As fentanyl tore across New England, Kelly Ayotte, then a U.S. senator from New Hampshire, introduced legislation to combat the powerful drug. It was September 2015, just months after the DEA issued a “nationwide alert” warning of a fentanyl surge and a spate of deaths in her state, as well as in New Jersey, Pennsylvania, Rhode Island and Missouri.
A former prosecutor and Republican state attorney general who handled myriad drug cases, Ayotte was surprised at fentanyl’s rapid rise. She learned it was being manufactured in China and sent to the United States through the mail or smuggled over the Mexican border before wending its way into the nation’s illicit drug supply.
Her bill would have mandated a 10- to 20-year prison term for anyone convicted of distributing certain amounts of fentanyl and would have reduced the quantity of the drug necessary to trigger stiff prison sentences.
Around the same time, on the other side of the Capitol, then-Rep. Thomas Rooney, R-Fla., and Rep. Tim Ryan, D-Ohio, led a bipartisan group of 11 co-sponsors in introducing a companion bill to Ayotte’s.
Ayotte almost immediately ran into a roadblock. The Senate was attempting to pass a sweeping criminal justice reform bill that would overhaul sentencing for drugs, including shortening the duration of mandatory sentences. Some thought Ayotte’s bill would clash with the effort and possibly imperil the bill’s passage. The fentanyl-related bills never received a vote.
An early warning about fentanyl went unheeded.
“Who is for fentanyl?” Ayotte said in a recent interview, recalling her frustration with Washington’s lack of urgency as the drug emerged as a widespread killer. “Fentanyl has not truly been dealt with. There are still people who are dying from it.”
Ayotte would lose her reelection bid the next year. Rooney reintroduced the bill in 2017, but it again went nowhere.
Rooney said he doesn’t know why his bill failed but suspects electoral politics played a part. As a Republican from a reliably red district who wasn’t going to face a difficult path to reelection, he didn’t need a legislative success to tout on the campaign trail.
“I get it, I understand that there’s some people who need victories more than people like me, somebody from a more competitive district,” he said. “It wasn’t like I was being punished or something like that. That’s just the way that it works.”
It took Congress until December 2017 to pass a bill specifically targeting fentanyl — nearly four years after legislators first received warnings about the dangers of the drug. In that time, more than 67,000 Americans had died from overdoses of fentanyl and other synthetic opioids. Fentanyl death rates are still rising.
A small group of lawmakers has been sounding the alarm on fentanyl since the drug started causing a spike in overdose deaths in 2013. But they were unable to pick up traction in Congress, controlled by Republicans for years, watching bills to address fentanyl languish and expire, sometimes, they said, at the behest of powerful interests including the pharmaceutical industry, which has made billions of dollars from opioids.
In recent interviews with The Washington Post, nearly two dozen current and former members of Congress expressed anger and exasperation that the rise of synthetic opioids drew so little notice and action in Washington.
“Congress has become inept and incapable of meeting the challenges of our time, and fentanyl is the latest example,” said Ryan, who is a 2020 presidential candidate.
The fentanyl epidemic has hit Ohio hard, and the state’s junior senator, Rob Portman, has given more than 50 speeches on heroin and fentanyl since 2016. But he said lawmakers have long lacked a sense of urgency on opioids, and the legislative process is cumbersome.
“I think it’s just inertia,” Portman, a Republican, said. “It’s hard to bring people together, hard to get stuff done around here.”
Republican leaders, who controlled both houses of Congress from 2015 through 2018, say they took the threat of opioids seriously, and that lawmakers ultimately succeeded in passing legislation to fight it in a deeply partisan environment.
While Congress passed bills to combat heroin and prescription drug abuse in 2016 and 2018 that expanded drug treatment and recovery programs and access to a medication that can reverse opioid overdoses, little has been done to specifically address fentanyl. Public health experts, advocates and many lawmakers believe the pieces of legislation are merely starting points and have not provided nearly enough money to help localities where it remains extremely difficult for drug users to get into treatment, even as fentanyl deaths continue unabated and people die while on waiting lists.
”Let’s be honest: They started to act when their phones started ringing off the hook,” said Andrew Kessler, a policy consultant who specializes in behavioral health.
