It’s time to permanently ban fentanyl-related substances

For the third year in a row, Milwaukee County in Wisconsin is on pace to set a record for drug overdose deaths. About 80 percent of the 613 fatal overdoses last year in Milwaukee County involved fentanyl. In Wisconsin alone, fentanyl overdose deaths grew by 97 percent from 2019 to 2021. 

This is not just a local or state issue. Last year, there were over 100,000 overdose deaths nationwide (a nearly 30 percent increase from the previous year), the large majority attributable to illicit fentanyl. The lethal dose of fentanyl is 2 mg (equivalent to 5 grains of sand), meaning that one teaspoon is enough to kill 2,000 people. As those of us working on the front lines know, all it takes is one pill to kill. 

Bad actors in China and Mexican drug cartels exploited loopholes in U.S. law. By tweaking just one element of fentanyl’s chemical structure, they created deadly new fentanyls that were then legal. We were forced to play a lethal game of scheduling whack-a-mole, unable to react and make them illegal until hundreds of our kids died. 

Archie Badura was an alter server at church with my daughters. I also happened to be his doctor in the emergency room for his second to last overdose. Tragically, his next fentanyl-laced overdose ended young Archie’s life in 2014. His mother, my friend Lauri, founded Saving Others For Archie shortly after. The organization works with families who are desperately trying to help their loved ones with this scourge of addiction. 

Through my years serving as an emergency physician in Waukesha County and while on the Wisconsin Medical Examining Board and Controlled Substances Board, I saw this crisis develop and then multiply. I realized that some of this unimaginably tragic loss of life could be stopped by enacting simple, common-sense legislation.

Sen. Ron Johnson (R-Wis.) has led the country and the world in this area, working with Lauri Badura and me to introduce the Stopping Overdoses of Fentanyl Analogs (SOFA) Act in 2017. It proactively schedules all likely bioactive fentanyls as a class before they are created, thereby removing the incentive for illicit chemists to develop new fentanyl variants, effectively stopping them from existing. It is the most basic form of harm reduction and prevention — you can’t die from ingesting something that was never created. 

The Drug Enforcement Administration (DEA) saw the wisdom in the idea and implemented the SOFA language nationally in 2018 in a temporary order. The SOFA fentanyl class language is now recognized as model legislation and is being implemented around the globe. In 2019, the Chinese copied the SOFA language, effectively unplugging the entire fentanyl variant machine and shutting down illicit development and production of new deadly fentanyls worldwide. This is clearly not a partisan issue. 

But despite the already proven success of the SOFA language and the overwhelming support expressed by all 50 U.S. state attorneys general in both 2018 and 2019, along with large numbers of members of both parties in Congress, SOFA is still not permanent law. 

Progressive interest groups and members of Congress are standing in the way, blocking the SOFA language from passing. Sens. Cory Booker (D-N.J.), Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.), among others, are blocking progress by pushing fig leaf arguments related to scientific research and criminal justice. But the data and research are not on their side. And if they succeed with their grandstanding and political pandering, countless lives could be endangered. 

The SOFA Act language used so effectively by Drug Enforcement Administration (DEA) needs to be reenacted by the end of this year. Lauri Badura and many other advocates are raising the profile of the issue, including appearing on national television and putting billboards in Times Square around the recent Fentanyl Awareness and Prevention Day and coining the phrase “Fentanyl is America’s new F word.”

I have told more than enough families that their loved ones won’t be coming home because of this scourge. Fentanyl doesn’t care about party lines, so why should Congress? Congress must close the deadly loophole, making this common-sense, lifesaving legislation permanent.

Dr. Tim Westlake, MD, FFSMB, FACEP, is a full-time emergency physician, immediate past chairman of the Wisconsin Medical Examining Board, a former member of the Wisconsin Controlled Substances Board and a former member of the Governor’s Task Force on Opioid Abuse.