AMERICA’S INSATIABLE DEMAND FOR DRUGS: 

THE PUBLIC HEALTH AND SAFETY IMPLICATIONS FOR OUR 

UNSECURE BORDER

 

A Majority Staff Report of the

Committee on Homeland Security and Governmental Affairs

United States Senate

Senator Ron Johnson, Chairman

September 1, 2016
Majority Staff Report

Committee on Homeland Security and Governmental Affairs

United States Senate

1

EXECUTIVE SUMMARY

The mission statement of the Senate Committee on Homeland Security and 

Governmental Affairs is to enhance the economic and national security of the United States. To 

improve our security, we first must properly define the problems we face. In doing so, it is 

important to focus on areas of agreement. In the 114th Congress, the Committee has convened 

hearings, roundtables, field hearings, and site visits all with the same goal in mind: to look for

areas of agreement and lay out the realities confronting the nation. 

The first area of broad agreement is the insecurity of our borders. Over the course of the 

Committee’s 18 border-security-related hearings, many witnesses testified that our borders are 

not secure. President Clinton’s drug czar testified that U.S. Customs and Border Protection 

(CBP) agents seize just five to ten percent of the illegal drugs smuggled across the border.1 

Meanwhile, the former Commander of Southern Command under President Obama emphasized 

that “an unlimited amount of drugs get into this country,” that “tens of thousands of people 

[illegally] come into this country,” and that “millions and millions of items of counterfeit 

industry type items like electronics get in.”2These facts lead to the inevitable conclusion “that 

our border is not secure.”3

Accepting this reality, one root cause for our insecure border is America’s insatiable 

demand for drugs. Although it is hard to calculate how much profit the drug cartels generate 

from supplying drugs in the United States, it is clear that this figure is in the billions each year.4 

Some experts estimate that Mexican transnational criminal organizations (TCOs), which 

represent the greatest criminal drug threat in the United States, generate somewhere between $19 

and $29 billion per year in U.S. drug sales.5 In testimony before the Committee, one witness 

stated that “illicit trafficking is estimated to be a $650 billion industry worldwide—larger than 

the GDP of all but 20 countries in the world.”6 

 

1

Securing the Border: Assessing the Impact of Transnational Crime: Hearing Before the S. Comm. on Homeland 

Security & Governmental Affairs, 114th Cong. (2015) (statement of General Barry R. McCaffrey, USA (Ret.), 

Former Director of the Office of National Drug Control Policy (1996-2001)). 

2 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement of Gen. John F. Kelly, USMC (Ret.), Former Commander of the United 

States Southern Command (2012-2016)). 

3

Id.

4

See United States of America-Mexico Bi-National Criminal Proceed Study, Joint Message from Assistant 

Secretary John Morton, U.S. Immigration & Customs Enforcement, and Director Garyling G. Williams, DHS Office 

of Counternarcotic Enforcement, available at https://www.ice.gov/doclib/cornerstone/pdf/cps-study.pdf.

5

Id. 

6 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement of Gen. John F. Kelly, USMC (Ret.), Former Commander of the United 

States Southern Command (2012-2016)). 
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This profit is enough to motivate the cartels to find a way, any way, to penetrate our

borders. Where fences exist, the cartels dig tunnels under them or fly ultralight aircraft over

them.7 Where there is desert, backpackers carry loads across the border, endangering homes in

rural border towns along the way.8 For the most part, the cartels simply drive across the border

through legal ports of entry, creatively concealing drugs in spare tires, batteries, and hidden

compartments.

9

 

In November, the Committee’s majority staff released The State of America’s Border 

Security, which, among other things, found that the enormous profits generated by supplying 

America’s demand for drugs fuels widespread government corruption and violence south of the 

border.

10

 As outlined in the report, “As product moves through Central America the drug cartels 

have dramatically weakened the public institutions and rule of law within those nations. The 

resulting corruption and criminal impunity enjoyed by gangs and extortion racketeers have led to 

high murder rates, destroyed economic opportunity, and created significant incentives to migrate 

to America—the so called ‘push factors’ of illegal immigration.”11

Once these drugs cross the border, they are sent to distribution hubs in such places as

Phoenix, Arizona, or Chicago, Illinois.12 From there, the drugs are further disseminated by street

gangs into local communities throughout America.13 No community is left untouched from this

sophisticated and fully integrated network,

14 and the U.S. government—whether at a federal,

state, or local level—has not been effective at stopping it.

After concluding that our borders are insecure and that a key driver of our insecure 

border is America’s insatiable demand for drugs, the Chairman focused on addressing this 

 

7

See Phil Benson, Suspected Drug Tunnel Found Near Nogales, AZ, AZFAMILY.COM (Mar. 29, 2016), 

http://www.azfamily.com/story/31593377/suspected-drug-tunnel-found-near-nogales-az; see also Drug Enforcement 

Administration, DEA-DCT-DIR-008-16, 2015 National Drug Threat Assessment Summary 3 (Oct. 2015), available 

at www.dea.gov/docs/2015%20NDTA%20Report.pdf.

8

See generally Securing the Southwest Border: Perspectives from Beyond the Beltway: Hearing Before the S. 

Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015).

9 Drug Enforcement Administration, DEA-DCT-DIR-008-16, 2015 National Drug Threat Assessment Summary 43, 

51 (Oct. 2015), available at www.dea.gov/docs/2015%20NDTA%20Report.pdf.

10 S. Comm. on Homeland Security & Governmental Affairs, The State of America’s Border Security (Nov. 23, 

2015), available at https://www.hsgac.senate.gov/media/majority-media/icymi-johnson-releases-border-report; see 

also Idlefonso Ortiz, 2015: Another Year of Mexican Cartel Violence and Government Corruption, BREITBART

(Dec. 27, 2015), available at http://www.breitbart.com/texas/2015/12/27/2015-another-year-mexican-cartelviolence-government-corruption. 

11 S. Comm. on Homeland Security & Governmental Affairs, The State of America’s Border Security (Nov. 23, 

2015), available at https://www.hsgac.senate.gov/media/majority-media/icymi-johnson-releases-border-report.

12 Drug Enforcement Administration, DEA-DCT-DIR-008-16, 2015 National Drug Threat Assessment Summary 3 

(Oct. 2015), available at www.dea.gov/docs/2015%20NDTA%20Report.pdf.

13 Id. 

14 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015) 

(statement of John “Jack” Riley, Acting Deputy Administrator, Drug Enforcement Agency). 
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demand. The Committee convened a hearing on media campaigns and prevention,15 a hearing 

with the drug czar to discuss how the Obama Administration is prioritizing federal drug 

spending,16 and a roundtable to discuss alternative approaches to address drug demand and 

addiction in this country.17 Moreover, the Committee 

held four field hearings across the country—in New 

Hampshire,18 Arizona,19 Wisconsin,20 and Ohio21—

specifically focused on the opioid epidemic plaguing 

this nation. 

The public health crisis associated with drug use 

is also undisputed. The Centers for Disease Control and 

Prevention (CDC) reported there were 47,055 drug 

overdose deaths in 2014—meaning, on average, 129 

Americans died from a drug overdose each day.

22 Of 

these deaths, 18,893 were associated with prescription 

opioids and 10,574 were attributed to heroin.23

According to the Drug Enforcement Administration 

(DEA), “Drug overdose deaths have become the leading 

cause of injury deaths in the United States, surpassing 

the number of deaths by motor vehicle [accidents] and 

firearms every year since 2008.”24

 

15 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs,114th Cong. (2016).

16 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016).

17 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016).

18 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015).

19 America’s Heroin Epidemic at the Border: Local, State, and Federal Law Enforcement Efforts to Combat Illicit 

Narcotic Trafficking: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. 

(2015).

20 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016).

21 Examining the Impact of the Opioid Epidemic in Ohio: Hearing Before the S. Comm. on Homeland Security &

Governmental Affairs, 114th Cong. (2016). 

22 Rudd et al., Increases in Drug and Opioid Overdose Deaths-United States, 2000-2014, MORBIDITY AND 

MORTALITY WEEKLY REPORT (Jan. 1, 2016), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm; see 

also Lenny Bernstein, Deaths From Opioid Overdoses Set a Record in 2014, WASH POST (Dec. 18, 2015), 

https://www.washingtonpost.com/news/to-your-health/wp/2015/12/11/deaths-from-heroin-overdoses-surged-in2014. 

23 Id. 

24 Drug Enforcement Administration, DEA-DCT-DIR-008-16, 2015 National Drug Threat 

Assessment Summary iii (Oct. 2015), www.dea.gov/docs/2015%20NDTA%20Report.pdf.

"We're going to lose 120 

Americans today. We're 

going to lose 120 Americans 

every day until we move. We 

measure that statistic, but 

that's not a statistic. Those 

120 are moms and dads and 

brothers and sisters and 

sons and daughters. That's 

what's got to stop." – Rob 

Brandt, Founder, Robby’s 

Voice, Examining the Impact of the 

Opioid Epidemic in Ohio: Hearing 

Before the S. Comm. on Homeland 

Security & Governmental Affairs.
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To address the drug crisis in this country, an estimated $1 trillion has been spent on the 

“war on drugs” by federal, state, and local governments during the past 40 years.25 Annually, on 

a federal level, the United States allocates approximately $30 billion on drug control spending.26 

Despite this heavy investment, the number of illicit drug users has held steady over the 

years.27 Data from the 2014 National Survey on Drug Use and Health reports that every year 

from 2002 to 2013 there has been an increase in marijuana and heroin use, as well as steady rates 

of nonmedical pain reliever use.28 As of 2014, there were an estimated 27 million illicit drug 

users.29 According to testimony to the Committee, the majority of illicit drug use consists of 

marijuana use, and, to a lesser extent, prescription drugs, which can translate to between 22 to 24 

million illicit drug users.30 This leaves approximately three million people—or one percent of 

the U.S. population—who abuse “hard drugs,” such as cocaine, crack, meth, and heroin.31 This 

figure is important to understand as the United States looks for ways to prevent illicit use of hard 

drugs and to curb demand. 

 

Moreover, the prevalence and purity of heroin has increased. Multiple witnesses testified 

in Committee hearings that heroin is increasingly more potent and less expensive today than ever 

before.

32

 For example, according to the Wisconsin Attorney General, heroin sold in Wisconsin

 

25 Matt Sledge, The Drug War and Mass Incarceration by the Numbers, THE HUFFINGTON POST (Apr. 8, 2013), 

available at http://www.huffingtonpost.com/2013/04/08/drug-war-mass-incarceration_n_3034310.html.

26 See, e.g., Executive Office of the President, Nat’l Drug Control Budget, FY 2017 Funding Highlights (Feb. 2016), 

available at https://www.whitehouse.gov/sites/default/files/ondcp/press-releases/fy_2017_budget_highlights.pdf; 

see also Executive Office of the President, FY 2016 Budget and Performance Summary, Companion of the National 

Drug Control Strategy (Nov. 2015), available at https://www.whitehouse.gov/sites/default/files/ondcp/policy-andresearch/fy_2016_budget_summary.pdf. 

27 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Hon. Michael P. Botticelli, Director, 

Office of National Drug Control Policy) (“the overall prevalence of drug use . . . has remained relatively stable over 

the years” and responding “Generally” to the question, “In general, the percentage of Americans using hard drugs 

has held pretty steady?”). 

28 Increased Marijuana, Heroin Use Contribute to Highest Reported Illicit Drug Use in More Than a Decade, 

American Society of Addiction Medicine (Sept. 10, 2015), available at 

http://www.asam.org/magazine/read/article/2015/09/10/increased-marijuana-heroin-use-contribute-to-highestreported-illicit-drug-use-in-more-than-a-decade.

29 Martha Mendoza, U.S. Drug War Has Met None of Its Goals, AP (May 13, 2010), 

http://www.nbcnews.com/id/37134751/ns/us_news-security/t/us-drug-war-has-met-none-its-goals/#.V3U54fkrJhF.

30 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs,114th Cong. (2016) (statement of Jonathan P. Caulkins, Ph.D., Stever Professor of Operations Research & 

Public Policy, Heinz College, Carnegie Mellon University). 

31 Id. 

32 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015) 

(statement of John “Jack” Riley, Acting Deputy Administrator, Drug Enforcement Agency); Border Security and 

America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and Prescription Opioids in 

Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2016)

(statement of James Bohn, Executive Director, Wisconsin High Intensity Drug Trafficking Area (HIDTA) Program).
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has increased from five percent in purity in the 1980s to now between 20 and 80 percent.33

Meanwhile, the price of heroin has decreased from a nationwide average of $3,260 per gram of 

pure heroin in 1981 to $100 to $150 per gram in Wisconsin today.34 That can translate into as 

little as $10 for one hit.