The pharmaceutical lobby, a massive political donor, fought bills that would have criminalized the illicit manufacturing and distribution of fentanyl and its many chemical cousins. The Pharmaceutical Research and Manufacturers of America, a trade group, said in a statement to The Post that such legislation could hamper research. Legal fentanyl often is used for pain management in hospitals.
The industry successfully lobbied Congress to pass a bill limiting the Drug Enforcement Administration’s powers to disrupt the drug companies’ distribution of opioids. President Barack Obama signed it into law in 2016.
“The work by Congress has been absolutely dismal, disappointing and ineffective,” said Rep. David Trone D-Md., whose 24-year-old nephew died of a fentanyl overdose in 2016 while alone in a hotel room. “I really think they need to talk fentanyl, fentanyl, fentanyl. That word should come off everybody’s lips.”
Sen. Edward Markey stood at the back of a church in Taunton, Massachusetts, and asked the police chief and mayor to tell him about the most pressing issue in this industrial city of 55,000. The answer surprised Markey: fatal fentanyl overdoses.
Until that day in January 2014, Markey, D-Mass., had never heard of fentanyl. He knew his state was a hotbed for heroin and prescription pill abuse, but during the Martin Luther King Jr. Day service at the Baptist Church of All Nations, he learned of a new scourge, a powerful synthetic opioid that already had caused dozens of overdoses in a matter of weeks after it hit the streets. Markey promised to immediately bring the issue to Washington and press the federal government to make fentanyl a priority.
”We were kind of a preview of coming attractions in the opioid crisis,” Markey said in an interview in his Senate office. “What I was trying to do was get more attention paid to this on a preventative basis before it, too, spun out of control.”
The meeting in the Taunton church in 2014 set Markey on an odyssey that would last several years.
It began when Mayor Tom Hoye and Police Chief Edward Walsh told Markey that Taunton was seeing an alarming spike in overdoses after people used heroin laced with fentanyl.
”The issue of fentanyl playing a major role, that was just something that I had not heard,” Markey said.
Taunton, south of Boston, is one of the oldest cities in the United States. It also was one of the first communities to feel the wave of fentanyl abuse, the third stage of the nation’s opioid epidemic.
The epidemic saw its beginnings in the late 1990s, when patients became addicted to powerful opioid painkillers. As the government cracked down on unscrupulous prescribers, manufacturers and drug distributors, the addicted turned to illicit heroin. In 2013, fentanyl started to show up in the heroin supply and quickly took over, prized for its potency and low cost.
Like many other blue-collar towns across New England and Appalachia, the loss of traditional industry in Taunton had hollowed out the community, and pain pills and heroin had filled the vacuum. Fentanyl soon entered the thriving black market there.
Markey brought the nation’s drug czar, Gil Kerlikowske, to Taunton’s central fire station at the end of February 2014 to discuss fentanyl with local officials. During the meeting, the loudspeaker crackled: There was a suspected overdose on Oak Street. Emergency personnel raced from the station, sirens blaring. A woman had called 911: “Look, a man has overdosed,” she said. “He needs help now. Right now.”
By that April, more than 130 people had overdosed in Taunton, most of them from fentanyl abuse. Markey said he called numerous federal agencies, including the DEA and the head of the National Institute on Drug Abuse, to alert them to the fentanyl spike in Massachusetts.
Markey said the Obama administration had no coordinated plan to battle fentanyl across the various agencies that address drugs and public health. Fentanyl, he said, continued to hide in plain sight, masked within an epidemic of heroin and prescription drugs.
Even though people had been dying for more than a decade, members were slow to realize that the opioid epidemic, fentanyl aside, was ravaging the country.
Rep. Harold Rogers, R-Ky., and former congresswoman Mary Bono, a Republican who represented a Southern California district for 15 years, said in separate interviews that opioids were barely on the radar of lawmakers who hadn’t yet seen overdoses in their districts.
Bono said she would print out copies of stories about overdose deaths and give them to representatives from the corresponding congressional districts. Some slid the pieces of paper away without a glance, she said.
