Nearly 1 million packages a day enter the country without any advance electronic information that might flag the presence of dangerous opioids such as fentanyl, much of which is manufactured in China, said Juliette Kayyem, a former assistant Homeland Security secretary.
An estimated 340 million pieces of mail each year pass unchecked through the Postal Service and US Customs without the prior electronic screening that was authorized by Congress 14 years ago but has yet to be fully implemented, Kayyem said.
The problem “is as disruptive to our country as any terrorist act has been” said Kayyem, who teaches at the John F. Kennedy School of Government at Harvard University.
In 2015, Massachusetts ranked second per capita in synthetic-opioid deaths, which include fentanyl, according to a new report from the Centers for Disease Control and Prevention. The number of such deaths in the state increased 109 percent from 2014 to 2015, the report said.
The scourge of fentanyl is still growing in Massachusetts. The drug has been found this year in three-quarters of overdose victims who had a toxicology test after their deaths, according to the state Department of Public Health.
Through September, as many as 1,475 opioid-related deaths had been confirmed or suspected in the state, a number on pace to break last year’s total of 1,759.
Much of the synthetic opioids that find their way into the United States — including fentanyl, which is 50 times more potent than heroin — originate in China but come through Mexico, where they are processed and packaged by drug cartels before being smuggled into the United States, federal officials say.
But a significant amount is bought by American users on the so-called dark web, a term for Internet sites that sell illegal products and then ship them directly from overseas and through the US mail, according to the experts.
For this, many buyers need no more than a computer, a click of a mouse, and delivery to their mailboxes.
The ease of using US mail to ship illicit drugs was tested in 2015 by the consulting firm LegitScript, which made 29 purchases from illegal online pharmacies, mostly in India. All 29 of the packages were delivered by the Postal Service after failing to be intercepted by customs.
Currently, much mail received from 191 foreign postal services, including China, Russia, and India, does not contain basic data such as the sender’s name, an address, and the package’s contents, according to Americans for Securing All Packages, a nonpartisan organization. (Kayyem serves as senior adviser for the group.)
Such data can be used to flag a package shipped from a suspicious or known illegal supplier. Once in the United States, officials said, the package stands a better chance to be plucked from the mail stream.
The national response to opioid-related deaths has been lagging, critics say. In 2002, Congress authorized the Customs Service to receive basic advance data on all incoming international mail. But since then, only private carriers such as Federal Express and United Parcel Service have conformed, Kayyem said.
‘Donald Trump will need to understand that you cannot just build a wall to keep fentanyl out of America.’
US Senator Edward Markey, who is working to curb the drug’s entry into the US
David Partenheimer, a Postal Service spokesman, wrote in an e-mail to the Globe that the agency does receive advance electronic data on international shipments from “multiple countries, including China.”
However, Partenheimer did not specify what details are received, how they are used, or what percentage of mail from large countries such as China, Russia, and India contain this information.
“The Postal Service shares the goal of those calling for expanding efforts to keep dangerous drugs out of the US mail system,” Partenheimer wrote.
To bolster screenings, Representative Richard Neal, a Democrat from Springfield, co-sponsored a bipartisan bill in September that would require advance electronic data — instead of merely authorizing the collection of such information — before packages enter the United States.
“This is one of those fascinating issues that unites Democrats and Republicans,” Neal said.
“It’s got the potential to equip the Postal Service and investigative agencies with the tools that they’re going to need.”
Senator Edward Markey of Massachusetts, a Democrat who called fentanyl “the Godzilla of opioids” in an interview, also is working to curb the drug’s entry into the United States.
He and Senator Marco Rubio, a Florida Republican, secured approval of a resolution from the Foreign Relations Committee that calls on the US government to make the issue of illicit fentanyl “of the highest importance in our relations with China and Mexico,” Markey said.
“Donald Trump will need to understand that you cannot just build a wall to keep fentanyl out of America,” Markey said.
“We’re going to need a much closer working partnership with the Mexican and Chinese governments if we are going to be successful, and they need to understand that we mean business,” he said.
The senator said he also is crafting a bill to provide the Customs Service with high-tech equipment and more scientists to detect fentanyl on the spot.
