more broadly, North America, also Canada is being mixed into not just heroin and opioids, it's also being mixed into methamphetamine and cocaine. In fact, arguably the presence of fentanyl is one of the reasons that's keeping the cocaine market in the United States alive. So it's really swept through the North American markets and we are seeing fentanyl emerging in other parts of the world.

LINDSAY:
Okay, so Vanda there's a lot there. I'd like to unpack it. Maybe we could begin with this issue of how fentanyl is a synthetic opioid that contrasts with a natural opioid, heroin, morphine, which are derivatives of the poppy plant, whereas fentanyl is a chemical or the combination of a series of chemicals, it can be made in a lab. Correct?

FELBAB-BROWN:
That is absolutely right. So broadly in the world, in the illicit markets and in legal markets as well, there are two types of drugs; those that are derived from plants like heroin and cocaine or cannabis, and those that are synthetically mixed in labs. Synthetic opioids like fentanyl or methamphetamine are part of that latter class. Just as the fentanyl is devastating the United States and spreading in Canada and spreading to other parts of the world, the globe is really undergoing synthetics drugs revolution that's taking place from Afghanistan to Australia and New Zealand to Latin America and features other drugs, not just synthetic opioids, but synthetic opioids are currently the most dangerous drugs on the market.

LINDSAY:
Now, fentanyl is different than the drug problem we saw emerge at the beginning of the century in the United States with the abuse of OxyContin, correct?

FELBAB-BROWN:
Well, it is a different drug, but it is also an opioid, so the United States is experiencing an opioid epidemic. Its current phase, the most lethal phase is the synthetic opioid element of the opioid epidemic. But the epidemic started with a legal market. It is significant because sometimes people who are understandably frustrated with the challenges, problems, and failures of counternarcotics approaches over many decades say, "Well, drugs should just be legal. If drugs were legal, then we would have better ability to deal with demand and make sure the demand does not escalate into problematic dimensions."

While the U.S. opioid epidemic should be a strong warning against that, with respect to many drugs, it was the legal market in pharmaceutical prescriptions like OxyContin that really started the opioid epidemic that caused massive levels of substance use disorder and ultimately, mutated to the current legal phase of fentanyl. No illegal market could get as many people addicted to use the common parlance as a legal commercialized, heavily promoted marketed. With the major companies, the major villains in the story, like Purdue Pharma, really being able to co-opt and subvert essentially every regulatory body that was supposed to protect consumers and public health by making fallacious claims that drugs like OxyContin were not addictive.

LINDSAY:
Okay, so we had the issue with OxyContin in that epidemic. Those were legal drugs that were over-prescribed by doctors who at least in the beginning thought that these had magical properties in the sense the alleviated pain and would not be addictive. It turned out, in fact, they were. Fentanyl, we're seeing as the spread largely through illegal manufacture and distribution. One of the things you said, Vanda, that struck me is that we're seeing fentanyl combined with other drugs. Why is that? Why is fentanyl being added to cocaine or to heroin or to methamphetamines?

FELBAB-BROWN:
Let me a little bit back up, Jim, in answering the question and filling in the story, which explains why fentanyl today is present in other drugs. So after the 1990s and 2000s, when there is this massive overprescription of legal opioids, pharmaceutical opioids like OxyContin, the United States wakes up to the fact that OxyContin, thebaine-based opioids are still highly addictive. The spigot is turned off, not completely turned off, but very much turned off compared to the fifteen years. But at this point, you have vast numbers of Americans with substance use disorders, specifically opioid use disorders. This is a different market. 

This is not just kids when they are thirteen, fourteen in their teens or even younger, starting to experiment with illicit recreational drugs. This is everyone from young people, perhaps high school sports, athletes all the way to sixty, seventy-year-old grandmothers who are suffering from substance use disorder. But all of a sudden, they can no longer just show up at their doctor and say, "Give me more Vicodin." "Give me more OxyContin," and so they start sourcing opioids in the illegal market. 