The ease with which a person with a substance use disorder can access heroin has led to

an alarming rise in overdoses across the country. In Milwaukee County alone, 109 heroinrelated overdose deaths were reported in 2015.35 More recently, in August 2016, Milwaukee

County reported 20 overdose deaths in the span of just two weeks.36 This “unprecedented” death

toll continues to rise as Mexican cartels begin to cut heroin with fentanyl, a synthetically

produced opioid that is significantly stronger and more lethal than heroin.37 According to one

Committee witness, fentanyl may account for as many as 5,500 overdoses in 2014.38

For these reasons, we can all agree that it is time to seriously reassess our strategies

concerning America’s insatiable demand for drugs, our war on drugs, and the resulting lack of

border security. This report highlights the Committee’s hearings on America’s insatiable

demand for drugs, including the Committee’s four field hearings across the country. The report

examines the effect that America’s insatiable demand for drugs has had on U.S. national and

border security, closely scrutinizes the current opioid epidemic in the United States, and

considers possible approaches to curb illicit drug use and addiction. At multiple Committee

hearings, witnesses testified that an “all of the above” approach is needed—prevention,

treatment, and law enforcement—to tackle this public health crisis. This report considers all of

these approaches, as well as alternative approaches. While there is no silver bullet solution to

curb the demand for drugs in this country, one thing is clear: our current approach is not

working. 

 

33 Id. (statement of Brad Schimel, Attorney General, Department of Justice, State of Wisconsin).

34 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr.

2015), at 31 (on file with the Committee); Border Security and America’s Heroin Epidemic: The Impact of the

Trafficking and Abuse of Heroin and Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of James Bohn, Executive Director,

Wisconsin High Intensity Drug Trafficking Area (HIDTA) Program).

35 Id. 

36 Crocker Stephenson, Heroin Suspected in 20 Deaths in 2 Weeks, MILWAUKEE JOURNAL SENTINEL (Aug. 12, 

2016), http://www.jsonline.com/story/news/crime/2016/08/11/fentanyl-deaths-spike/88580884/.

37 Id. 

38 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of David Murray, Hudson Institute). 
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TABLE OF CONTENTS

Executive Summary........................................................................................................................ 1

Table of Contents............................................................................................................................ 6

I. Introduction......................................................................................................................... 7

II. Impact on National and Border Security ............................................................................ 9

III. America’s Opioid Epidemic ............................................................................................. 11

a. Prescription Opioids.......................................................................................................... 12

b. Heroin ............................................................................................................................... 15

c. Fentanyl............................................................................................................................. 18

IV. Addressing America’s Insatiable Demand for Drugs....................................................... 21

a. Prevention ......................................................................................................................... 22

i. Just Say No..................................................................................................................... 22

ii. Office of Drug Control Policy Media Campaign ........................................................... 23

iii. The Truth Campaign ...................................................................................................... 24

iv. Prevention and Education Campaigns Today ................................................................ 25

b. Treatment .......................................................................................................................... 28

c. Law Enforcement.............................................................................................................. 30

d. Alternative Approaches .................................................................................................... 32

i. Decriminalization........................................................................................................... 33

ii. Legalization.................................................................................................................... 35

iii. Supervised Injection Facilities....................................................................................... 38

V. Conclusion ........................................................................................................................ 40

Appendix A: Tables and Statistics................................................................................................ 43

Appendix B: Chairman’s Findings of Fact from Committee Hearings and Roundtables ............ 47
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I. INTRODUCTION 

America’s so-called “war on drugs” began in 1971, when President Nixon stated that drug 

abuse is “public enemy number one.”

39

 President Nixon’s efforts changed the complexion of drug 

policy in this country. Drug enforcement funding was increased and Congress enacted the 

Controlled Substances Act (CSA).40 CSA placed drug regulation under federal jurisdiction and 

made a schedule system that classified drugs using the following criteria: “(1) how dangerous they 

are considered to be, (2) their potential for abuse and addiction, and (3) whether they have 

legitimate medical use.”41 

In 1973, Congress created the DEA and placed it within the Department of Justice (DOJ) 

to enforce the CSA.42 By 2014, the DEA budget had grown to $2 billion and the agency 

employed more than 9,000 people.43

In the 1980s, with the emerging problem of “crack” cocaine, President Reagan launched 

a renewed effort to combat drug use with a law enforcement response. Between 1980 and 1986, 

spending on drug enforcement tripled, and the number of people convicted of drug offenses more 

than doubled.44 In 1984, Congress passed the Comprehensive Crime Control Act, which 

enhanced penalties for violations of the CSA and gave the Attorney General the authority to 

place substances on a temporary schedule.45 

Two years later, Congress passed the Anti-Drug Abuse Act of 1986, which established 

penalties for simple possession of a controlled substance and trafficking offenses.46 The AntiDrug Abuse Act of 1988 created the Office of National Drug Control Policy (ONDCP).

47 By 

2015, ONDCP had 81 employees and provided funding for programs in 16 departments of the 

federal government with a total annual budget of $26.3 billion.48 Today, ONDCP “is responsible 

for: (1) developing a national drug control policy, (2) developing and applying specific goals and 

performance measurements to evaluate the effectiveness of national drug control policy and 

National Drug Control Program agencies’ programs, (3) overseeing and coordinating the 

 

39 Richard Nixon, Remarks About an Intensified Program for Drug Abuse Prevention and Control (June 17, 1971), 

available at http://www.presidency.ucsb.edu/ws/?pid=3047.

40 Pub. L. No. 91-513; see also Lisa N. Sacco, Cong. Research Serv., R43749, Drug Enforcement in the United States: 

History, Policy, and Trends (Oct. 2, 2014), available at https://www.fas.org/sgp/crs/misc/R43749.pdf. 

41 Id.

42 Id.; see also Exec. Order No. 11727, 3 C.F.R. 785 (1971-1974).

43 Id.

44 Id.

45 Id.; see also Pub. L. No. 98-473. 

46 Id.; see also Pub. L. No. 99-570.

47 Id.; see also Pub. L. No. 100-690.

48 Exec. Office of the President, National Drug Control Strategy: Budget and Performance Summary, FY 2016 

(Nov. 2015), available at https://www.whitehouse.gov//sites/default/files/ondcp/policy-andresearch/fy_2016_budget_summary.pdf. 
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implementation of the national drug control policy, and (4) assessing and certifying the adequacy 

of the budget for National Drug Control Programs.”

49

In 2010, ONDCP developed a strategy with seven goals to reduce drug use by 2015. In 

2013, the Government Accountability Office (GAO) reviewed the implementation of the 

strategy, assessed progress toward achieving the strategic goals, and reviewed the drug abuse and 

treatment programs.50 GAO found that data 

was only available for five of the seven goals, 

with one showing progress, and four 

demonstrating no progress.51 GAO also 

reported that drug abuse prevention and 

treatment programs were scattered among 15 

federal agencies, which could cause overlap 

and inefficiencies.52 In December 2015, GAO 

reported on the progress since the 2013 report, 

this time finding progress in one goal, no 

progress in three, and mixed results in three, 

with none of the strategic goals fully 

achieved.53

Today, opioids represent the country’s 

newest public health crisis. In July 2016, the 

House and Senate agreed to and passed the 

conference report to the Comprehensive 

Addiction and Recovery Act (CARA), to battle 

the ongoing opioid epidemic. This legislation will expand the availability of naloxone to law 

enforcement and first responders, improve prescription drug monitoring programs, and allocate 

resources to treat people with substance use disorders who are incarcerated.54 CARA provides

more than $400 million in grants through 2021 to be distributed through the Department of 

Health and Human Services (HHS) and the Substance Abuse and Mental Health Services 

Administration (SAMSHA), as well as more than $500 million in grants to states, local 

governments, and/or Indian tribes through the DOJ.

55

 

49 U.S. Gov’t Accountability Office, GAO-13-333, Office of National Drug Control Policy: Office Could Better 

Identify Opportunities to Increase Program Coordination (2013).

50 Id.

51 Id. 

52 Id. 

53 U.S. Gov’t Accountability Office, GAO-16-57T, Office of National Drug Control Policy: Lack of Progress on 

Achieving National Strategy Goals (2015).

54 Summaries for the Comprehensive Addiction and Recovery Act of 2016, Govtrack.us,

https://www.govtrack.us/congress/bills/114/s524 (last visited Mar. 29, 2016).

55 Congressional Budget Office, S. 524, Comprehensive Addiction and Recovery Act of 2016 (Feb. 16, 2016), 

available at https://www.cbo.gov/publication/51291.

“The War on Drugs has had a 

devastating impact on the world: 

murder and mayhem in Mexico, 

Central America, and so many other 

parts of the planet, a global black 

market estimated at 300 billion dollars 

a year...Meanwhile, there are just as 

many people using drugs as ever. It is 

our country’s history with alcohol 

prohibition and Al Capone, times 50.” 

– Ethan Nadelmann, Drug Policy 

Alliance, America’s Insatiable Demand For Drugs: 

Examining Alternative Approaches: Roundtable

Before the S. Comm. on Homeland Security &

Governmental Affairs.
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II. IMPACT ON NATIONAL AND BORDER SECURITY 

America’s insatiable demand for drugs has a direct effect on U.S. national and border 

security. In 2014, the DEA proclaimed that “[g]lobally, drug trafficking is not just a criminal 

issue, not just a health and safety issue, it’s a national security issue. Addiction and abuse across 

the world is funding and fueling insurgents.”56 In the same year, the DEA estimated that nearly 

half of the foreign terrorist groups on the designated list have ties to drug trafficking.57

Profits generated from drug sales are attractive funding sources for terrorist 

organizations.58 In 2003, then-Assistant Director of the Federal Bureau of Investigation’s (FBI)

Office of Intelligence, Steven McCraw, testified before the Senate Judiciary Committee that 

“drug trafficking is a highly lucrative enterprise generating billions of dollars in profit that 

terrorist organizations can easily tap into.”59 More recently, the Obama Administration’s 

National Security Council similarly reported a correlation between drug trafficking expansion 

and increases in crime and corruption.60 According to the President’s Strategy to Combat 

Transnational Organized Crime, “[t]he demand for illicit drugs, both in the United States and 

abroad, fuels the power, impunity, and violence of criminal organizations around the globe.”61 

The Revolutionary Armed Forces of Colombia (FARC), a group designated as a foreign 

terrorist organization by the State Department since 1997, relies heavily on taxing, producing, 

and trafficking illegal drugs to fund their militant operations.62 In 2012, Colombia’s Defense 

Minister stated that Colombia’s illegal drug market generated an estimated $6 to $7 billion 

annually, of which the FARC earned $2.4 to $3.5 billion.63 Some experts argue that the number 

was exaggerated and it is more likely $200 million to $1 billion.64 Nonetheless, FARC anti-

 

56 Remi L. Roy, How Lucrative Illegal Drug Trafficking Finances International Terrorist Organizations, THE FIX

(Oct. 26, 2014), http://www.alternet.org/drugs/how-lucrative-illegal-drug-trafficking-finances-international-terroristorganizations.

57 Drug Enforcement Administration, DEA Programs: Money Laundering, https://www.dea.gov/ops/money.shtml 

(last visited July 11, 2016).

58 Narco-Terrorism: International Drug Trafficking and Terrorism – A Dangerous Mix: Hearing Before the S. 

Comm. on the Judiciary, 108th Cong. (2003) (statement of Steve McCraw, Assistant Director, Office for 

Intelligence, Federal Bureau of Investigation), available at http://www.judiciary.senate.gov/meetings/narcoterrorism-international-drug-trafficking-and-terrorism_-a-dangerous-mix. 

59 Id.

60 Exec. Office of the President, Strategy to Combat Transnational Organized Crime, National Security Council 

(July 25, 2011), available at https://www.whitehouse.gov/administration/eop/nsc/transnational-crime.

61 Id.

62 John Otis, The FARC and Colombia’s Illegal Drug Trade, Wilson Center (Nov. 2014), available at 

https://www.wilsoncenter.org/sites/default/files/Otis_FARCDrugTrade2014.pdf. 