Neal said the fentanyl trade probably is being promoted by gangs and criminal syndicates as part of China’s vast underground economy.
If his bill is approved, Neal said, he is hopeful that the Drug Enforcement Administration “and other investigative agencies here can work with their counterparts overseas to undertake this in more of a preventive manner.”
In the meantime, the congressman said, “There is a long way to go.”
Brian MacQuarrie can be reached at brian.macquarrie@globe.com.
WEDNESDAY, Dec. 21, 2016 (HealthDay News) -- People trying to kick addiction to heroin or prescription painkillers often wait weeks or months before they can get into a treatment facility, putting them at continued risk for a fatal overdose.
Now, two innovative programs attempt to get addicts the help they need as quickly as possible.
Police in Gloucester, Mass., created an "Angel Program" that encourages opioid addicts to come to the department, with no threat of arrest, so officers can get them placed in local treatment programs immediately.
Meanwhile, researchers in Vermont started prescribing the anti-addiction drug buprenorphine to people placed on a waitlist at a treatment clinic, to try to tide them over.
Both programs reported promising results in the Dec. 21 issue of the New England Journal of Medicine.
Gloucester police got about 95 percent of people who came to the department with a substance abuse disorder into a detoxification or treatment program during the first year of the initiative, researchers reported.
"The police are persistent," said senior researcher David Rosenbloom, a professor of health law, management and policy at the Boston University School of Public Health. "They are going to do everything they can to avoid having that person walk out the door and use and perhaps fatally overdose."
In Vermont, providing early access to buprenorphine helped people stay off drugs and also reduced psychological symptoms such as anxiety and depression, which come with fighting addiction, researchers said.
"If you just give them some medication that eradicates their illicit drug use and criminal activity, then you may see some pretty impressive psychological benefits from giving them treatment they want but can't access," said lead researcher Stacey Sigmon. She's a research associate professor of psychology and psychiatry at the University of Vermont.
The United States is in the grip of an "epidemic" of opioid addiction, according to the U.S. Centers for Disease Control and Prevention. Every day, 91 Americans die from an opioid overdose.
Stricter regulation has reduced access to prescription painkilling opioids such as oxycodone (OxyContin), sending addicts to the street to purchase heroin and synthetic opioids such as fentanyl. The death rate from fentanyl overdose doubled between 2013 and 2014, the CDC said, while heroin caused nearly one out of every four overdose deaths in 2014.
Despite this, only 21 percent of people addicted to opioids in the United States received any treatment between 2009 and 2013, the study authors said in background notes.
Hoping to boost treatment rates, the Gloucester police said they would no longer criminalize addiction. While still enforcing laws against drug sales, the police promised that people who came to them seeking treatment would not be arrested, but instead would be immediately referred to a program, Rosenbloom said.
Within the first year, 376 addicts sought assistance from the police, said lead researcher Dr. Davida Schiff, a pediatrician at Boston Medical Center.
"Gloucester created a model where people felt they could come and get the help they really needed," Schiff said.
Programs similar to their Angel Program have since been adopted by 153 other police departments in 28 states, the study authors said.
For the Vermont study, 25 people were randomly assigned to receive daily buprenorphine treatment while they awaited entry into a treatment program.
Buprenorphine acts on the same brain receptors targeted by heroin and morphine, reducing drug cravings without the same intense intoxication normally caused by opioids, according to the U.S. National Institute on Drug Use.
Participants were given a secure computerized dispenser that released each day's dose during a pre-programmed three-hour window, Sigmon said. They also received daily calls from a computerized phone bank to assess their cravings and drug use.
Nearly nine out of 10 people who got buprenorphine tested drug-free after waiting a month for treatment, the researchers found. And 68 percent of the participants were drug-free even after three months on a waitlist.
"I think there's a lot of potential for clinics offering this," Sigmon said.
Emily Feinstein is director of health law and policy with the U.S. National Center on Addiction and Substance Abuse.
"Programs that offer immediate help can capitalize on the moment when a person is motivated to enter treatment and are likely to have better outcomes," Feinstein said.
"We encourage states and cities to examine the barriers faced by their local population and to design tailored programs that facilitate the immediate initiation of medication to treat opioid use disorder as well as appropriate behavioral therapy," she added.
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