It is two set of actors that come in; Mexican cartels and Chinese producers, the Mexican cartels such as Sinaloa Cartel and Cartel Jalisco Nueva Generación at first start bringing in the opioid to which they are used, which is heroin. So we see poppy cultivation going up significantly in Mexico and heroin being produced and brought into the U.S. market. But the Chinese producers with Chinese traders, with the vast pharmaceutical chemical sector industry in China, second perhaps in the world, perhaps the largest in the world with very poor monitoring comes in and brings in much more potent synthetic opioid, fentanyl, that is very cheap and now very easily made and much more potent than heroin. So the Chinese traders start shipping directly through mail, fentanyl to the illegal U.S. drug market. 

The Mexican cartels are watching it and all of a sudden realize that there is this drug that's superior to what they can bring from Mexico and has tremendous advantages. It's very potent, so very small amounts are sufficient to supply the market. That means that evading law enforcement becomes very easy. You don't need to control territory. Growing poppy, growing coca requires the control of territory and the ability to prevent the government from destroying those crops. All of a sudden, all you need is precursors to be bought in China or India and a few labs and you can supply the U.S. market. Because synthetic opioids in particular are so cheap to make, it's also easy to mix them. It's also appealing to traffickers to mix them to other drugs because that reduces the cost. But because of their qualities, their highs, the intensity of the high and the addictive quality, they also generate new substance use disorders, new addicts.

LINDSAY:
Basically, you hook your customers.

FELBAB-BROWN:
Right. So very recently the Drug Enforcement Administration released the indictments of the current heads of the Sinaloa cartel, Los Chapitos, the sons of the notorious El Chapo. The indictments are absolutely striking in many ways, including the way the current leaders of the cartel speak about what they are doing with fentanyl and how from about 2014, 2015, they really invest heavily into fentanyl, both to deal with their competitor, the other big cartel Jalisco Nueva Generación, but they also speak about wanting to create streets of American junkies, streets of junkies around the world to whom they can supply this very cheap drug on which they make these high marks ups.

It's also really striking the indifference with which they look at overdose and lethal overdose. You quoted the statistics at the beginning about lethal overdose, but for every overdose for which someone dies, there are five overdose that are reversed, but not all overdose that are reversed mean that the person is completely healthy. Many of the people who will experience overdose will have devastating morbidity effects for the rest of their lives. So the level of devastation is much greater than already the huge number of tens of thousands of people dying actually from the drug.

LINDSAY:
So Vanda, let's talk about the source production of fentanyl. I take your point that fentanyl appeals to producers on the basis that you get a lot of potency out of a small amount of substance. I read recently that the customs and border patrol in the United States intercepted a shipment. It was fifty-four pounds of fentanyl, and it was estimated that that would produce enough doses to kill 12 million people. So again, it goes a long way. Let's talk first about the provision of what are called precursor chemicals from China to drug cartels in Mexico. I take it that you have these pharmaceutical companies and other perhaps mid or small size companies in China make the ingredients, sell them to drug traffickers who combine them in labs in Mexico to create fentanyl. But I thought the Obama administration had reached out to Beijing to get Beijing to crack down on this trade. What happened?

FELBAB-BROWN:
So when first fentanyl emerges in the illegal U.S. market in around 2013, 2014, it is shipped as a whole finished fentanyl from China directly to the United States, from Chinese traders, pharmaceutical companies, chemical brokers directly to wholesale suppliers or even retail dealers and sometimes directly to customers. Essentially, people would just log into the web and buy fentanyl from China. This is at a time when fentanyl and other opioids in the fentanyl class of opioids are produced in China without any restrictions. So as the problem emerges in the United States, two things happens. Two set of actors notice it. One is the Mexican criminal groups, the big cartels who are fearing that their heroin is no longer of interest because there is this new potent opioid coming out of China and they want to get in on the game. The second is U.S. authorities, law enforcement authorities, the U.S. government, who are starting to comprehend the much worse mutation of the opioid crisis is taking place.