63 Id.

64 Id.
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government operations and drug-related violence in Colombia destabilized the region, resulting 

in more than 200,000 deaths and the displacement of more than 5 million people since 1958.65

Meanwhile, it is reported that Mexican drug cartels are taking in $19 to $29 billion per 

year from U.S. drug sales.66 These 

criminal organizations represent a 

significant threat, because they control 

entire networks in Mexican border towns 

and are well connected within the United 

States.67 According to the DEA, “Mexican 

transnational criminal organizations 

(TCOs) remain the greatest criminal drug 

threat to the United States; no other group 

can challenge them in the near term.”68 

As outlined in the majority staff 

report, The State of America’s Border 

Security, the profit to be gained by 

supplying drugs to America creates a huge 

incentive to penetrate our borders, no 

matter what defenses the United States

erects.69 The result has been a porous 

border, which is not only penetrated by 

drug trafficking organizations, but also by 

human smugglers and human traffickers.70

The porous border imposes significant 

costs for the nation, public safety, and 

 

65 Id.; see also Associated Press in Bogota, Colombian Conflict Has Killed 220,000 in 55 Years, Commission Finds, 

THE GUARDIAN (July 25, 2013), http://www.theguardian.com/world/2013/jul/25/colombia-conflict-death-tollcommission. 

66 United States of America-Mexico Bi-National Criminal Proceed Study, Joint Message from Assistant Secretary 

John Morton, U.S. Immigration & Customs Enforcement, and Director Garyling G. Williams, DHS Office of 

Counternarcotic Enforcement, available at https://www.ice.gov/doclib/cornerstone/pdf/cps-study.pdf.

67 Christopher Woody, 2 of Mexico’s Most Powerful Cartels Are Clashing Just Across the U.S. Border, BUSINESS 

INSIDER (Feb. 28, 2016), available at http://www.businessinsider.com/cjng-and-sinaloa-cartel-violence-in-tijuana2016-2. 

68 Drug Enforcement Administration, DEA-DCT-DIR-008-16, 2015 National Drug Threat Assessment Summary v 

(Oct. 2015), available at www.dea.gov/docs/2015%20NDTA%20Report.pdf.

69 S. Comm. on Homeland Security & Governmental Affairs, The State of America’s Border Security (Nov. 23, 

2015), available at https://www.hsgac.senate.gov/media/majority-media/icymi-johnson-releases-border-report.

70 Id. 

“I would just simply say we think that an 

unlimited amount of drugs get into this 

country, in the hundreds of tons, not even 

counting marijuana; in the hundreds of tons 

of cocaine, heroin and methamphetamine. It 

gets in, no problem; gets all the way to 

Portland, Maine as fast as it gets to San 

Diego. We know that tens of thousands of 

people come into this country; I'm not talking 

about the—kind of the economic people 

seeking a better life. I'm talking about sex 

workers and—and other people; they get 

here, no problem. Millions and millions of 

items of counterfeit industrial type items like 

electronics get in... If all of that's getting in, 

no problem, then I would argue that our 

border is not secure.” – Gen. John F. Kelly, 

USMC (Ret.), Former Commander of the 

United States Southern Command, America’s 

Insatiable Demand for Drugs: Hearing Before the S. 

Comm. on Homeland Security & Governmental Affairs.
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communities on the border that are directly affected by trafficking and migration.71 

Further, the drug trade generates such high profits for criminal organizations that even 

when authorities suppress drugs and drug-trafficking in one area, the criminals are likely to move

their operations to another area. According to a 2012 report from the UN Office on Drugs and 

Crime, when one country’s drug control efforts are successful, other countries experience a rise 

in organized crime, black markets, and other problems associated with drugs and drug 

trafficking.

72 This is known as the “balloon effect” and there are many examples of this 

phenomenon: “Peru and Bolivia to Colombia in the 1990s, the Netherlands Antilles to West 

Africa in the early 2000s, and Colombia and Mexico to El Salvador, Honduras, and Guatemala in 

the 2000s and 2010s.”73 In a span of ten years, the United States spent $8 billion to assist 

Colombia in its drug war and ongoing conflict with the Revolutionary Armed Forces of 

Colombia, only to see drug-traffickers establish new routes in Ecuador and Venezuela.74 On a 

congressional delegation trip to Honduras, Committee Members and staff were briefed on how 

the government is addressing the flow of drugs to the United States.75 Given Honduras’ limited 

resources to effectively curtail the flow of drugs, the government is focused on trying to divert

the flow from its shores, rather than stop the flow altogether.

76

III. AMERICA’S OPIOID EPIDEMIC 

Today, opioid abuse represents America’s newest public health crisis. Prescription pain 

medication, heroin, and fentanyl are all “opioids” that share similar characteristics, attach to the

same receptors, and produce similar effects on the human brain. Thus, those who become 

addicted to prescription drugs often satisfy their addiction by turning to heroin or fentanyl, which

today are more readily available and offered at lower prices.

According to the National Institute on Drug Abuse (NIDA), current research “suggests 

that abuse of [prescription opioid pain medications] may open the door to heroin abuse.”77 

NIDA further notes that “nearly half of young people who inject heroin surveyed in three recent

 

71 For example, the Tohono O’odham Nation is located at the Southern border of Arizona. The nation is affected by 

significant drug trafficking and migration activity. According to the Department of Homeland Security and Tonoho 

O’odham Police Department, the Nation bears considerable costs associated with border crossings, including both 

financial costs for death investigations and removing abandoned property on the remote land as well as threats to 

public safety. Observations during staffdel to the Tohono O’odham Nation (July 2016) (Notes on file with the 

Committee).

72 United Nations Office of Drugs and Crime, World Drug Report 2012, available at 

https://www.unodc.org/documents/data-and-analysis/WDR2012/WDR_2012_web_small.pdf.

73 German Lopez, America Can End Its War on Drugs. Here’s How., VOX (Apr. 25, 2016), 

http://www.vox.com/2016/4/25/11445454/end-war-on-drugs.

74 Id. 

75 Observations during Johnson-Carper CODEL to Central America (Oct. 2015) (Notes on file with the Committee).

76 Id. 

77 DrugFacts: Heroin, National Institute on Drug Abuse (Oct. 2014), 

http://www.drugabuse.gov/publications/drugfacts/heroin. 
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studies reported abusing prescription opioids before starting to use heroin.”78 In testimony 

before the Committee, ONDCP Director Michael Botticelli testified that “four out of five newer 

users to heroin started by misusing prescription pain medication.”79

NIDA found that individuals “reported taking up heroin because it is cheaper and easier 

to obtain than prescription drugs.”80 For example, the DEA reports than in Nashville, Tennessee, 

where prescription opioid abusers are beginning to use heroin, a dosage unit of prescription 

opioids on the black market costs $30 to $80 as compared to $10 to $15 for a dosage unit of

heroin.81 

a. Prescription Opioids

Prescription opioids are Schedule II controlled 

substances,

82 commonly referred to as “prescription 

painkillers,” and include drugs such as hydrocodone 

(Vicodin), oxycodone (OxyContin), and fentanyl 

(Duragesic).83 Taken as prescribed, opioids can responsibly 

be used to manage pain safely and effectively.84 

Prescription opioids entered the U.S. market in the 

late 1990s and immediately took off. OxyContin sales have 

gone from $45 million in 1996 to $3.1 billion by 2010.85

In 1995, the American Pain Society (APS) introduced the “Pain as the 5th Vital Sign” 

(P5VS) campaign.86 According to the APS, pain management is a patient right and pain should 

 

78 Id.

79 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 

80 DrugFacts: Heroin, National Institute on Drug Abuse (Oct. 2014), 

http://www.drugabuse.gov/publications/drugfacts/heroin.

81 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 26 (on file with the Committee).

82 Commonly Abused Drugs Charts: Prescription Opioids, National Institute on Drug Abuse (last updated Mar. 

2016), available at http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#prescription-opioids. 

83 Prescription Drugs & Cold Medicines, National Institute on Drug Abuse (last updated Mar. 2015), available at

http://www.drugabuse.gov/drugs-abuse/prescription-drugs-cold-medicines. 

84 Prescription Drug Abuse: What Are the Possible Consequences of Opioid Use and Abuse?, National Institute on 

Drug Abuse (last updated Nov. 2014), available at http://www.drugabuse.gov/publications/prescription-drugsabuse-addiction/opioids/what-are-possible-consequences-opioid-use-abuse. 

85 Mike Mariani, How the American Opiate Epidemic Was Started by One Pharmaceutical Company, THE WEEK

(Mar. 4, 2015), available at http://theweek.com/articles/541564/how-american-opiate-epidemic-started-bypharmaceutical-company. 

86 Karen Lafleur, RN, Taking the Fifth (Vital Sign), THE MODERN MEDICINE NETWORK (July 1, 2004), 

http://www.modernmedicine.com/modern-medicine/content/taking-fifth-vital-sign. 

“[W]e all have to look at 

ourselves in the mirror and 

figure out when we became a 

culture that has to be pain free 

at all times.” – Carole Rendon, 

Acting U.S. Attorney, Northern 

District of Ohio, Examining the Impact 

of the Opioid Epidemic in Ohio: Hearing Before 

the S. Comm. on Homeland Security &

Governmental Affairs.
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13

be measured like blood pressure, heartbeat, and breathing.87 Because there was no device to 

objectively measure pain, pain would be measured on a “1-10” scale by the patient. In 1998, the 

Department of Veterans Affairs (VA) made the P5VS part of its national pain management 

strategy.

88

 In 2001, the Joint Commission on Accreditation of Health Care Organizations 

(JCAHO) issued new guidelines for patient pain management and reassured the public about the 

safety of opioids to treat pain.89 By 2013, more than 200 million prescriptions were written for 

prescription opioids.90

Today, NIDA reports that “[o]ver 2 million people in the United States suffer from 

substance use disorders related to prescription opioid pain relievers,” and that while the “causes 

are complex . . . they include overprescription of 

pain medications.”91 To address this problem, on 

April 7, 2016, Chairman Johnson, along with 

Senators Manchin, Barrasso, and Blumenthal,

introduced S. 2758, the Promoting Responsible 

Opioid Prescribing (PROP) Act to reduce the 

pressure doctors currently face that may lead to 

overprescribing.92 Specifically, the PROP Act 

prohibits pain management questions on patient 

surveys from being factored into Medicare 

reimbursement calculations.93 In July 2016, HHS 

recognized the importance of this proposal and 

proposed to remove pain management questions 

from hospital payment calculations. 

The tragic consequences of opioid abuse can be seen dramatically in Chairman Johnson’s 

investigation of the VA Medical Center in Tomah, Wisconsin (Tomah VAMC). In August 2014, 

U.S. Marine Corps veteran Jason Simcakoski passed away from “mixed drug toxicity” at the 

 

87 Leon Gussow, The Money and Influence Behind “Pain as the Fifth Vital Sign,” THE POISON REVIEW (Dec. 16, 

2012), http://www.thepoisonreview.com/2012/12/16/the-money-and-influence-behind-pain-as-a-fifth-vital-sign. 

88 U.S. Dep’t of Veterans Affairs, VHA Pain Management, available at 

http://www.va.gov/PAINMANAGEMENT/VHA_Pain_Management_Strategy.asp; see also Richard A. Mularski, 

Foy White-Chu, Devorah Overbay, Lois Miller, Steven M. Asch, & Linda Ganzini, Measuring Pain as the 5th Vital 

Sign Does Not Improve Quality of Pain Management, 21 U.S. National Library of Medicine, National Institutes of 

Health (Jan. 2006), at 607-612. 

89 Ronald Hirsch, MD, The Opioid Epidemic: It’s Time to Place Blame Where It Belongs, KevinMD.com (Apr. 6, 

2016), available at http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-itbelongs.html.

90 DrugFacts: Prescription and Over-the-Counter Medications, National Institute on Drug Abuse (last updated Dec. 

2014), available at http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications. 

91 Id. 

92 S.2578, PROP ACT of 2016, 114th Cong. (2015-2016).

93 Id. 

“Perhaps as far as what you 

could do for regulation of 

prescribers, [the PROP Act is] 

the single-most important piece 

of federal legislation reform 

that you could do.” – Timothy 

Westlake, M.D., Border Security and 

America’s Heroin Epidemic: The Impact of the 

Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing 

Before the S. Comm. on Homeland Security &

Governmental Affairs.
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facility.94 At the time of his death, Simcakoski had over a dozen different drugs in his system.95 

Beginning in January 2015, Chairman Johnson conducted a lengthy investigation into allegations 

of opioid over-prescription and drug diversion at the Tomah VAMC.96 The investigation showed 

that the facility had a reputation as a “big pill box” and was known in the community as “Candy 

Land.”97 A subsequent VA review found that the facility prescribed opioids at a higher rate than 

the national average.98 Because of Chairman Johnson’s investigation, the Tomah VAMC has 

changed its opioid prescription practices, decreasing the number of patients receiving opioids 

and benzodiazepines by 16 percent.99

Unfortunately, the VA Medical Center in Milwaukee, Wisconsin has also suffered 

problems. Last November, a veteran died of a heroin overdose at the facility. Chairman Johnson 

immediately pushed for attention to this issue, which was provided in August 2016 when the 

Secretary of Veterans Affairs personally traveled to Milwaukee to tour the facility with the 

Chairman. The investigation into the death of the veteran is ongoing. 

