NEW REPORT: Fentanyl as Sentinel - The Emerging Threat of Synthetic and Counterfeit Drugs

Authored by John J. Coleman, PhD and Robert L. DuPont, MD, and published by The Heritage Foundation

This compelling report outlines the story of fentanyl and identifies key policy recommendations to address the national drug epidemic. 

Fentanyl is a sentinel calling our attention to the potential for a slew of laboratory-based drugs produced by an ever-expanding illegal global drug market to meet a growing demand. Included in this threat are the fentanyl-laced counterfeit drugs manufactured to look like well-known and trusted pharmaceutical products but containing deadly amounts of fentanyl instead of the expected active pharmaceutical ingredient. Unrestrained by regulatory controls and labeling requirements, today’s drug trafficker-entrepreneur poses a serious threat to patients and non-patients alike. If we hope to meet these challenges successfully, we will need radically new thinking, better data systems, and improved technology to keep counterfeit drugs and deadly fentanyl analogs out of our communities and medicinal drug supplies.

Read the Full Report and print a PDF copy here.

Podcast: IBH President Robert L. DuPont, MD interviewed on the 50th anniversary of Nixon’s Special Message on Control of Narcotics and Dangerous Drugs

As the second White House “Drug Czar” and the first Director of the National Institute on Drug Abuse (NIDA), Dr. DuPont was in the midst of a concerted effort by President Nixon and Congress to address the rising heroin and marijuana epidemics of the 1960s and 70s. He was recently asked by the Nixon Foundation to discuss his unique perspective on the 50th anniversary of the July 14th, 1969 Special Message to the Congress on Control of Narcotics and Dangerous Drugs, in which Nixon insisted that “A national awareness of the gravity of the situation is needed; a new urgency and concerted national policy are needed at the Federal level to begin to cope with this growing menace to the general welfare of the United States.”

Looking back, Dr. DuPont sees Nixon’s Message as a “remarkable document” that anticipated and drove the development of many aspects and institutions of research, law enforcement, treatment, and international cooperation that still form the core of US drug policy to this day. In particular, Dr. DuPont observes that Nixon’s Message broke new ground in two areas that were key in Dr. DuPont’s own career: the recognition that law enforcement and treatment are synergistic rather than competing components of effective drug policy, and the promotion of medically-assisted treatment (MAT), which Dr. DuPont helped pioneer in 1969 with the first large-scale MAT program in Washington, DC.

The interview concludes with Dr. DuPont offering his perspective on today’s drug policy landscape, including the marked shift from “cultivated” drugs to “synthetic” drugs, the drug legalization movement, and the new threat of what he calls “commercialized recreational pharmacology”, with businesses now a key driver of developing and marketing stronger, more addictive drugs and new delivery systems such as vaping and edibles. As he succinctly observed in a 2018 interview with Opiod Watch, “drug users are able to buy more drugs, at higher potency, and lower prices, with more convenient delivery, than ever before.”

Panel Discussion: The Health Risks and Policy Problems of Marijuana Legalization

IBH President Robert L. DuPont, MD recently participated in a panel discussion at the American Enterprise Institute (AEI) centered around the book, Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence by Alex Berenson. Mr. Berenson and Dr. DuPont were joined by Jonathan Caulkins, PhD of Carnegie Mellon University, and AEI Resident Scholar Sally Satel, MD.

Although the discussion began with the issue of psychosis and mental illness, the panel covered a wide range of topics, including the impact of marijuana commercialization and the various marijuana policy options available, the Parents’ Movement, individual and societal risks of marijuana, and public attitudes towards the negative impacts of nicotine, alcohol, and opioids compared to marijuana.

Dr. Robert L. DuPont's Op-Ed Regarding CBD Published by The Washington Examiner

Building on the recent testimony of IBH President Robert L. DuPont, MD to the FDA regarding the exploding commercialization of cannabidiol (CBD), The Washington Examiner published an op-ed on this important topic. Dr. DuPont observes that “[t]he irrational enthusiasm for the medical use cannabidiol, or CBD, is unique and frightening. We are watching the explosive creation of a multibillion-dollar industry poised to make tremendous profits off desperate patients and their loved ones…Anecdotes and testimonials, not science, are driving the marketing of unregulated, nonprescription forms of CBD. This scenario is reminiscent of 19th century patent medicines. These concoctions claimed to cure every known condition; their peddlers were commonly known as ‘snake oil’ salesmen.”