So the Obama administration starts engaging China to get China to schedule fentanyl class drugs. Now what does scheduling mean? It does not mean banning the drugs. We don't want to ban them because they are important in surgeries. They are important as an anesthetics. They are important for palliative care, but to produce them and sell them and export them with tight control and restriction special licenses, this process is called scheduling. So the Obama administration starts the process and ultimately, during the Trump administration in December 2018, President Xi Jinping announces that the entire class of fentanyl type drugs would be scheduled in China, a regulation that comes in effect in May 2019. Now, this was a significant move by China because there are really only two countries in the world that scheduled drugs by class: The United States where fentanyl class drugs are currently scheduled as a class of drugs, but actually it's just a permanent measure. The U.S. Congress still has to make this measure permanent, and the second is China. 

So China had to change its laws to be able to accommodate this request from the United States. Both Trump and Obama administrations also engaged China on other efforts to crack down on the vast illegal supply that's coming out of China and going to the United States at first and then Mexico. So after China's schedules in 2019, we see changes in behavior in the Chinese market with many of the traders that were selling fentanyl to the United States now switching to selling precursor chemicals. Those are basic chemicals from which fentanyl is mixed, and they're selling those chemicals to Mexican cartels that then mix them into fentanyl and export fentanyl from Mexico to the United States. China subsequently scheduled three other precursors for fentanyl, but in the current market, both in fentanyl and in methamphetamine, the crystal meth and fentanyl are produced from such basic chemicals. They have such wide use in all kinds of legal, chemistry, pharmacology, pharmaceutical industry that they will just not be scheduled. They are very basic chemicals with wide use. The Mexican cartels have now perfected methods with both crystal meth and fentanyl to be making those dangerous drugs out of those very basic chemicals. 

That's giving China a claim to say, "Look, we cannot do anything more on enforcement because those drugs are not scheduled." That's not completely true, however, because it's quite obvious when Chinese sellers sell to the Mexican cartels, they often advertise a combination of precursors for methamphetamine, fillers for cocaine, precursors for fentanyl. They will sometimes combine their sale pitch with commercials such as, "We know how to evade Mexican customs." In some of the webpages, it's pretty obvious that the target is criminal groups.

LINDSAY:
So we have Beijing no longer trying to crack down on the sale of precursor chemicals, most of which go to the Mexican drug cartels. What's happening in Mexico? What is the Mexican government doing or has been doing to try to stop the flow of drugs north across the border?

FELBAB-BROWN:
Well, tragically we are in a moment where neither China nor Mexico is doing anything remotely enough. So China made these moves to tighten supply, to schedule fentanyl class drugs, to mount more inspection in its ports and post offices in 2019. At the time, it also acted on U.S. intelligence and arrested chief fentanyl smugglers who were identified at the time by the U.S. Drug Enforcement Administration. But at this peak of activity 2018, 2019, the enforcement activity and cooperation by China fell off. Why? Because China views counternarcotics cooperation as derivative of the overall geostrategic relationship it has with countries. 

So with countries whom it has a good geostrategic relationship or whom it seeks to court, it cooperates in law enforcement and counternarcotic efforts. This was the case with Australia until relations between Australia and China soured. This has been the case to some extent it's Southeast Asian countries, but when the relations tense, certainly relationship with the United States has approached Cold War like dynamics, China stops law enforcement cooperation. So China invested in this counternarcotics law enforcement cooperation with the U.S. when in hope that would make the Trump administration to back off from the tariff war and would make the Biden administration lessen the economic pressure and basic containment geostrategy competition. When neither happened, China just pulled back and really frankly, abrogated its law enforcement and counternarcotics corporation. 

With Mexico, the story is also a very troubled one, but for different reason. Since the administration of Andrés Manuel López Obrador, who is popularly referred to as AMLO, came to office in December 2018, the administration has pulled back both from cooperating with the United States in law enforcement counternarcotics domains, and has significantly pulled back from taking on Mexican criminal groups domestically in Mexico as well. This has multiple sources, one of which is the political persuasion ideology of President López Obrador, his view of the world that's very much like that of a Mexican nationalist politician of the 1950s, 1960s. He does not like intense presence of U.S. and Mexico. Multiple Mexican administrations have been unhappy with the U.S. seeing the levels of corruption and infiltration by the cartels into all domains of life in Mexico. López Obrador has also believed that if he doesn't put law enforcement pressure on the cartels, if he just lets them be, they will redefine territories among themselves and violence will subside. 