Finally, initial lawful and appropriate uses of prescription opioids can become illicit 

when the drugs are diverted or otherwise misused. This often occurs due to the highly addictive 

nature of opioids. To address the issue of diversion, in 2010, OxyContin was reformulated to 

make it more tamper-resistant and more difficult to abuse.100 In addition, state governments are 

working to reduce potential drug misuse. In Wisconsin, the Heroin Opiate Prevention and 

Education (HOPE) agenda—a package of 17 bills signed into law—among other things, 

encourages local communities to set up drug disposal programs so that unwanted prescription 

drugs do not fall into the wrong hands.101 

Greater awareness among prescribers and the public about the dangers of prescription 

opioid misuse and drug take-back initiatives have helped reduce prescription opioid diversion 

and abuse.102 According to Director Botticelli, positive testing for prescription pain medication 

 

94 Aaron Glanz, Opiates Handed Out Like Candy to ‘Doped-up’ Veterans at Wisconsin VA, REVEAL NEWS (Jan. 8, 

2015).

95 Id.

96 See S. Comm. on Homeland Security & Governmental Affairs, The Systemic Failures and Preventable Tragedies 

of the Tomah VA Medical Center (May 31, 2016).

97 Id.

98 Id.

99 Tomah VAMC: Examining Patient Care and Abuse of Authority: Hearing Before the S. Comm. on Homeland 

Security & Governmental Affairs, 114th Cong. (2016) (statement of Sloan D. Gibson, Deputy Secretary, Veterans 

Affairs).

100 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 27 (on file with the Committee).

101 HOPE Agenda: Legislation, Heroin, Opioid Prevention Education (HOPE) Agenda, available at

http://legis.wisconsin.gov/assembly/hope/legislation (last visited Apr. 7, 2015). 

102 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 27 (on file with the Committee).
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has actually decreased.103

b. Heroin 

Heroin is a Schedule I opioid drug produced 

from morphine, which is a naturally occurring 

substance extracted from the seed of the Asian opium 

poppy plant.104 It typically appears in one of three 

forms: white powder heroin, brown powder heroin, or 

black tar heroin.105 Heroin is generally consumed 

either by inhalation (snorting or smoking) or by 

injection.106

The effects of heroin use and dependency are serious and wide-ranging. According to 

NIDA, fatal overdose, spontaneous abortion, and infectious diseases are commonly associated 

with heroin abuse and chronic users can develop a number of health issues, including collapsed 

veins, infection of the heart lining and valves, abscesses, gastrointestinal issues, and liver or 

kidney disease.107 Chronic users are generally in poor health and thereby susceptible to a 

number of additional health problems.108 Heroin abuse during pregnancy can lead to neonatal 

abstinence syndrome (NAS) in which a baby is born physically addicted to heroin due to the 

mother’s use.109

Mexico is the primary supplier of heroin to the United States and opium poppy 

cultivation in Mexico has dramatically increased in recent years.110 The profitability of such 

production and trafficking is astounding: a kilogram of heroin that can be produced in Mexico 

for around $5,000 can be sold to dealers for as much as $80,000.111 According to General John 

F. Kelly, former Commander of U.S. Southern Command, “heroin often times provides greater 

return and less risk when compared to cocaine” as cartels are forced “to ship much larger 

 

103 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Hon. Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 

104 Heroin, National Institute on Drug Abuse (last updated Mar. 2015), http://www.drugabuse.gov/drugsabuse/heroin. 

105 Id.

106 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 24 (on file with the Committee).

107 DrugFacts: Heroin, National Institute on Drug Abuse (last updated Oct. 2014), 

http://www.drugabuse.gov/publications/drugfacts/heroin. 

108 Id. 

109 Id.

110 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 24 (on file with the Committee).

111 Todd C. Frankel, Cheap Fix: Heroin’s Resurgence – Pellets, Planes, and the New Frontier, WASH POST (Sept. 

24, 2015), available at http://www.washingtonpost.com/sf/national/2015/09/24/pellets-planes-and-the-new-frontier. 

“Heroin is no longer someone 

else’s problem. It’s our problem. 

It’s America’s problem. And 

Arizona is the front door.” 

–Arizona Governor Ducey,

America’s Heroin Epidemic at the Border: 

Local, State, and Federal Law Enforcement 

Efforts to Combat Illicit Narcotic Trafficking: 

Hearing Before the S. Comm. on Homeland 

Security & Governmental Affairs.
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volumes of cocaine to match the profits generated by heroin.”112

At the Committee’s field hearing in New Hampshire, the DEA witness testified that his 

agency has seen a 50 percent increase in poppy cultivation in Mexico, resulting in a 

corresponding increase in heroin production and trafficking.113 In just one year (from 2013 to 

2014), opium poppy cultivation in Mexico increased from 11,000 hectares with an estimated 

pure potential production of 26 metric tons to 17,000 hectares with a potential production of 42 

metric tons of pure heroin.114 This increase is attributed to reduced poppy eradication and 

Mexican organizations shifting their focus to heroin trafficking. The DEA estimates that poppy 

cultivation in Colombia remains limited.115

Historically, the heroin market in the United States has been divided along the 

Mississippi River: western markets used Mexican black tar or brown powder heroin and eastern 

markets used white powder heroin.116 The “largest, most 

lucrative heroin markets in the United States are the white 

powder markets in major eastern cities.”

117

 

Heroin is most commonly brought to the United 

States over land across the southwest border (via Mexican 

cartels) or transported by couriers through commercial 

airlines (via Columbian cartels). In the 2000s, Mexican 

production of heroin increased while Colombian production 

of heroin decreased.118 At the same time that Mexican 

heroin production increased, Mexican traffickers began 

transporting Colombian heroin on behalf of Colombian 

traffickers. For these reasons, over the last fifteen years the amount of heroin seized at the 

southwest border has increased exponentially—from 846 kilograms in 2009 to 2,196 kilograms 

in 2013.

119

 Today, 78 to 84 percent of heroin interdictions in the United States occur at the 

 

112 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement for the record of Gen. John F. Kelly, USMC (Ret.), Former Commander of 

the United States Southern Command (2012-2016)). 

113 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015) 

(statement of John Riley, Acting Deputy Administrator, Drug Enforcement Administration). 

114 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 51 (on file with the Committee).

115 Id.

116 Id. at vii.

117 Id. 

118 Id. at 15. 

119 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015) 

(statement of John Riley, Acting Deputy Administrator, Drug Enforcement Administration). 

“I’ve been with the DEA almost 

30 years, and I’ve got to tell you, 

I’ve never seen it this bad. – John 

Riley, Acting Deputy 

Administrator, Drug Enforcement 

Agency, All Hands on Deck: Working 

Together to End the Trafficking and Abuse 

of Prescription Opioids, Heroin, and 

Fentanyl: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs.
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southwest border, largely at lawful ports of entry.120

Wholesale quantities of pure heroin are typically smuggled into the United States and 

delivered to a “mill” location where they are broken down into smaller quantities and diluents or 

adulterants are added and repackaged for mid-level or retail sale, often by signature packaging or 

stamps as a marketing strategy by the distributor.

121

 Heroin is not produced in the United States, 

there are no known heroin processing labs in the United States, and there has never been a 

seizure of an opium-to-heroin laboratory in the United States.122

As a result of the ease by which drug trafficking organizations (DTOs) can move heroin 

and other illicit narcotics across the southwest border, heroin available in the United States today 

is higher in purity and lower in price.123 The DEA reports that in 1981, the retail level purity of 

heroin was 10 percent and by 1999 that had increased to 40 percent.124 According to the 

Wisconsin Attorney General, heroin has increased from a purity level of five percent in the state 

of Wisconsin, to ranges today between 20 and 80 percent.125 During this same time, the price of 

heroin has significantly dropped. In 1981, the average price per gram of pure heroin was $3,260 

 

120 Information provided by U.S. Customs & Border Protection (Apr. 2016) (Notes on file with the Committee). 

121 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 7 (on file with the Committee).

122 Id. at 5.

123 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Brad Schimel, Attorney General, Department of Justice, State of Wisconsin). 

124 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 1 (on file with the Committee).

125 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Brad Schimel, Attorney General, Department of Justice, State of Wisconsin).
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(in 2012 U.S. dollars) and by 2012 the price per gram had decreased to $465 (in 2012 U.S. 

dollars).126 In Wisconsin, the price of heroin averages from a high of $180 per gram to as little 

as $100 per gram.127 This can translate into $10 for one hit. 

Today, the falling price of heroin, the rising toxicity of the product, and the highly 

addictive nature of opioids that have been overprescribed to a generation of Americans has 

resulted in a public health crisis across this nation. Media reports state that there are currently 

914,000 heroin users in the United States, a 145 percent increase from 2007.128 In 2014, 10,574 

people across the nation died from a heroin overdose, up from 8,257 in 2013.129 According to a 

witness at the Committee’s field hearing in Wisconsin, in 2015 “Milwaukee County alone 

reported 109 heroin-related overdose deaths,” up from 31 in 2008.130 Chairman Johnson has had 

the opportunity to meet with a number of Wisconsinites who have been impacted by heroin 

addiction through various events in the state, including the field hearing he convened in 

Pewaukee, Wisconsin. The Chairman has also traveled with Attorney General Schimel to 

promote how CARA, legislation Chairman Johnson supported, will provide needed resources to 

Wisconsin in order to address this epidemic. 

c. Fentanyl 

Fentanyl is a Schedule II synthetic opiate similar to, but more powerful than, 

morphine.131 It is used to treat patients with severe pain.132 Like heroin and other opioids, 

fentanyl binds to receptors in the brain, driving up dopamine levels and producing a state of 

euphoria and relaxation.133 When prescribed by a physician to treat severe pain, fentanyl is 

generally administered via injection, patch, or lozenge. The type of fentanyl contributing to 

recent overdose deaths, however, is being produced in clandestine labs and mixed with—or 

 

126 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr.

2015), at 1 (on file with the Committee).

127 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of James Bohn, Executive Director, Wisconsin High Intensity Drug Trafficking Area 

(HIDTA) Program).

128 Did Painkiller Crackdown Cause Heroin Epidemic?, U.S. National Library of Medicine (Jan. 13, 2016), 

available at https://www.nlm.nih.gov/medlineplus/news/fullstory_156675.html. 

129 Centers for Disease Control and Prevention, Number and Age-Adjusted Rates of Drug-Poisoning Deaths 

Involving Opioid Analgesics and Heroin: United States, 2000-2014, available at

http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf.

130 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of James Bohn, Executive Director, Wisconsin High Intensity Drug Trafficking Area 

(HIDTA) Program).

131 Fentanyl, National Institute on Drug Abuse (last updated Dec. 2012), http://www.drugabuse.gov/drugsabuse/fentanyl. 

132 Id.

133 Id.
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passed off as—white powder heroin.134

The DEA estimates that fentanyl is 25 to 40 times more potent than heroin,135 which 

significantly increases the likelihood that even an experienced heroin user will overdose when 

switching to fentanyl for a “better” high or 

unknowingly using heroin that has been cut with 

fentanyl. According to the CDC, one gram of 

fentanyl can equal as much as 7,000 street doses 

of heroin.136 

Fentanyl is so potent that it can present a 

safety threat to law enforcement or others who 

come into contact with small amounts of it. In 

fact, at a recent Committee roundtable on 

international mail security, a representative from 

the DEA explained that canines are not trained to

identify fentanyl because just sniffing the 

contents of fentanyl on the outside of a package 

would kill the dog.137

In 2015, New Hampshire recorded 428 

overdose deaths, a record, with almost two-thirds 

involving fentanyl.138 Fentanyl has already been

responsible for 30 deaths in Milwaukee County, 

Wisconsin in the first three months of 2016,

139

and recently there were 12 overdose deaths in 

just 5 days attributed to either heroin or fentanyl in Cuyahoga County, Ohio.140

 

134 Id.

135 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 31 (on file with the Committee).

136 Centers for Disease Control and Prevention, Nonpharmaceutical Fentanyl-Related Deaths— Multiple States, 

April 2005-March 2007, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a1.htm.

137 Preventing Drug Trafficking Through International Mail: Roundtable Before the S. Comm on Homeland Security 

& Governmental Affairs, 114th Cong. (2016) (statement of Joseph P. Murphy, Chief, International Postal Policy 

Unit, Office of Specialized and Technical Agencies, Bureau of International Organization Affairs, U.S. Department 

of State). 

138 Casey McDermott, N.H. Medical Examiner: At Least 10 Drug Overdoses in 2016, 86 Cases Pending, NEW 

HAMPSHIRE PUBLIC RADIO (Mar. 15, 2016), http://nhpr.org/post/nh-medical-examiner-least-10-drug-overdoses2016-86-cases-pending.