”There was no interest or dialogue,” she said, noting that she believes her colleagues brushed her off because she was looking at the issue as a parent, not as a legislator. “People in the beginning thought I was just an upset mom and discounted it and never realized it was hitting every community in America.”
Bono said she implored the chairmen of the House Energy and Commerce Committee and its health subcommittee to take up the issue, but they had other priorities. So, in 2011, she held her own hearing on opioids in the commerce, manufacturing and trade subcommittee she chaired.
”If 30,000 Americans died every year from food poisoning, Congress would take action,” Bono said in her closing statement. “If 30,000 Americans died from pesticide exposure, Congress would take action. And if 30,000 Americans died in airplane crashes every year, trust me, Congress would take action, in a huge way.
”So why are the victims of prescription drug abuse treated differently?”
Rep. Fred Upton, R-Mich., was chairman of the committee at the time. His spokesman, Josh Paciorek, said the opioid epidemic “is an issue close to Fred’s heart.”
Bono declined to implicate any one lawmaker for the inaction, instead blaming the way Congress operates. She said if Congress had acted sooner and stopped the epidemic before tens of thousands of Americans died, it would have been difficult to publicly claim victory over a theoretical problem.
”It’s hard in Congress to prove a negative,” Bono said. “There’s no money in that.”
Rogers, who each year since 2012 has hosted a summit on opioid abuse, said the fact that overdoses were soaring across the country didn’t gain traction because people in Congress didn’t see the issue as one that could help them win reelection.
”It’s hard to get people’s attention raised to a sufficient level to make things happen for whatever reason, whether it’s the stigma of not wanting to be involved in something really bad or dirty or unpleasant, or the bureaucracies that are involved,” Rogers said. “So it’s been a history of frustration, slow progress and a realization that we’ve got to deal with it. It’s killing us.”
Manchester chief’s warning
With Congress finally starting to focus on prescription opioids in January 2016, Enoch “Nick” Willard, then the police chief in Manchester had a blunt assessment for lawmakers: You are missing the real crisis.
“I want to get to fentanyl because we really haven’t talked about it. But fentanyl is what’s killing our citizens,” Willard, who is now the U.S. marshal for New Hampshire, told a congressional committee, noting that about two-thirds of fatal overdoses in Manchester the year before involved fentanyl.
In March 2016, Sen. Jeanne Shaheen, D-NH, proposed a measure to provide $600 million in emergency funding to fight opioids. It did not mention fentanyl. It was defeated, with just five Republicans voting in favor. Shaheen noted that Congress allocated more than $1 billion in emergency funding to fight the Zika virus — Zika-related illnesses killed two Americans — and $5.4 billion to combat Ebola, which killed one American.
“If we can spend billions to fight Ebola on a distant continent, surely we can allocate $600 million to combat a raging epidemic here at home,” Shaheen said in September 2016.
Also that year, while in the middle of a high-profile reelection fight, Sen. Patrick Toomey, R-Pa., implored the Obama administration to try to cut off the foreign supply of fentanyl. But he couldn’t find any co-sponsors on either side of the aisle.
“You might be surprised I had difficulty finding a co-sponsor,” Toomey said. “Unfortunately, it works that way sometimes.”
If Congress was not addressing fentanyl directly, it at least took steps to address the larger drug addiction crisis. As opioids were starting to get mentioned on the presidential campaign trail, two bills that would provide an infusion of money to battle addiction also gained ground.
The Comprehensive Addiction and Recovery Act (CARA), which Portman had initiated years earlier, authorized enhanced recovery and treatment programs but did not provide any direct funding. The Obama administration backed a different package, 21st Century Cures, which included $1 billion in grant money intended for states hardest hit by opioids.
Both measures ultimately passed in the second half of 2016, and they were touted as huge victories.
But many public health experts, local officials and some in Congress believe the bills, while important, were nowhere near what was needed nationwide.
The word “fentanyl” did not appear in the 21st Century Cures Act. CARA made a passing reference to increasing “public awareness to the dangerous effects of fentanyl when mixed with heroin or abused in a similar manner.”
Markey continued trying to convince Washington that its focus was on the wrong opioid.