Click here to read Dr. DuPont’s full op-ed on The Washington Examiner website.

Self-Care Tips for Family Members Facing Substance Use Disorders

Family members who are helping loved ones suffering substance use disorders face their own difficulties with stress and exhaustion. IBH Vice President Caroline DuPont, MD recently wrote about steps they can take to care for themselves while caring for others in a blog post featured on the Addiction Policy Forum website. The importance of self-care cannot be overstated, as it ultimately benefits both the family member and the loved one they are seeking to help. As Dr. DuPont notes in her post, you must “put on your own oxygen mask first before helping another”.

Dr. Robert L. DuPont's Written Testimony to the FDA Regarding the Health Impacts of CBD

***Click here to view or print a PDF copy of this commentary.***

We also encourage you to file your own testimony with the FDA about this important issue. You can do so via docket FDA-2019-N-1482 before July 2, 2019

Docket No. FDA-2019-N-1482, Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments

As a Harvard Medical School graduate, a board-certified and practicing psychiatrist, a veteran of NIH training and a clinical professor at Georgetown Medical School since 1980, I’ve witnessed many dramatic changes over my career. Yet the hoopla and hysteria surrounding the medical use of marijuana and cannabinoid-containing products is unlike anything I have ever seen. It is frightening to me and should be to all who are trusted to protect the public’s health and safety.

With that perspective as context, I commend the FDA for tackling the enormous challenge of creating a regulatory pathway for cannabis-derived products. I believe that Congress had products like these in mind when it passed the Food, Drug and Cosmetic Act in 1906. Yet even with an eye toward protecting the public’s health and safety as the motivation for the act, a century ago people couldn’t have imagined the amount of deceptive advertising we’re seeing today for cannabidiol (CBD). To hear the marketers tell it, CBD cures everything.

We are watching the explosive creation of a multi-billion-dollar industry poised to make tremendous profits off desperate patients and their loved ones. Anecdotes and testimonials, not science, drive the marketing of unregulated, non-prescription forms of CBD. It is reminiscent of 19th century patent medicines, with its peddlers commonly known as “snake oil” salesmen.

Massachusetts Doctors, Clinicians and Scientists Issue a Powerful New Statement of Concern on Marijuana

A powerful new “Statement of Concern” was published recently by a cohort of Massachusetts doctors, clinicians, and scientists. They strongly reject their state’s treatment of marijuana as an “ordinary commodity” that requires little or no consideration of its impact on the health of the citizens of Massachusetts, and call for it instead to be “Regulate[d] and govern[ed]… using a Public Health Framework…[that] prioritizes population-level health over commercial market interests…”

They observe that while not all marijuana users will experience negative effects, “the risk is substantial enough to require policies which discourage use.”

Among the key points of the Statement are:

  • that just like the previous “regulatory failure[s]” of the state regarding tobacco, opiods, and vaping, such regulatory failure is likely in the case of marijuana as well if the state does not prioritize public health

  • Marijuana is a potentially addictive drug, and its potency is ever-increasing, thereby increasing the risks of harm

  • “the tobacco industry has spent billions of dollars” to enter the vaping and marijuana markets, and they are likely to combine the two interests to produce high-THC vapes, which are of particular and growing risk to youth.

  • “Marijuana use by adolescents can impair brain development…reduce academic success, impact long-term career growth, and even lower user IQ. (These two points are a particular focus of IBH through its One Choice teen drug use prevention initiative.)

  • Massachusetts doctors and clinicians are seeing these effects first-hand in their own patients.

IBH encourages everyone who cares about public health to read this Statement of Concern, and to actively seek to implement its conclusions in their own states as well as at the federal level.

Click here to read the Statement of Concern via

Click here to visit the Marijuana Policy Initiative’s web page about the Statement.

Drug Crises Over the Horizon

Two important aspects of the drug epidemic are at the forefront of national attention. The first is the legalization of the production, sale, and use of marijuana. The second is the explosion of drug overdose deaths that has resulted in overdose becoming the leading cause of death for Americans age 50 and younger[1] and has led to a remarkable decline in U.S. life expectancy for the third consecutive year.[2] These are the poles of drug policy: efforts to relax and even eliminate prohibition of marijuana on the one hand and increasing restrictions on opioids to discourage use and to reduce overdose deaths on the other. As we consider present and future drug crises, we can learn useful lessons both from expanding the focus beyond marijuana and opioids and from exploring the path that has led the nation to the current drug epidemic.

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