139 Crocker Stephenson, Fentanyl-Related Deaths Spike to 30 in Milwaukee County in ’16, MILWAUKEE JOURNAL 

SENTINEL (Apr. 7, 2016), http://www.jsonline.com/news/health/fentanyl-related-deaths-spike-to-30-in-milwaukeecounty-in-16-b99701948z1-374873441.html. 

140 Preventing Drug Trafficking Through International Mail: Roundtable Before the S. Comm on Homeland Security 

& Governmental Affairs, 114th Cong. (2016) (statement of Joseph P. Murphy, Special Agent in Charge, Special 

Operations Division, Drug Enforcement Agency, U.S. Department of Justice).

“The number of overdose deaths has 

continued to increase, particularly with the 

introduction of fentanyl, which has proven 

to be incredibly deadly. According to the 

Cuyahoga County Medical Examiner, 

while there were only five overdose deaths 

in 2013 involving fentanyl, in 2014 that 

number rose to 37, and in 2015 to 91 . . . In 

2016, we have had 125 fatal overdoses 

from heroin and fentanyl in Cuyahoga 

County alone, and it is only April. We were 

overwhelmed by a death a day in the early 

part of the year. Then, in March, we 

started to see an average of two overdose 

deaths a day. The devastation is 

undeniable.” – Carole Rendon, Acting 

U.S. Attorney, Northern District of Ohio, 

Examining the Impact of the Opioid Epidemic in 

Ohio: Hearing Before the S. Comm. on Homeland 

Security & Governmental Affairs. 
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While pharmaceutical fentanyl is sometimes diverted for abuse, recent overdose deaths 

attributed to fentanyl are largely a result of clandestinely-produced fentanyl arriving from 

Mexico.141 According to the DEA, clandestinely-produced fentanyl is primarily produced in 

Mexican labs with analogues and precursors coming from China.142 The fentanyl produced in 

these Mexican labs is often mailed to the United States from China, smuggled into Mexico to be 

cut with heroin, and then trafficked back to the United States primarily in the same manner as 

heroin.143 Drug traffickers “are able to hide the [fentanyl] shipments on mislabeled manifests in 

order to circumvent law enforcement,” limiting the interdiction of these illegal precursors to 

approximately one to three percent of all commercial cargo containers.144 

The Committee has sent oversight letters to the U.S. Postal Service, the Department of 

Homeland Security, and the Department of State inquiring how each agency is working to 

prevent fentanyl from entering the country through foreign mail.145 In April 2016, the 

Committee held a roundtable with these agencies, as well as the DEA and the United Parcel 

Service, to examine drug trafficking through the mail.146 At the roundtable, the participating 

agencies emphasized the need for foreign postal operators to share more advanced and electronic 

information on mail shipments entering the United States, similar to the advanced and electronic 

customs data submitted by international packages imported by private carriers.147 According to 

CBP, this information is the key to more effective targeting of mail that may contain fentanyl 

and other drugs.148

Continued oversight will be necessary, as the supply of fentanyl shows no sign of 

declining. As an example, in late 2015, federal authorities arrested multiple individuals in 

“Operation Denial” following the fentanyl overdose death of a teenager in North Dakota. One of 

the individuals arrested claimed to buy $1.5 million worth of fentanyl citrate, delivered from 

 

141 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 41 (on file with the Committee).

142 Id.

143 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement for the record of Gen. John F. Kelly, USMC (Ret.), Former Commander of 

the United States Southern Command (2012-2016) (“Drug traffickers continue to coordinate illegal shipments of 

fentanyl and its precursors from China.”). 

144 Id. 

145 Letter from Chairman Ron Johnson and Ranking Member Tom Carper, Senate Committee on Homeland Security 

& Governmental Affairs to Megan J. Brennan, Postmaster General, U.S. Postal Service (March 25, 2016); Letter 

from Chairman Ron Johnson and Ranking Member Tom Carper, Senate Committee on Homeland Security & 

Governmental Affairs to Secretary Jeh Johnson, U.S. Department of Homeland Security (March 25, 2016); Letter 

from Chairman Ron Johnson and Ranking Member Tom Carper, Senate Committee on Homeland Security & 

Governmental Affairs to Secretary John Kerry, U.S. State Department (March 25, 2016).

146 Preventing Drug Trafficking Through International Mail: Roundtable Before the S. Comm on Homeland Security 

& Governmental Affairs, 114th Cong. (2016). 

147 Id. 

148 Id. (statement of Todd Owen, Executive Assistant Commissioner, Office of Operations, U.S. Customs & Border 

Protection, U.S. Department of Homeland Security). 
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China in FedEx packages, in one month alone.149

In addition to being combined with heroin, fentanyl may also be manufactured into a pill 

form and sold as another prescription opiate, such as OxyContin or hydrocodone.150 Individual 

drug dealers can order a pill press and fentanyl online and have it shipped directly to a U.S. 

address.151 American buyers take little risk in the delivery of the fentanyl, as the Chinese 

companies selling the fentanyl guarantee delivery and will resend the drugs if they are seized.152 

Like with fentanyl–laced heroin, users may not be aware the pills contain the much stronger 

fentanyl, making the drugs even more deadly. On April 1, 2016, the DEA released a public 

safety report about counterfeit hydrocodone tablets that contained fentanyl.153 Over 12 days, this 

batch of counterfeit pills resulted in 42 overdoses and 10 deaths.154

IV. ADDRESSING AMERICA’S INSATIABLE DEMAND FOR DRUGS

The Administration’s Fiscal Year (FY) 2017 budget requested $31 billion for federal 

drug programs, a 25 percent increase since President Obama took office.155 Funding for 

ONDCP, which provides funding for federal drug programs across the federal government, is 

divided into two categories: “demand reduction” for prevention and treatment, and “supply 

reduction” for global interdiction and law enforcement. In 2016, for the first time in ONDCP 

history, the funding request for demand reduction surpassed the funding request for supply 

reduction.156

When President Obama took office in 2009, 60 percent of ONDCP funding was allocated 

to supply reduction.157 For FY2017, 51 percent of funding is requested for demand reduction 

and 49 percent is requested for supply reduction.158 The 2017 budget request also reduces 

 

149 Dave Kolpack (Associated Press), Colombian National Linked to North Dakota Drug Overdoses, HERALDNET

(Sept. 14, 2015), http://www.heraldnet.com/article/20150914/NEWS03/150919455. 

150 Alex Zielinski, America’s Overdose Crisis Is Being Fueled by a Drug 50 Times More Potent than Heroin, THINK 

PROGRESS (Apr. 6, 2016), http://thinkprogress.org/health/2016/04/06/3766556/fentanyl-explainer. 

151 David Armstrong, ‘Truly Terrifying’: Chinese Suppliers Flood U.S. and Canada with Deadly Fentanyl, STAT 

(Apr. 5, 2015), https://www.statnews.com/2016/04/05/fentanyl-traced-to-china/.

152 Id.

153 Public Safety Alert from Drug Enforcement Administration, Counterfeit Hydrocodone Tablets Containing 

Fentanyl, Drug Enforcement Administration (Apr. 1, 2016), available at 

http://www.dea.gov/divisions/sf/2016/sf040116.shtml. 

154 Alex Zielinski, America’s Overdose Crisis Is Being Fueled by a Drug 50 Times More Potent than Heroin, Think 

Progress (Apr. 6, 2016), available at http://thinkprogress.org/health/2016/04/06/3766556/fentanyl-explainer.

155 Tim Dickinson, Why America Can’t Quit the Drug War, ROLLING STONE (May 5, 2016), 

http://www.rollingstone.com/politics/news/why-america-cant-quit-the-drug-war-20160505.

156 Id. 

157 Id. 

158 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 
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international drug funding by $952 million, downsizing the role of the State Department and 

Defense Department in drug eradication in countries like Mexico, Colombia, and Afghanistan.

159

 

This section considers funding priorities and approaches to prevention, treatment, and 

law enforcement, as well as alternative approaches to address drug addiction in this country. 

a. Prevention 

Prevention is perhaps the most 

important thing that can be done to address

drug demand. According to testimony 

before the Committee, if we can prevent the 

experimentation of drugs by youth between 

the ages of 11 and 22—the age in which 

brain functions are forming—there is a high 

likelihood that we can prevent them from 

using drugs for life.160 The United States has always had policies of prevention embedded into 

its national drug control strategy, with some approaches having more success than others. 

i. Just Say No 

In the early 1980s, a young student in Oakland, California asked former First Lady Nancy 

Reagan, “What should I do if somebody offers me drugs?” Mrs. Reagan answered, “Well, you 

just say no.”161 The phrase caught on, and Just Say No groups were formed throughout the 

country.162 Students participated in community service activities and took pledges to refrain 

from trying drugs.163 The campaign also featured a series of anti-drug media advertisements 

meant to educate youth on the dangers of drugs. One memorable television commercial featured 

an egg thrown into a hot frying pan and as the egg sizzled, the announcer intoned, “This is your 

 

159 Tim Dickinson, Why America Can’t Quit the Drug War, ROLLING STONE (May 5, 2016), 

http://www.rollingstone.com/politics/news/why-america-cant-quit-the-drug-war-20160505 (“On the supplyreduction side, there has been reorganization. International funding has been slashed from $2.5 billion in Obama’s 

first budget to $1.6 billion in the current request. These cuts have downsized the role of the State Department and 

the Department of Defense in combating the international drug trade—reducing funding for drug eradication and 

military equipment in countries like Afghanistan, Colombia and Mexico. The DEA’s international footprint, in 

contrast, has grown slightly and now accounts for about one-sixth of the agency’s $2.8 billion budget.”). 

160 Id. 

161 Just Say No 1982-1989, The Ronald Reagan Presidential Foundation & Library, available at 

https://www.reaganfoundation.org/ronald-reagan/nancy-reagan/her-causes/.

162 Id. 

163 Joe Monzingo, Sonali Kohli, & Zahira Torres, 'Just Say No' Anti-Drug Campaign Helped Define Nancy Reagan's 

Legacy, LA TIMES (Mar. 7, 2016), http://www.latimes.com/local/california/la-me-nancy-reagan-drugs-20160307-

story.html. 

“Prevention strikes at demand. It does 

not matter what the product is, if there 

are no buyers, the seller ultimately 

loses.” – Rob Brandt, Founder, Robby’s 

Voice, Examining the Impact of the Opioid Epidemic in 

Ohio: Hearing Before the S. Comm. on Homeland Security 

& Governmental Affairs. 
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brain on drugs, any questions?”164 At the height of the campaign, the Just Say No foundation 

had more than one million members in 12 countries.165

The Just Say No campaign was routinely criticized for its simplistic message,166 and 

many felt the drug problem required a more thorough approach to truly affect behavior. 167 The 

largest program operating at the time under the Just Say No campaign was the Drug Abuse 

Resistance Education (DARE) program.168 According to an article in Scientific American, 

researchers found that the students enrolled in the DARE program were just as likely to use 

drugs as students who were not enrolled in the program.169 Moreover, drug use among high 

school students was already declining before the campaign’s start. One study from 2015 showed

that marijuana use reached its height in 1979, with 51 percent of high school seniors reporting to 

have smoked, as compared to 40 percent by the early 1980s.170

In contrast, there were many positive developments attributed to this campaign. First, 

many people thought that Mrs. Reagan’s Just Say No campaign brought needed attention to an 

important issue. Ivy Cohen, president of the Just Say No Foundation for a decade, explained that

“[w]ithout Nancy Reagan there would not have been the public climate to support drug abuse 

prevention.”171 Dr. Herbert Kleber, director emeritus of the Columbia University Division on 

Substance Abuse, succinctly stated: “My experience is Just Say No wasn’t terribly effective, but 

it was better than not doing it.”172

ii. Office of Drug Control Policy Media Campaign

From 1998 to 2004, Congress appropriated more than $1.2 billion to ONDCP for an antidrug media campaign utilizing television, radio, and print.173

 The goals of the campaign were to 

“educate and enable America’s youth to reject illegal drugs; prevent youth from initiating the use 

 

164 Steve Smith, This Is Your Brain on Drugs: How Drug Public Service Announcements Have Changed over the 

Years, MEDICAL DAILY (Sept. 29, 2015), http://www.medicaldaily.com/your-brain-drugs-how-drug-public-serviceannouncements-have-changed-over-years-354734. 

165 Mark Stricherz, What Ever Happened to ‘Just Say No’?, THE ATLANTIC (Apr. 29 2014), 

http://www.theatlantic.com/politics/archive/2014/04/ghost-of-just-say-no/361322. 