”Fentanyl is the epidemic,” Markey had warned during a May 2016 hearing. “It is not heroin. It is fentanyl.”
Sen. Maggie Hassan carries on
By the time Sen. Maggie Hassan, D-NH, and Rep. Brian Fitzpatrick, R-Pa., were sworn in for their first terms in January 2017, 800 people in New Hampshire and 2,000 in Pennsylvania had died from fentanyl and other synthetic opioids. Both lawmakers wanted to make Washington come to grips with the deadly drug.
Hassan had narrowly defeated Ayotte. She arrived on Capitol Hill after four years as governor, during which time she had signed a law that increased penalties for dealing the drug.
“I think it did take a little while for people to understand the difference” between prescription drugs, heroin and fentanyl, she said of Congress.
Fitzpatrick had left his job as an FBI supervisory special agent to run for the eastern Pennsylvania seat his brother was leaving. He heard a near-constant refrain on the campaign trail: The opioid crisis was overwhelming the district. After he got to Congress, he volunteered to chair the House bipartisan heroin task force and sought to shift its focus to fentanyl.
”It’s unacceptable that the problem was able to get to this point because there were plenty of warning signs,” Fitzpatrick said in a recent interview with The Post. “It’s really frustrating that Congress didn’t act sooner.”
In March 2017, the House Energy and Commerce Committee held a hearing titled “Fentanyl: The Next Wave of the Opioid Crisis.”
But the wave had already crashed ashore. By early 2017, more than 35,000 people nationwide had died from fentanyl or other synthetic opioid overdoses.
Six fentanyl-specific bills were introduced in 2017. They included a measure championed by Hassan, Fitzpatrick and Massachusetts Sen. Edward Markey — the Interdict Act — that designated $15 million for new equipment to detect illicit fentanyl at the nation’s ports of entry and postal facilities and for scientists who could translate test results.
Fitzpatrick said the legislation was crucial because it was the first acknowledgment that the federal government could do something to try to keep fentanyl, produced mostly in China, from reaching the United States.
”U.S. Customs and Border Protection just didn’t have the capability to screen, and they didn’t have chemists on call to test these packages,” Fitzpatrick said.
By 2017, lawmakers were becoming increasingly attuned to fentanyl. That year, President Trump declared the broader opioid crisis a public health emergency. Debate in Congress finally turned to serious talk about the need to put real money behind the fight.
But House Republicans also proposed cuts to the Substance Abuse and Mental Health Services Administration, which administers major opioid grant programs for treatment and research. During a committee vote on a funding bill that would have stripped $200 million from the agency’s budget, Rep. Rosa DeLauro, D-Conn., said, “We speak often about the opioid crisis, but when the opportunity arises to take strong action, we fail to fund these priorities in a meaningful way.”
The three lawmakers who led the Republican Party during fentanyl’s rise — House Minority Leader Kevin McCarthy, R-Calif.; Senate Majority Leader Mitch McConnell, R-Ky.; and Paul Ryan, R-Wis., who was speaker of the House from 2015 to 2019 — all declined to be interviewed or did not respond to requests for comment.
McConnell’s office said the senator has taken meaningful steps to address the opioid crisis, including holding roundtables in his home state — one of the most affected in the nation. He led an effort in 2015 and again in 2018 to address opioid addiction in pregnant women. His office did not respond to detailed questions relating to the Senate’s role in combating opioids and fentanyl.
A former House GOP leadership aide who spoke on the condition of anonymity because they were not authorized to speak on behalf of the party said the criticism of congressional efforts to combat the opioid crisis is understandable, as is the perception that Congress came to it “woefully late.” After CARA passed in 2016, the plan was to expand upon it, but no one anticipated the effect a nascent Trump administration would have on Washington.
”I think, from a Speaker Paul Ryan perspective, this was a priority. This was as top a priority he could make in his first real year as speaker,” the aide said. In 2016, “he was able to work with President (Barack) Obama. We produced a process that was leading to real change. The tools were there to carry it forward, but there was a fundamental realigning of Washington writ large and not just opioids, but everything, the whole national agenda had to be repurposed through a new prism. And that had consequences up and down the board.”
