Trump’s border war won’t stop overdoses. In fact, it might make things worse

I’m an addiction and emergency medicine physician in southern Arizona, a region highly politicized by the war on drugs. Both my home and the hospital where I work are less than 100 miles from Mexico, and one of our fire departments serves a city split in two by the border wall. Although I love the ways in which the cultural milieu of the borderlands enriches our community – the school mariachi bands, colorful adobe houses in the barrios, saguaro cactus in a surprisingly verdant desert, some of the best bicycle infrastructure in the country, and even the most delicious food – Tucson was the first UNESCO city of gastronomy in the U.S. – we still have our challenges.

Although Arizona doesn’t have the highest rates of opioid overdose in the country, our rates aren’t the lowest, either: we are slightly above average. Nearly one in four Arizonans rely on Medicaid for their health insurance, and these rates are even higher in the rural communities along the border. Based on the Trump administration’s frequent visits to the borderlands and promises to help us, one might be optimistic that proposed policies would reduce overdoses and improve health outcomes.

Unfortunately, the administration is also threatening to drastically cut the very programs that actually reduce overdose deaths, both here in the borderlands and across the country at large. If staff and funding are slashed — from Health and Human Services, Substance Abuse and Mental Health Services, Health Resources and Services Administration, Centers for Disease Control and Prevention, and perhaps even Medicaid — so too will the most effective tools we have to prevent fatal overdose: naloxone and medications for addiction treatment.

Instead of focusing on evidence-based health approaches to save lives, the Trump administration is enacting punitive policies: arresting immigrants, militarizing the border, implementing tariffs against Mexico, and building more walls. During his inaugural address, President Trump promised to deport “millions and millions of criminal aliens,” and he has since mandated quotas for arrests from Immigration and Customs Enforcement. According to his America First Priorities, his administration will “take bold action to secure our border” by “building the wall” and deploying the Armed Forces.

In April, Trump signed an executive order to impose tariffs upon Mexico and signed a memorandum authorizing the deployment of thousands of National Guard troops to the Southern border. Currently, the administration is seeking bidders for a contract to extend the border wall between Nogales and Naco, Arizona. But without also stymying the demand for drugs, none of these supply-side approaches will work — we know this from past mistakes. Even worse, these policies will cause senseless harm in our communities.

Although the current scapegoat is Mexican people, this isn’t the first time our country has used drugs as an excuse to target minoritized populations. When an economic downturn hit San Francisco in the 1870s, white people blamed Chinese immigrants for stealing their jobs and began to villainize opium, a substance associated with the Chinese community. Many whites even believed that the Chinese community was trying to hook them on opium in order to undermine American society. And so, the city criminalized it, passing our country’s first anti-drug law.

In the early 20th century South, the target became the Black community. Although influential whites such as Sigmund Freud and the former surgeon general of the U.S. Army had publicly lauded the benefits of cocaine, many believed that the drug would cause Black men to “become oblivious of their prescribed bounds and attack white society.” Some police departments at that time so believed that cocaine made African Americans impervious to standard bullets that they actually increased the caliber of their revolvers, an erroneous idea that still has reverberations today.

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During the 1930’s “reefer madness” era, officials rebranded cannabis with the Spanish name “marijuana” to link it to Mexican immigrants, beginning a propaganda campaign to associate its use to depravity and crime. Within a few years, cannabis was criminalized, and the mandatory sentences mandated by the Boggs Act ensured that people arrested for possession faced a minimum of two to ten years of incarceration. Although whites and people of color use drugs at the same rates, mandatory sentencing unfairly targets communities of color and is one of the greatest contributors of mass incarceration.

And, perhaps most notoriously, the Anti-Drug Abuse Act of 1986 set mandatory minimums that were one hundred times greater for crack cocaine, associated with Black users, than for powder cocaine, associated with white users. Crack is just a more concentrated formulation of cocaine — the drug is otherwise the same. Enforcement became the primary way to fight the war on drugs, with over one million arrests for simple drug possession each year. As a result, one out of every five people behind bars now lives in the United States. Not only that, but incarceration actually increases someone's risk for a fatal overdose: drugs are present, effective treatment is rare, and people very often relapse as soon as they are released. Although we have certainly tried to arrest our way out of our country’s drug problems, it has never worked. It never will.