166 Joe Monzingo, Sonali Kohli, & Zahira Torres, 'Just Say No' Anti-Drug Campaign Helped Define Nancy Reagan's 

Legacy, LA TIMES (Mar. 7, 2016), http://www.latimes.com/local/california/la-me-nancy-reagan-drugs-20160307-

story.html.

167 Carol Cone, What Cause Movements Can Learn from ‘Just Say No’, Campaign U.S. (Mar. 14, 2016), available at 

http://www.campaignlive.com/article/cause-movements-learn-just-say-no/1387202.

168 Id.

169 Id.

170 Jacob Sullum, The Darker Side of ‘Just Say No’, Reason.com (Mar. 14, 2016), available at 

http://reason.com/archives/2016/03/14/the-darker-side-of-just-say-no. 

171 Joe Monzingo et al., 'Just Say No' Anti-Drug Campaign Helped Define Nancy Reagan's Legacy, LA TIMES (Mar. 

7, 2016), http://www.latimes.com/local/california/la-me-nancy-reagan-drugs-20160307-story.html.

172 Id.

173 U.S. Gov’t Accountability Office, GAO-06-018, ONDCP Media Campaign: Contractor’s National Evaluation 

Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use (2006).
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of drugs, especially marijuana and inhalants; and convince occasional users of these and other 

drugs to stop using drugs.”174

In 1999, ONDCP entered into an inter-agency agreement with NIDA to begin a longterm analysis of the effects of the media campaign. The contract was awarded to Westat, Inc. 

and the evaluation period occurred from 1999 to 2004.175 Preliminary reports released in 2002

were unfavorable, and in 2004, Westat concluded that the media campaign was not effective in 

reducing youth drug use.176 GAO examined the study and found that the methods used by 

Westat were scientifically sound and recommended that Congress reduce ONDCP’s media 

campaign funding.177 When asked about this review at a Committee hearing, GAO testified that 

“in some groups when teenagers were exposed to the anti-drug message, they actually used drugs 

more frequently.”178 Congress eventually eliminated funding for the media campaign in 2012.

179

iii. The Truth Campaign

Truth began in 2000 and was funded by tobacco companies as part of a multi-state court 

settlement in 1998. The settlement set aside $1.5 billion to the Legacy Foundation for an antitobacco media campaign.180

 According to experts, any such public awareness effort would have 

to compete with the $13 billion the tobacco industry spent each year in marketing, and the 

exposure of the average 14-year-old to more than $20 billion worth of tobacco marketing from 

the age of six.181 To do so, the Truth campaign exploited the same research used to inform the 

advertising of the British-American Tobacco Company in the 1950s: meet the psychological 

needs of adolescents to take risks, rebel, fit in, remain independent, self-express, and be 

respected.182 The campaign sought to “out-brand” Big Tobacco and “un-sell” cigarettes.

Learning from the counterproductive tactics of past campaigns that sounded parental, the 

first Truth TV ad instead featured graphic and shocking images of teenagers dumping 1,200 

body bags outside a tobacco company’s headquarters, representing the annual smoking death 

 

174 Id.

175 Id.

176 Id.

177 Id.

178 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Diana C. Maurer, Director, 

Homeland Security and Justice, U.S. Government Accountability Office). 

179 Budget Hearing – National Drug Control Policy: Hearing Before the H. Comm. on Appropriations, Sub. Comm. 

on Financial Services and General Government, 112th Cong, (2012) (statement of R. Gil Kerlikowske, Director, 

National Drug Control Policy). 

180 Jeff Beer, How the Truth Campaign Plans to End Youth Smoking Once and For All, FAST COMPANY (Aug. 13, 

2015), http://www.fastcocreate.com/3049629/behind-the-brand/how-the-truth-campaign-plans-to-end-youthsmoking-once-and-for-all. 

181 Pete Favat & Bryan C. Price, The Truth Campaign and the War of Ideas, Combating Terrorism Center Sentinel 

(July 28, 2015), available at https://www.ctc.usma.edu/posts/the-truth-campaign-and-the-war-of-ideas. 

182 Id.
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toll. In a follow-on TV ad, 1,200 students wearing white numbered shirts stood outside a 

tobacco company’s headquarters and fell down “dead” simultaneously at a pre-determined time. 

In addition, print ads in skateboarding magazines encouraged guerilla marketing stunts that 

engaged youth in a grassroots campaign to expose the lies and manipulation of the tobacco 

industry in the days before social media.183 The campaign was an immediate success, according 

to a study featured in the American Journal of Public 

Health: in 2000, there were 300,000 fewer smokers due to 

this initiative.184

More recent studies have shown that Truth has 

lowered the teen smoking rate from 23 percent to 8 percent 

over the past 15 years.185 According to Robin Koval, CEO 

of the Legacy Foundation, the Truth campaign was 

rebranded in 2015 as the Truth Initiative.

186

 Despite the 

success of the Truth campaign, Koval stated the rebranding 

was necessary “in order to fight complacency.”187 Today, 

“the organization is trying to tap the social power of the 92 

percent of kids who don’t smoke cigarettes to get youth 

smoking down to zero.”188 The revamped program still 

features ads with the “Truth Attitude” but will also focus 

on information and content that can be shared on social 

media.189

iv. Prevention and Education Campaigns Today 

While GAO recommended limiting appropriations for ONDCP’s previous anti-drug 

media campaign because it found that the campaign was not successful, it cautioned that such a

finding “cannot be construed to mean that a media campaign that is configured differently from 

this one cannot work.”190 Doubling down at a Committee hearing, GAO noted the success of 

campaigns designed to reduce the use of tobacco or encourage the use of seat belts, noting these 

to be “generational changes that require people to rethink the way they fundamentally approach 

things” and that “there may be things we can learn from those efforts that we could apply to the 

 

183 Id.

184 Kim Krisberg, Anti-Smoking Campaign Lowers Youth Smoking Rates with "Truth" Funding Threatened, 

Medscape (2005), available at http://www.medscape.com/viewarticle/502009. 

185 Jeff Beer, How the Truth Campaign Plans to End Youth Smoking Once and For All, Fast Company (Aug. 13, 

2015), available at http://www.fastcocreate.com/3049629/behind-the-brand/how-the-truth-campaign-plans-to-endyouth-smoking-once-and-for-all.

186 Id.

187 Id. 

188 Id.

189 Id.

190 U.S. Gov’t Accountability Office, GAO-06-818, ONDCP Media Campaign: Contractor’s National Evaluation 

Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use (2006).

“Marijuana is sort of similar to 

alcohol and tobacco in that it is 

consumed by a lot of people....

The other bin, the heroin, 

cocaine, meth, is 1 percent of the 

country that is completely 

dominating the consumption, 

and hence the cross-border 

flows. It's hard to reach the 1 

percent with the media.” –

Jonathan P. Caulkins, Carnegie 

Mellon University, America’s 

Insatiable Demand for Drugs: Hearing 

Before the S. Comm. on Homeland Security 

& Governmental Affairs.
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drug problem in this country.”191 Today, various media campaigns educate children on the 

harms of drug use, as well as the link between prescription medications and heroin addiction. 

After the preliminary findings from Westat’s

evaluation, ONDCP launched a new initiative titled 

“Above the Influence” (ATI), which focused on the 

message that marijuana was inconsistent with a teen’s 

autonomy and the achievement of their goals.192 

Studies showed that the ATI message was more 

effective in reaching teens and influencing behavior.193 

In 2010, the ATI program expanded its focus to 

include other drugs. An article in Prevention Science

magazine in 2011 found that the “Above the Influence 

campaign is trending towards positive impacts on 

attitudes and behavior . . . .”

194 After congressional 

funding ceased, the non-profit organization, the Partnership for Drug-Free Kids, assumed control 

of the ATI initiative.195 The Partnership for Drug-Free Kids generates funding through donations 

from individuals, foundations, and corporations, as well as government grant programs.196 In 

2014, the organization had an $8.2 million operating budget and $88.4 million for contributed 

services, media time, and air space.197

Beyond media campaigns, through field hearings across the country, the Committee 

observed local advocates—oftentimes those directly affected by addiction—who have begun 

their own prevention and education campaigns. In Wisconsin, Tyler Lybert, who is in recovery 

after battling with addiction for 11 years, and his family, launched Your Choice-Live.

198 Your 

 

191 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Diana C. Maurer, Director, 

Homeland Security and Justice, U.S. Government Accountability Office). 

192 National Anti-Drug Campaign Succeeds in Lowering Marijuana Use, Study Suggests, The Ohio State University, 

available at http://researchnews.osu.edu/archive/aboveinfluence.htm (last visited Mar. 28, 2016). 

193 Id.

194 Michael D. Slater et al., Assessing Media Campaigns Linking Marijuana Non-Use with Autonomy and 

Aspirations: “Be Under Your Own Influence” and ONDCP’s “Above the Influence,” U.S. National Library of 

Medicine, National Institutes of Health (Mar. 2011), available at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042048. 

195 Josie Feliz, The Partnership at Drugfree.org to Lead above the Influence Campaign, Partnership for Drug-Free 

Kids (Jul.16, 2013), available at http://www.drugfree.org/newsroom/the-partnership-at-drugfree-org-to-lead-abovethe-influence-campaign. 

196 FAQ: Where Does the Partnership Receive Its Funding?, Partnership for Drug-Free Kids, available at 

http://www.drugfree.org/about/faq/#q3 (last visited Mar. 29, 2016).

197 2014 Annual Report, Partnership for Drug-Free Kids, available at http://www.drugfree.org/2014-annualreport/financials (last visited Mar. 29, 2016).

198 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016).

“The average age of first use in 

Wisconsin is 12 years old. Kids 

need to hear clear and consistent 

prevention messages from 6th grade 

until 12th grade.” – Tyler Lybert, 

Your Choice-Live, Border Security and 

America’s Heroin Epidemic: The Impact of the 

Trafficking and Abuse of Heroin and Prescription 

Opioids in Wisconsin: Hearing Before the S. 

Comm. on Homeland Security & Governmental 

Affairs.
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Choice-Live is a drug and alcohol awareness program with the mission of “reach[ing] our youth 

before the drugs do with the knowledge and skills to make the best choice, and the resolve to

remain substance free.”199 Tyler and his family travel across the state of Wisconsin, sharing 

Tyler’s struggles with addiction and emphasizing how his battle with addiction impacted the 

entire family. 

Similarly, Lauri Badura, whose son died of a heroin overdose in 2014, founded the 

Saving Others for Archie foundation.200 She testified at the Committee’s field hearing in 

Wisconsin that she not only travels across the state of 

Wisconsin sharing her story, but she also serves as a 

resource to those people who feel they have nowhere else 

to turn.201 “My commitment to all these people is 

unwavering,” she testified. “I talk to each and every 

person who calls me seeking help.”202 Similarly, in New 

Hampshire, Doug Griffin, whose daughter, Courtney 

Griffin, died of an overdose in 2014, testified about the 

“tremendous support community” in his state, including 

his family’s church, which holds a service once a month 

for addicts and their families.203 Mr. Griffin stated that he, 

like Ms. Badura, now serves as a resource for others: “I’ll 

take anybody’s call any hour of the day.”204 

Finally, in Ohio, Rob Brandt, who founded 

Robby’s Voice after his son died of a heroin overdose, testified during the Committee’s field

hearing in Cleveland about the importance of comprehensive education and prevention.

205

 

Specifically, Mr. Brandt advocated that prevention campaigns require science-based education 

from K-12 with different curriculum elements building off the student’s knowledge year after

year.

206

 He also spoke to the importance of parental education, law enforcement education, and 

increased training at all levels to assist in understanding addiction and the critical nature of lifesaving drugs like naloxone.

207

 Finally, Mr. Brandt called for an investment in communities to 

 

199 Your Choice, About Us, http://www.yourchoice-live.org/about_us (last visited Aug. 25, 2016). 

200 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Lauri Badura, mother of Archie Badura).

201 Id. 

202 Id. 

203 All Hands on Deck: Working Together to End the Trafficking and Abuse of Prescription Opioids, Heroin, and Fentanyl

Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2015) (statement of 

Doug Griffin, father of Courtney Griffin). 

204 Id. 

205 Examining the Impact of the Opioid Epidemic in Ohio: Hearing Before the S. Comm. on Homeland Security &

Governmental Affairs, 114th Cong. (2016) (statement of Rob Brandt, Founder, Robby’s Voice). 

206 Id. 

207 Id. 

“There’s a tremendous 

support community out 

there that doesn’t have 

licenses. They’re not 

clinicians; they’re people.” 