Unfortunately, almost at the end of his administration, we have one more year to go. This has not happened. The cartels are not just more powerful than ever, but they're also more ambitious and aggressive than ever. They are taking over Mexico's territory, institution, people, and legal economies. They're also shipping fentanyl en masse to the United States mixed in fake OxyContin, mixed in heroin, mixed in methamphetamine and cocaine and strikingly indifferent to the deaths and devastation this causes in the United States.

LINDSAY:
So Vanda, how should the United States respond to this? Maybe we could begin first by talking about dealings with China. I will note the historical irony China suffered in the nineteenth century from the flood of opium into China was one of the causes of the Opium Wars. Now China seems to be facilitating the flow of deadly drugs into the United States. As I understand what you're telling me, Xi Jinping views these issues as, "If you're not going to scratch my back, I'm not going to scratch your back." He's not getting what he wants from the United States on other issues, so he is not going to use the power of the Chinese state, which is considerable, to crack down on this trade. What should U.S. policy do?

FELBAB-BROWN:
Yeah. So unfortunately, especially with China, I think we are in a tough bind because of this basic calculus that China makes of subordinating law enforcement, narcotics cooperation to the geostrategic relationship. I think it's very unlikely that we would see significant improvements in the geostrategic relationship that would likely be necessary for much better, more robust and sustained Chinese cooperation. Nonetheless, we have a set of opportunities. China very much likes to position itself as the global drug cop because of the Opium Wars and the opioid epidemic that China went through, certainly in scale, if not lethality, perhaps the second-largest opioid epidemic after the current North American one, China is very sensitive about drugs and likes to define itself as a very strict drug cop. In practice, there are multiple connections between the Chinese triads, those are the equivalents of the Mexican cartels, the very powerful criminal groups and the Chinese government and the Chinese Communist Party with the triads often providing a variety of services to Chinese government offices, embassies abroad, including monitoring diaspora, engaging in extralegal or illegal enforcement.

So China likes to schedule drugs. It likes to act a global drug diplomacy, but it very rarely acts against top echelons of the cartels only when they cross particular interest of the Chinese Communist Party or particular government officials. But nonetheless, we should use this image that China wants to foster of being a counternarcotics leader to emphasize that it needs to act against synthetic drugs. China is also the principle exporter of precursors for the production of crystal meth, devastating Southeast Asia and of Asia Pacific, including Australia and New Zealand, and Chinese triads are the principle traffickers. China is very focused on that region, so we can be combining forces with countries like Vietnam, Cambodia, Thailand, Indonesia, the Philippines, all of which are experiencing big devastating increases in crystal meth use and substance use disorder to push China on cracking down on trafficking, on acting more robustly on money laundering measures.

We can go tougher than just that. We could, for example, and we being the United States, condition access to U.S. markets on best practices for Chinese firms. The large Chinese pharmaceutical industries are often less likely to be the major violators that leak precursors to criminal groups than are smaller companies. But nonetheless, even the large Chinese pharmaceutical companies and chemical companies often have very minimal monitoring enforcement measures, hardly adequate and certainly not up to the standards of best practices that Western companies operate with. We should be encouraging self-regulation and regulation of the industry. We can do so also through indictments portfolios against certainly individuals linked to illegal activities, but perhaps even pressure mechanisms on important leaders in the pharmaceutical sector, in the industry sector. Nonetheless, I want to caution that while the United States tries to delink the counternarcotics cooperation from the overall geostrategy competition, China very much mixes the two. So there are limits to how much we can induce China to cooperate better in the absence of a warming of the relationship.

LINDSAY:
Okay, Vanda, let's talk about the other country at play here, which is Mexico. Now, I will note that many Mexicans would say, and they would say they have their own grievances against the United States about the flow of guns coming from north of the border south into Mexico, arming these drug cartels and that America's reaction to that seems to be to throw its hands up in the air, "Sorry, we can't do anything because of the Second Amendment." So what is it that Washington can do to change the dynamic with Mexico to get greater cooperation to disrupt these drug cartels?