The larger budget fight was punted into 2018. As a group of bipartisan lawmakers fought for more money for the crisis, Congress nearly unanimously approved the Interdict Act — the first passage of a stand-alone bill aimed at stopping fentanyl.
By that time, Ayotte had already been gone from Congress for a year, and it was almost four years to the day after Markey stood in a Taunton church and learned of fentanyl’s destructive impact on his state.
At the signing ceremony in January 2018, President Donald Trump sounded a somber note: “It feels like a very giant step, but unfortunately it’s not going to be a giant step because no matter what you do, this is something that keeps pouring in.”
He signed the legislation and handed the pen to Markey.
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Heading into the 2018 midterm election year, the opioid crisis had become a top concern for voters. Once limited to pockets around the country, it had spread indiscriminately to communities large and small, liberal and conservative, rich and poor.
Six parents who had lost children to opioids testified before a House committee that spring. Four of the deaths were due to fentanyl. Michael Gray’s 25-year-old daughter Amanda had died just four months earlier. He carried with him prayer cards with her smiling face that he pressed into the hands of every staffer and lawmaker he met.
Lawmakers agreed in March 2018 to add an additional $6 billion to battle opioids between 2018 and 2019. Funding for opioid-related programs through the U.S. Department of Health and Human Services increased from $2.7 billion in 2017 to $5.5billion in 2018. The largest share of the HHS money, $2.1 billion, went toward treatment and recovery programs.
But advocates and some lawmakers argued it still wasn’t enough, and it did little to directly address fentanyl.
”Cost cannot be an issue,” Fitzpatrick said. “When we’re fighting war overseas, we never say we’re out of money. Well, we’re fighting a war inside the country and we’re losing an entire generation.”
Sen. Elizabeth Warren, D-Mass., and Rep. Elijah Cummings, D-Md., began pushing a plan to dedicate $100 billion over 10 years to fight the opioid crisis — a package modeled after the Ryan White Comprehensive AIDS Resources Emergency Act, which is credited with stanching the AIDS epidemic. But Republicans weren’t interested in that long-term investment, Cummings said in an interview.
Instead, a diverse group of lawmakers facing tough reelection campaigns suddenly clamored to introduce opioid-related legislation; more than 60 bills were proposed, and nearly a dozen dealt directly with fentanyl.
Several focused on increasing criminal penalties for fentanyl, as Ayotte wanted to do years prior. Others dealt with withholding aid from China if it didn’t do its part to stop the flow of fentanyl manufactured there.
The House and Senate were moving separately on bills to cover prevention, treatment and recovery efforts. The House took a grab bag of 55 or so bills from lawmakers and formed one mammoth package. It passed in June 2018.
Some drug abuse prevention advocates worried that McConnell would slow-walk the legislation through the Senate, reluctant to give Democrats in red states a victory before the midterms, something McConnell has strongly denied, but a tweet from Trump backing the legislation ignited a sense of urgency. The Senate passed its version in September.
Portman introduced one of the most consequential pieces of legislation that year, requiring the U.S. Postal Service to scan packages from overseas for fentanyl, after a nearly 18-month investigation by Portman’s office found that fentanyl was being sent through regular mail.
The full Congress passed the opioid package, including Portman’s bill, in October, and Trump signed it 13 days before the midterm elections.
”In the face of 72,000 people dying last year, more than the entire Vietnam War, people are starting to wake up,” Portman said, referring to all drug overdose deaths in 2017. “How can you not see this? We won not so much because of our brilliance but because of the obvious need for something.”
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While lawmakers celebrated their work on the opioids package, public health advocates were less impressed. Many said the bill was merely an election-year political document that tinkered around the edges of a problem that could only be solved with a long-term financial commitment.
There also was widespread concern that Congress would simply move on.
”I’m in that camp that says just because you passed it doesn’t mean you have it right,” Rep. Greg Walden, R-Ore., said. “Let’s see what’s worked and what hasn’t.”
When Walden handed over the gavel to the House Energy and Commerce Committee after Democrats won control of the House, he urged his successor to continue work on the opioid crisis. The committee held a hearing on how the federal government is combating fentanyl on July 16, after Walden and five Democratic and Republican colleagues sent letters to six federal agencies, requesting briefings on how fentanyl flows into the United States.