– Doug Griffin, father of 

Courtney Griffin, All Hands on 

Deck: Working Together to End the 

Trafficking and Abuse of Prescription 

Opioids, Heroin, and Fentanyl: Hearing 

Before the S. Comm. on Homeland 

Security & Governmental Affairs.
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promote sustained recovery and a cohesive state and local strategy with leadership from the 

federal government.208 

b. Treatment 

In FY2017, for the first time, the Administration 

requested more money to support drug treatment and 

prevention programs than to address supply-reduction 

efforts.209 At $31.1 billion, the FY2017 request 

represents a 70 percent increase in funding for drug 

treatment programs, with $1 billion over two years to 

expand access to treatment and recovery support 

services for opioid addiction.210 

Specifically, the Administration’s request will fund “$920 million to support cooperative 

agreements with States to expand access to treatment for opioid use disorders;” “$50 million to 

the National Health Service Corps to expand access to substance use disorder treatment 

providers;” and “$30 million to evaluate the effectiveness of treatment programs employing 

medication-assisted treatment and to improve treatment for patients with opioid use disorder.”211

According to witness testimony, not enough people receive the treatment they need to 

address their addiction.212 Specifically, only about one or two people out of ten who have an 

opioid use disorder receive treatment.213 Comparatively, while somewhere between 10 to 20 

percent of people with substance use disorders receive treatment, the treatment rate for 

diabetes—which is of a similar prevalence—is around 80 to 85 percent.214 According to 

SAMSHA, there are approximately half a million people who want treatment for their substance 

abuse disorders but cannot access it.215 Robert Budsock, the President and CEO of Integrity 

House, a nonprofit addiction treatment program in New Jersey, testified to the Committee that,

 

208 Id. 

209 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 

210 Id. 

211 Id. 

212 Id. (statement of Kana Enomoto, Principal Deputy Administrator, Substance Abuse and Mental Health Services 

Administration, U.S. Department of Health and Human Services). 

213 Id. 

214 Id. (statement of Michael P. Botticelli, Director, Office of National Drug Control Policy). 

215 Id. (statement of Kana Enomoto, Principal Deputy Administrator, Substance Abuse & Mental Health Services 

Administration, U.S. Department of Health & Human Services). 

“Individuals with substance use 

disorders are not bad people 

trying to get good; instead, they 

are sick people trying to get 

well.” – Emily Metz, Program 

Coordinator, Project DAWN, 

Examining the Impact of the Opioid Epidemic 

in Ohio: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs. 
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as of May 20, 2016, his organization had a waiting list of 150 individuals with an average wait 

time of 8 to 12 weeks.216

While access to treatment is important, the overall effectiveness of treatment also must be 

considered. Tyler Lybert, who currently is recovering from a substance use disorder, testified at 

the Committee’s field hearing in Wisconsin that he tried various treatment options for years, with 

no results.217 Other testimony suggests that success rates for treatment can be as low as one in 

ten or one in twenty.218 Even Mr. Budsock testified that “the chronic nature of the disease means 

that relapsing back to drug use is not only possible, but also likely, with symptom reoccurrence

rates similar to those for other well-characterized chronic medical-diseases.”219 

The government’s response to the low success rate of various treatment options discussed 

above is that “not all treatment is created equal.”220 For example, very few treatment programs 

have incorporated medication-assisted treatment into their programs, which shows higher rates of 

success.

221 Moreover, the Administration believes that more treatment facilities should provide 

evidence-based services and interventions.222 

Of course, treatment also differs for different addictions. For opioids, it is possible to 

maintain dependent users on a legally-supplied substitute opioid, such as methadone or 

buprenorphine, both of which work by binding to the same cell receptors as heroin to effectively 

wean an individual off of heroin by gradually reducing his or her craving.223 Naltrexone, which

prevents heroin from having an effect by altogether blocking opioid receptors, is another 

medication-assisted treatment for heroin.

224 Specifically, Vivitrol is a new form of injectable 

 

216 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement for the record of Robert Budsock, President and Chief Executive Officer, 

Integrity House, Inc.). 

217 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Tyler Lybert, Your Choice: Live)

218 See generally America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. 

Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2016).

219 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement of Robert Budsock, President and Chief Executive Officer, Integrity House, 

Inc.). 

220 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Kana Enomoto, Principal Deputy 

Administrator, Substance Abuse & Mental Health Services Administration, U.S. Department of Health & Human 

Services). 

221 Id. (statement of Michael P. Botticelli, Director, Office of National Drug Control Policy). 

222 Id. (statement of Kana Enomoto, Principal Deputy Administrator, Substance Abuse & Mental Health Services 

Administration, U.S. Department of Health & Human Services). 

223 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement of Jonathan P. Caulkins, Ph.D., Stever Professor of Operations Research & 

Public Policy, Heinz College, Carnegie Mellon University). 

224 DrugFacts: Heroin, National Institute on Drug Abuse (last updated Oct. 2014), 

http://www.drugabuse.gov/publications/drugfacts/heroin.
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naltrexone that blocks the effects of opioids, but the cost of Vivitrol can be quite expensive.225

Importantly, there is no known medication-assisted treatment option for other illicit drugs such 

as cocaine and meth.226 Any comprehensive strategy to address treatment must recognize and 

address this fact. 

Finally, naloxone (Narcan) is an opioid overdose reversal tool.227 While it should not be 

viewed as a solution to addiction, it has saved lives from fatal overdose. As law-enforcement 

officers and/or firefighters are typically those who respond first to an overdose emergency, many 

state and local agencies are beginning to train first responders in the administration of Narcan. 

For example, as part of the HOPE agenda, in April 2014, the state of Wisconsin passed a law that 

required emergency medical technicians (EMTs) and allowed first responders such as firefighters 

and police officers to carry and administer Narcan.228 Further, as a result of the Committee’s 

field hearing in Wisconsin, CBP recently announced its plan to include the Milwaukee port of 

entry (POE) as a CBP location piloting the use of Narcan by CBP officers.229

c. Law Enforcement 

While prevention and treatment are key legs to the stool, addressing supply-side policies

must not be forgotten. As outlined in the majority staff report, The State of America’s Border 

Security: 

Mexican [drug trafficking organizations] have become experts at evading the 

Border Patrol. According to General McCaffrey, former Director of the White 

House’s Office of National Drug Control Policy, the Border Patrol “seizes just 5-

10 percent of the illegal drugs smuggled across the border.” 

* * *

Between the POEs, smuggling groups use “an extensive system of scouts armed 

with radios, solar-powered radio repeaters, cellular phones, and weapons situated 

on high points along drug trafficking routes.” This type of structure provides 

 

225 See generally America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before 

the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. (2016).

226 See id. (statement of David Murray, Senior Fellow, Hudson Institute).

227 Drug Enforcement Administration, DEA-DCT-DIR-022-15, 2015 National Heroin Threat Assessment (Apr. 

2015), at 32 (on file with the Committee).

228 Press Release, Office of the Governor Scott Walker, Investing in Wisconsin’s Communities: Governor Scott 

Walker Signs H.O.P.E. Bills into Law (Apr. 7, 2014), available at http://www.wisgov.state.wi.us/newsroom/pressrelease/investing-wisconsins-communities-governor-scott-walker-signs-hope-bills-law. 

229 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Gil Kerlikowske, Commissioner, U.S. Customs & Border Protection, U.S. 

Department of Homeland Security). 
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smugglers with a high level of situational awareness of law enforcement presence 

on both sides of the border. 

At the POEs, cartels have begun smuggling drugs in smaller packages and using 

deep concealment to increase their likelihood of success. Officers at the Otay 

Mesa POE in the San Diego sector have 

found drugs hidden in batteries, gas tanks, 

jalapeno jars, and fire extinguishers. Media 

reports indicate cartels have concealed drugs 

in “frozen sharks, sprinkled on donuts, and 

crammed into cucumbers.”230

As noted, the increase in purity and decrease 

in price for a gram of heroin highlights the 

importance of enhancing supply interdiction. During 

one Committee hearing, the U.S. drug czar 

concurred, noting that a “comprehensive, 

multifaceted approach” that included prevention, 

treatment, supply reduction, international efforts, and 

domestic law enforcement, would be needed in order 

to tackle this problem.

231

 

As to domestic law enforcement, according to a witness at the Committee’s field hearing 

in Arizona, during the same time period that the state of Arizona’s population doubled, the 

prison population increased 1,196 percent.232 Arizona Governor Doug Ducey testified at this 

same hearing that 75 percent of inmates in Arizona’s prison system have a substance abuse 

problem.233 

Today, treatment programs exist in prisons to rehabilitate those with substance use

disorders. For example, the Residential Drug Abuse Treatment Program (RDAP) is a voluntary, 

500-hour treatment program for federal prisoners with substance use disorders.234 To incentivize 

 

230 S. Comm. on Homeland Security & Governmental Affairs, The State of America’s Border Security (Nov. 23, 

2015), available at https://www.hsgac.senate.gov/media/majority-media/icymi-johnson-releases-border-report

(internal citations omitted).

231 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Hon. Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 

232 America’s Heroin Epidemic at the Border: Local, State, and Federal Law Enforcement Efforts to Combat Illicit 

Narcotic Trafficking: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. 

(2015) (statement of Jeff Taylor, Member, Public Advisory Board/Public Policy, The Salvation Army). 

233 Id. (statement of Douglas A. Ducey, Governor, State of Arizona) 

234 U.S. Dep’t of Justice, Federal Bureau of Prisons, Psychology Treatment Programs (Mar. 16, 2009), available at 

https://www.bop.gov/policy/progstat/5330_011.pdf; see also Oversight of the Bureau of Prisons: First-Hand 

“I would say particularly in terms of 

heroin interdiction that we have a lot 

more work to do. Part of the reason 

that we are seeing such a dramatic 

increase in heroin is around the 

dramatic increase in availability and 

lower price in many parts of the 

United States.” – Michael Botticelli, 

Director, Office of National Drug 

Control Policy, America’s Insatiable Demand 

for Drugs: Assessing the Federal Response: Hearing 

Before the S. Comm. on Homeland Security &

Governmental Affairs.
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inmate participation, federal law allows the Bureau of Prisons (BOP) to reduce the sentences of 

the graduates of the program for those convicted of “nonviolent” offenses by up to one year.

235

 

According to the BOP, “[t]hose who complete [RDAP] are 16 percent less likely to recidivate, 

and 15 percent less likely to have a relapse in their substance use disorder use within 3 years 

after release.”

236

 

Nevertheless, according to a Committee witness 

who served several prison sentences for his drug 

addiction, “[d]rug treatment in a prison environment is 

not nearly as effective as drug treatment out of the prison 

environment.”237 Instead, the witness promoted the 

program that he credits for saving his life, the Salvation 

Army Drug Treatment Facility, which allows inmates to 

be released 90 days prior to the termination of their 

sentence and places the individual “in a highly monitored 

drug treatment program.”238 

According to the Arizona Department of 

Corrections, of the nearly 20,000 inmates that will be 

released this year, 77 percent are in need of substance 

abuse treatment.239 Programs such as the Offender 

Reentry Program provide screening, assessment, 

comprehensive treatment, and recovery support services 

to offenders reentering the community.240 

d. Alternative Approaches

While prevention, treatment, and law enforcement are all important elements to 

addressing the drug epidemic in this country, the Committee also examined alternative 

approaches being deployed in other areas. 

 

Accounts of Challenges Facing the Federal Prison System: Hearing Before the S. Comm. on Homeland Security &

Governmental Affairs, 114th Cong. (2015) (statement of Udi Ofer, Executive Director, ACLU of New Jersey). 

235 See id. 

236 Id. (statement of Charles Samuels, Jr., Director, Federal Bureau of Prisons, U.S. Department of Justice). 

237 America’s Heroin Epidemic at the Border: Local, State, and Federal Law Enforcement Efforts to Combat Illicit 

Narcotic Trafficking: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 114th Cong. 

(2015) (statement of Jeff Taylor, Member, Public Advisory Board/Public Policy, The Salvation Army). 

238 Id. 

239 Id. 

240 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Kana Enomoto, Principal Deputy 

Administrator, Substance Abuse & Mental Health Services Administration, U.S. Department of Health & Human 

Services). 

“We cannot incarcerate our way out 

of drug addiction. People are 

released with the same drug 

problem they were arrested with

....While incarcerated I learned how 

to manufacture crystal 

methamphetamine, a lot about 

identity theft, how to import and 

transport drugs, avoid canine 

detection, and was introduced to 

several high ranking drug cartel 

members. All while on a prison 

yard.” –Jeff Taylor, The Salvation 

Army, America’s Heroin Epidemic at the 

Border: Local, State, and Federal Law 

Enforcement Efforts to Combat Illicit Narcotic 

Trafficking: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs.
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i. Decriminalization 

Decriminalization of drugs is not legalization; drugs remain illegal but possession and use 

are punishable by a ticket or fine rather than criminal prosecution and the possibility of jail

time.