FELBAB-BROWN:
Well, certainly the issue of guns coming from the United States has been a high focus for many Mexican administrations going way beyond the López Obrador administration, even at the heyday of U.S.-Mexico cooperation between the Calderón administration and first the George W. Bush Administration later the Obama administration, this was a steady issue that the Mexican government has focused on, understandably. The Mexican government also has focused on the United States reducing demand for drugs. Again, important, very difficult when traffickers mix fentanyl into other substances that makes demand the reduction measures even more complicated than they are. 

But I want to correct the impression that the United States simply throws his hands in the air about stopping the flow of guns to Mexico because of the Second Amendment. No doubt the legislation creates all kinds of challenges, but the U.S. government has steadily invested and focused on stopping flows of guns. Is it enough? Certainly not from the perspective of Mexico, but much more effort on the U.S. side has gone into that element, including during the Biden administration.

LINDSAY:
So let's say we accept that point the United States can say to Mexico, "Look, we're doing something on guns. We need you to do more on drugs." What is it that we can do to persuade the Mexican government given the preferences you've ably laid out that AMLO has to induce greater cooperation?

FELBAB-BROWN:
I think we are left with a set of difficult options that nonetheless might be necessary. Various Republican politicians such as Senator Lindsey Graham have suggested designating Mexican criminal groups as foreign terrorist organizations. This is a proposal that very much resonates in Mexico. The Mexican government is very focused on it and strongly doesn't want it, does not like the idea. I do not support that proposal because I don't believe that it would add significant law enforcement measures, including in terms of money laundering. The most significant expansion of authority that the designation brings is the ability to use military force, but obviously we don't want to be in the war with our important neighbor, and we don't want to provoke even more difficult diplomatic relations. Plus, the amount of targets would be very minimal. I don't think it would significantly impact the cartels. 

However, the velvet glove approach constrained by migration that the Biden administration has adopted toward the Mexican government has also not produced cooperation. So some tougher measures might be needed and perhaps the measure that we might need to resort to is far tougher and systematic inspections at the U.S.-Mexico border. That is difficult because it'll significantly slow down legal trade and it'll cause damage to legal trade, including to agricultural exports from Mexico.

LINDSAY:
Well, it would also cause damage to U.S. industry because a lot of American industries depend upon goods coming across the border to the United States, particularly the North American automobile industry.

FELBAB-BROWN:
Absolutely. But the cost to the economy even on our side is still significantly smaller than the cost to the economy, not even counting the human cost, that the fentanyl crisis is causing. The level of estimates are about a trillion dollars worth of impact from the fentanyl epidemic, and that's even without the latest numbers. Jim, these are not preferable policies. Preferably, the Mexican government would come to realize that its own country is being destroyed by the Mexican cartels, and it would finally find the responsibility and wherewithal to stand up to them. So I don't suggest tightening the border and mounting inspections lightly, and it's devastating to see the indifference of the Mexican government to the multifaceted harm that the cartels are causing in Mexico. 

Another possibility would be to increase the amount of indictments against corrupt Mexican officials by the United States. We have seen very significant move in the fall of 2020 when the United States indicted the former Mexican Secretary of Defense Salvador Cienfuegos on drug trafficking charges and collusion with one of the vicious cartels. The Mexican government reacted to it extremely strongly and threatened to suspend all law enforcement cooperation unless we hand Cienfuegos back. The U.S. did so, but the Mexican government still liquidated counternarcotics cooperation. So it's perhaps time to look for more opportunities like that. 

Now, there is one caveat I will add, and that is that we are heading into elections in 2024 in the United States and also in Mexico. So presumably there will be a new Mexican government and there might be some opportunities to reset the law enforcement cooperation. The second caveat I want to put on is the most important one, which is that we can do much more on the U.S. law enforcement side even in the absence of cooperation from Mexico and China. 