And that’s partly because addiction is not a crime but a treatable, chronic disease defined primarily by continued use despite the harms. And thus, increasing the severity of punishments — such as those mandated through the HALT Fentanyl Act or fentanyl homicide laws — doesn’t get people to stop using. Nor will arresting undocumented immigrants or sending them to prisons in El Salvador. Instead, we have to remove someone’s desire to use via medical treatments; in the economic terms of supply-and-demand, we have to reduce their demand for fentanyl.

Although it sounds simple to fix our country’s overdose crisis by removing the supply, it's not so straightforward. In the middle of the 20th century, some politicians thought that we could forever end heroin overdoses by buying (and destroying) all of the opium in Burma, now known as Myanmar. But whenever one region decreased their heroin production, operations just shifted elsewhere. During the 1990s, prescription opioids replaced heroin as the main driver of fatal overdoses, and many thought we could end addiction by forcing doctors to prescribe less painkillers. And although we did drastically decrease our opioid prescriptions, a wave of illicit heroin rose to fill the demand. And when law enforcement cracked down on heroin, dealers then switched to fentanyl, a highly potent, synthetic opioid that is much easier to produce (and transport) than heroin, a crop that requires adequate land and good weather.

As one Mexican cartel operative told the New York Times in March, “Demand will never end, the product is still being consumed. Addiction means demand never ends.” With the right ingredients, fentanyl can be synthesized almost anywhere, even domestically — in tiny kitchens or rudimentary mountain labs — and that as long as Americans want fentanyl, it will get made, even if it requires increasing violence to do so.

Luckily, we do have a very effective way to prevent people from dying — naloxone and overdose prevention centers. And to reduce the demand for illicit drugs we have addiction treatment. The FDA has approved three medications to treat opioid use disorder: methadone, buprenorphine and naltrexone. Not only do these medications keep people alive by preventing fatal overdoses, but they also reduce the transmission of hepatitis C and HIV. In fact, these medications are some of the most effective treatments we have for any chronic disease, more so than those that many Americans take daily for conditions such as coronary artery disease, hypertension, diabetes and obesity. Unfortunately, less than one in five people with opioid use disorder receive these life-saving medications, and proposed funding cuts threaten to reduce this figure even further.

Here in Southern Arizona, Trump’s policies will directly weaken many of our most effective tools in the fight against the opioid crisis. When the Department of Health and Human Services abruptly canceled more than $12 billion in federal grants to states in March, a program for pregnant women with substance use and unstable housing was immediately shuttered in Tucson. At the University of Arizona, our addiction medicine fellowship receives funding from a federal program that is slated to be cut. If we lose our addiction medicine fellowship, we will lose our addiction physicians at the university hospitals — and hundreds of patients every year will miss out on life-saving treatment. Across the state, a naloxone distribution program has been largely funded through a SAMHSA grant that is now at risk of termination.

Although it is less obvious the ways in which general federal and staffing cuts will affect addiction treatment on the ground, I am worried that my patients will still be negatively affected. Many health departments rely heavily on federal funding, as do non-profits like Cochise Harm Reduction, which directly help people who use drugs along the U.S.-Mexico border. With every cut, such organizations might experience reduced prioritization, program disruption, and overall dilution of services.

Similarly, the Trump administration has talked about cutting Medicaid spending. In the borderland counties of Southern Arizona in which I live and work, 30% to 41% of the population rely on Medicaid for their insurance coverage, and it is estimated that nearly 90% of medical treatment for fentanyl addiction across the country is provided by Medicaid. If that were to go away, they would risk losing coverage for their addiction treatment.

But no matter which of these proposed changes are actually passed, they will all end with the same result: more lives lost from fentanyl and overdose. If the administration actually cared about borderland communities and reducing fatal overdoses as much as they claimed, they would be prioritizing harm reduction and treatment in Arizona, not dismantling it. Instead of repeating the past mistakes of punitive policies — arrests, militarization, walls aimed at reducing supply — we would bolster existing health approaches to reduce demand and save lives. But perhaps saving lives was never the real goal.