The House Oversight Committee has held three hearings this year criticizing the Trump administration’s response to the opioid crisis.
”If today’s hearing lasts for just two hours, 15 people are dying while we are sitting here explaining why you had no strategy for two years, and still don’t really have one today,” Cummings said in his opening statement at the first hearing in March.
More than a dozen bills pertaining to the drug have been introduced in 2019, including measures that would study how the drug is being purchased on the dark Web and many that focus on punitive actions against China. At least three bills would call for sanctions to be placed on foreign traffickers, particularly in China and Mexico. Another would withhold foreign aid, other than humanitarian, from governments that aren’t cooperating with U.S. efforts to outlaw fentanyl. Numerous lawmakers have traveled to China to pressure the government to crack down on fentanyl exports; China agreed to ban all classes of fentanyl in May.
Sen. Elizabeth Warren, D-Mass., and Rep. Elijah Cummings, D-Md., reintroduced their $100 billion opioid bill this session.
“Politicians and policymakers make vague promises, treating the crisis as if it’s an unprecedented or unmanageable problem,” Warren said in a videotaped statement. “Washington has only nibbled around the edges.”
The increased funding Congress provided to fight the opioid crisis during the past few years has coincided with a drop in opioid-related deaths, according to preliminary 2018 data from the Centers for Disease Control. But fentanyl deaths are still on the rise, and public health experts say Congress’s contribution is tens of billions of dollars less than what the nation needs.
The infusion of opioid grant money runs out next year if Congress doesn’t act to extend it. Portman recently introduced legislation to continue spending $500 million each year through 2024 and to allow states the flexibility to use the money for drugs other than opioids, such as methamphetamine and cocaine, which are on an upswing and also have been found to be laced with fentanyl.
Portman said he is worried that if Congress sees the opioid crisis improving it will not feel an urgency to keep up the funding, so he is trying to keep his colleagues aware that fentanyl is an ongoing threat.
“The problem is, Congress is under pressure to fund a lot of things, and with some leveling off of the problem, some might say, ‘OK, let’s move on to the next crisis, congrats, it’s working,’ “ Portman said. “That would be a grave mistake. We’d be wasting resources that got us to this place, and we’d see a lot more loss of life.”
That is what researchers from the Rand Corp. warned congressional staffers about just this month, telling them in a briefing that without new ideas and concentrated funding, fentanyl will continue to creep west.
”Congress is broken. We’re playing catch-up, and it’s a 21st-century problem and they’re using 20th-century tools,” said Bryce Pardo, an associate policy researcher at Rand. “We need to start innovating. If we just rely on the available tools, it’s going to condemn a lot of people to death.”
Judi Gilmore raised her four sons here as a single mother. Todd, 33, died of a heroin overdose in 2006. His brother, Jay, 49, at times homeless, would spend nights sleeping on Todd’s grave. He, too, struggled with addiction.
A fatal dose of fentanyl killed Jay in May 2018, when his mother found him unconscious in a downstairs bathroom after hearing his cellphone ring incessantly.
She called 911 five times, but she had trouble completing the call because her hands were shaking so badly. Doctors at the hospital told her Jay was dead. He had been on a waiting list for treatment and was supposed to check in the next day.
Gilmore buried Jay’s ashes in the same cemetery plot where Todd’s casket was lowered into the ground, hoping her sons could find peace together. She cries each morning, setting her alarm an hour early on the days when she has to work. Gilmore wants lawmakers to know she is incensed they haven’t done more.
”I would tell them I’m very, very angry,” she said. “You’re not doing your job. Do your job. If it was their son or their daughter, they would do it.”
Markey says he has been trying, often to no avail. This month, he plans to introduce yet another bill to thwart fentanyl from entering the country. This one would seek to implement technology to screen 100% of all incoming international mail from countries where illicit fentanyl often originates, including China.
”I first learned of fentanyl six years ago, and it has devastated communities and families in every corner of the country every day since,” Markey said. “We cannot stop our efforts in Congress to banish this fentanyl epidemic to the history books. Far too many lives are at stake for a less ambitious response.”