We still continue to think about the cartels in quite narrow terms as entities that traffic drugs, and they certainly do so, but they do much more than traffic drugs. They are taking over legal economies in Mexico like agriculture and fisheries. They are involved in wildlife trafficking. They are intimately connected to wildlife trafficking markets in China and through that indirectly to even Chinese government actors beyond Chinese triads. So we really need to expand the lens through which U.S. enforcement looks at the cartels and not just focus on stopping the flow of drugs, but really attacking the cartels along all the activities in which they are involved. That means boosting, for example, the priority of intelligence collections on issues like wildlife trafficking, which will provide a lot of intelligence both on the criminal groups but also on their state sponsors.

LINDSAY:
Vanda, I take your point that elections in the United States are perhaps more important than Mexico could create new opportunities for cooperation. But we probably don't want to slide too quickly by a concern that Washington has, aside from drugs in its dealings with Mexico, and that's the flow of immigrants across the border. You alluded to it a moment ago. I think the Biden administration is very concerned that Mexico will cease to cooperate in this policy of keeping migrants south of the border, which obviously gives the government in Mexico some leverage. But I want to close by getting back to the domestic side of the issue. You reference demand reduction and talked about it being complicated because what I often hear from people saying is that U.S. policy focuses too much on supply side, drugs coming into the United States, and not enough on keeping people from either becoming addicted or helping people break their addiction. How do you respond to that argument?

FELBAB-BROWN:
Well, domestic measures, demand reduction prevention and even domestic law enforcement are absolutely crucial. Indeed, historically, the balance has been overwhelmingly focused on stopping supply and not doing enough on demand. Ironically, in the Biden administration, the focus has been very much on increasing demand and the focus on supply or the opportunities on supply have been very constrained with both China and Mexico.

LINDSAY:
I think you meaning increasing investment in attacking demand.

FELBAB-BROWN:
Absolutely. So starting with the Obama Administration, we have seen several sets of improvements, expanded access to treatment, including through greater recognition of substance use disorder in medical insurance plans. Is it sufficient? Absolutely not. It can cost $40,000 a month out of pocket to be dealing with fentanyl or opioid use disorder for a person, excruciating amount of money. So far, still only perhaps 13 percent of people in need of treatment are able to access treatment. So much more needs to be done on that matter, absolutely. We have seen another big breakthrough, which is finally the important acceptance of harm reduction measures in the United States. Naloxone, the Narcan, the overdose reversing medication has become widely available without prescription. First responders carry it. And indeed, the lethality would be far higher if Narcan was still suppressed and prohibited and used to be the case for a long time in the United States. There is finally slow experimentation, the recognition of issues such as methadone maintenance for those with substance use disorders, safe needle exchange and safe ejection sites.

All those measures are important and need to be expanded, but we have a live demonstration of why relying on demand and harm reduction alone is not adequate, and that is British Columbia and Canada. That's the region of the world that has perhaps the most expansive demand access and demand treatment and the most expansive harm reduction measures anywhere in the world, and yet their fentanyl, opioid lethality rate are on par with some of the worst hit states in the United States such as West Virginia. The important lesson from that is that supply side alone will not stop drugs, but neither will harm and demand reduction. We need to avoid situations when the legal market like the 1990s pharmaceutical market causes devastating addictions, and we need to do as much as we can to be countering those very dangerous lethal drugs like synthetic opioids to be entering the United States, Supply will not alone solve it, but if it saves some lives, that's really important.

LINDSAY:
On that note, I'll close up The President's Inbox for this week. My guest has been Vanda Falbab-Brown, a senior fellow in the Foreign Policy program at the Brookings Institution. Vanda, thank you for joining me. Please subscribe to The President's Inbox on Apple Podcasts, Google Podcasts, Spotify, wherever you listen and leave us a review, we'd love the feedback. The publications mentioned in this episode and a transcript of our conversation are available on the podcast page for The President's Inbox on cfr.org. As always, opinions expressed on The President's Inbox is solely those of the host or our guests, not of CFR, which takes no institutional positions on matters of policy. 

Today's episode was produced by Ester Fang, with Director of Podcasting Gabrielle Sierra. Special thanks go out to Michelle Kurilla for her research assistance. This is Jim Lindsay. Thanks for listening.