241 The best example of a decriminalization framework and its outcomes is in the country 

of Portugal.242 

A 50-year dictatorship in Portugal ended in the 1970s and with the new-found freedom,

people began to experiment with drugs.243 In less than 20 years, the country was suffering from 

a severe heroin epidemic, with addicts numbering nearly one percent of the total population and 

HIV and hepatitis infections steadily climbing.244 In response to the crisis, the government 

assembled a team of experts, including social 

workers, medical doctors, psychiatrists, and 

judges.245 By 1998, the team developed a plan 

to decriminalize all drug use and focus on 

treatment and rehabilitation of addicts as 

opposed to punishment.246

The Portuguese Ministry of Health’s 

program, instituted in 2001, differs from others

as it operates with no assistance from the 

criminal justice system.247 Although drugs are 

still illegal in Portugal, a greater emphasis is 

placed on rehabilitation.

248

 If the weight of 

confiscated drugs meets a certain threshold, the 

individual in question can be charged with 

“drug trafficking.”249 However, if the quantity is lower than the pre-determined amount, the 

person is referred to the public health system where he or she reports to one of 18 commissions 

consisting of a panel of experts including a doctor, social worker, and teams “charged with 

developing an appropriate rehabilitative approach based on treatment.”250

 

241 Dr. Carl Hart, Congress Needs to Decriminalize All Drugs, Dr.CarlHart.com, 

http://www.drcarlhart.com/congress-needs-decriminalize-all-drugs (last visited June 6, 2016).

242 Id.

243 Lecia Bushak, Portugal’s Drug Experiment: Tackling Heroin Addiction by Decriminalizing Drugs and Focusing 

on Health, MEDICAL DAILY (Apr. 21, 2016), http://www.medicaldaily.com/portugal-drug-experiment-heroindecriminalizing-drugs-382598. 

244 Id.

245 Id.

246 Id.

247 Id.

248 Id.

249 Id.

250 Id.

“Efforts at controlling the illicit 

drug trade in the U.S. have by 

many accounts failed to produce 

measurable positive change, but we 

continue the same failed policies, 

hoping for a different result.” – Dr. 

Cheryl Healton, Dean, College of 

Global Public Health, New York 

University, America’s Insatiable Demand for 

Drugs: Hearing Before the S. Comm. on Homeland 

Security & Governmental Affairs. 
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In 2009, the Cato Institute published a report concluding that “[i]n certain key 

demographic segments, drug usage [in Portugal] has decreased in absolute terms in the 

decriminalization framework, even as usage across the [European Union] continues to increase, 

including in those states that continue to take the hardest line in criminalizing drug possession 

and usage.”251 Moreover, the Drug Policy Alliance suggests that since decriminalization in 

Portugal, people arrested and incarcerated for drug use dropped by 60 percent, drug-induced 

deaths decreased from 80 in 2001 to just 16 in 2012, and new HIV cases declined from 1,575 

new cases in 2000 to 78 new cases in 2013.

252

However, Brendan Hughes, principal scientific analyst at the European Monitoring 

Centre for Drugs and Drug Addiction, stated in a recent media report, “[i]t’s difficult to say 

scientifically that the Portuguese system is wonderful and others are terrible.”253 Hughes 

explained that while more Portuguese heroin users are in treatment today, that is the case in all of 

Europe.254 Moreover, while the HIV rate has 

dropped in Portugal, it has also dropped in other 

countries.255 Similarly, deaths are decreasing in 

both Portugal and the European Union.256

According to the DEA, prohibition 

discourages people from experimenting with drugs 

and enforcing our drug laws affects demand, price, 

purity, and availability—ultimately keeping prices 

high and hard drugs scarce.257 Moreover, the DEA 

points out that decriminalization blurs the lines 

between what is legal and illegal and removes 

incentives provided by the criminal justice system 

and drug courts to bring those with substance use 

disorders into treatment.

258 A witness emphasized this point at a Committee roundtable: “Not 

only are the incentives to remain ‘drug free’ weakened when drugs are readily and legally 

 

251 Glenn Greenwald, Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies, 

Cato Institute (2009), available at http://object.cato.org/sites/cato.org/files/pubs/pdf/greenwald_whitepaper.pdf.

252 Drug Decriminalization in Portugal: A Health-Centered Approach, Drug Policy Alliance (Feb. 2015), 

https://www.drugpolicy.org/sites/default/files/DPA_Fact_Sheet_Portugal_Decriminalization_Feb2015.pdf. 

253 Lecia Bushak, Portugal’s Drug Experiment: Tackling Heroin Addiction by Decriminalizing Drugs and Focusing 

on Health, MEDICAL DAILY (Apr. 21, 2016), http://www.medicaldaily.com/portugal-drug-experiment-heroindecriminalizing-drugs-382598.

254 Id. 

255 Id. 

256 Id. 

257 Drug Enforcement Administration, Speaking Out Against Drug Legalization, (2010)

https://www.dea.gov/pr/multimedia-library/publications/speaking_out.pdf.

258 Id.

“Every person with a substance abuse 

problem that I have talked to has said 

arrest was never a deterrent. The

physical and psychological need for the 

substance was far stronger than any 

seemingly rational deterrent that the 

police posed.” – Chief Frederick Ryan, 

Chief of Policy, Arlington, Massachusetts, 

America’s Insatiable Demand For Drugs: Examining 

Alternative Approaches: Roundtable Before the S. 

Comm. on Homeland Security & Governmental Affairs.
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available, but decriminalization commonly leads to the removal of a law enforcement/judicial 

role in supporting treatment.”259 

However, while not endorsing decriminalization, Chief Frederick Ryan, Chief of Police 

in Arlington, Massachusetts, emphasized to the Committee that “a strategy that relies largely on 

law enforcement and arrest, especially aimed at low end users, only fuels the epidemic and 

complicates the chances of long term recovery for people suffering from substance use 

disorders.”260 Instead, he advocated for strategies such as the Police Assisted Addiction 

Recovery Initiative (PAARI), in which officers who come into contact with someone using illicit 

drugs assists that person to enter treatment and recovery rather than arrest them.261 

ii. Legalization 

Although marijuana is still considered a Schedule I drug and is illegal under federal law, 

25 states and the District of Columbia have legalized it in some manner and 20 more states are 

considering legislation to legalize marijuana this year.262 The states of Alaska, Colorado, 

Oregon, Washington, and the District of Columbia have gone a step further, legalizing marijuana 

for recreational use. Adults in Alaska can possess up to one ounce and have six plants. In 

Oregon, residents are allowed to keep eight ounces in their homes and carry up to one ounce on 

their person.263 Similar amounts are legal in Colorado and Washington.264

As more states have legalized marijuana, the drug’s potency has also increased.265 

According to witness testimony, in 1980 the tetrahydrocannabinol (THC)—the main mindaltering ingredient found in marijuana—level in marijuana stood at three percent and increased 

steadily each year by about one percent.266 However, since the legalization of marijuana in 

Colorado, THC levels have reached 70 to 80 percent.267 While one witness asserted this high 

 

259 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. 

on Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of David Murray, Senior Fellow, 

Hudson Institute).

260 Id. (statement of Frederick Ryan, Chief of Police, Arlington, Massachusetts). 

261 Id. 

262 Here’s a Map of Every State and Their Marijuana Laws, YAHOO NEWS (Feb. 1, 2016), 

https://www.yahoo.com/news/heres-map-every-state-marijuana-224000007.html?ref=gs; Governing Data: State 

Marijuana Laws Map, Governing.com, http://www.governing.com/gov-data/state-marijuana-laws-map-medicalrecreational.html (last visited June 6, 2016); Curtis Silver, Marijuana’s $40 Billion Dollar Green Rush, FORBES

(June 2, 2016), http://www.forbes.com/sites/curtissilver/2016/06/02/marijuanas-40-billion-dollar-greenrush/#41c4d1853097. 

263 Id. 

264 Id.

265 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. 

on Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of David Murray, Senior Fellow, 

Hudson Institute); Id. (statement of Ethan Nadelmann, Executive Director, Drug Policy Alliance). 

266 Id. (statement of David Murray, Senior Fellow, Hudson Institute).

267 Id. 
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THC level can increase the risk of dependency and addiction,268 another witness countered that 

high potency marijuana does not provide a higher high but instead means the user will smoke 

less.269 

Marijuana Legalization Status270

Medical marijuana legalized

Marijuana legalized for recreational use

No laws legalizing marijuana

Moreover, while some analysts estimate that taxes generated on nationwide legal 

marijuana sales would be approximately $3 billion per year,271 David Mineta, the former Deputy 

Director for Demand Reduction at ONDCP, argues that any tax revenue generated from drugs 

would not begin to cover the societal costs, such as health care and lost productivity.272 For 

example, Mineta reports that in 2002, federal taxes collected on alcohol were $8.3 billion but the 

cost of alcohol related problems to the U.S. economy was $184 billion.273 Similarly, tobacco 

taxes were an estimated $25 billion but the annual cost to society exceeded $200 billion.274

 

268 Id. 

269 Id. (statement of Ethan Nadelmann, Executive Director, Drug Policy Alliance). 

270 Governing Data: State Marijuana Laws Map, Governing.com, http://www.governing.com/gov-data/statemarijuana-laws-map-medical-recreational.html (last visited June 6, 2016).

271 Austin Smith, 4 Marijuana Stats That Will Blow You Away, USA TODAY (May 19, 2016), available at 

http://www.usatoday.com/story/sponsor-story/motley-fool/2016/05/17/motley-fool-marijuana-stats/84326712. 

272 David Mineta, Decriminalization Would Increase the Use and the Economic and Social Costs of Drugs, 

AMERICAS QUARTERLY, available at http://www.americasquarterly.org/node/1915 (last visited June 6, 2016).

273 Id. 

274 Id.
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Supporters of legalization also argue that marijuana legalization shifts policing resources 

toward more serious crimes as it eliminates the black market for marijuana.275 Specifically, in 

2015, arrests for marijuana possession dropped 98 percent in Washington and 95 percent in 

Colorado.276 Nonetheless, according to Mark Vasquez, the Chief of Police of Erie, Colorado, 

“The black market is alive and well and will continue to thrive in Colorado” as prices on the 

black market continue to compete against higher prices in the “medical market.”277

Legalization of all drugs is perhaps the most controversial proposal to address the drug 

problem in the United States.278 Steve Rolles, a senior policy analyst at the Transform Drug 

Policy Foundation, suggests full legalization could be achieved by legalizing and then regulating 

different drugs based on their various danger levels:279 

 Medically supervised venues: Drugs in this category (heroin) would only be allowed 

with a prescription and direct supervision of trained expert (doctor in controlled 

facility).

 Pharmacies: Drugs in this tier (MDMA, powder cocaine, or amphetamines) would 

only be dispensed through pharmacies with a prescription or over the counter. 

 Licensed sales: Drugs in this classification (marijuana and stimulant-based drinks) 

would be dispensed by licensed, regulated vendors. 

 Licensed premises: These regulated establishments would dispense drugs, such as 

smoked opium, psychedelics, or poppy tea, much like alcohol is sold in bars today.

 Unlicensed sales: Drugs in this category, such as coca tea, would be available similar 

to caffeine.280

Rolles makes a case for full legalization by offering two arguments. First, legalization 

would eliminate black market drug sales that fuel violence around the world.281 Second, drug use 

could conceivably become safer as the drugs and the drug use locations (supervised injection 

facilities) are strictly regulated by the government.282 He explains that drug legalization will not 

solve all drug-related issues but could improve them: “Legalization and regulation does not get 

rid of the drug problem. It doesn’t necessarily deal with addiction. It doesn’t stop people dying 

from drugs. But it may reduce harms; it may reduce deaths. It just won’t eliminate them.”

283

 

275 Tom James, The Failed Promise of Legal Pot, THE ATLANTIC (May 9, 2016), available at

http://www.theatlantic.com/politics/archive/2016/05/legal-pot-and-the-black-market/481506/?utm_source=yahoo. 

276 Id. 

277 Id. 

278 German Lopez, America Can End Its War on Drugs. Here’s How, VOX (Apr. 25, 2016), 

http://www.vox.com/2016/4/25/11445454/end-war-on-drugs. 

279 Id.

280 Id.

281 Id.

282 Id.

283 Id.
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However, studies show that keeping drugs illegal has been instrumental in keeping 

“hard” drug prices high. In his testimony to the Committee, Jonathan Caulkins explained that 

“[w]ithin a regime that prohibits legal supply, the most effective way to reduce imports is 

through enforcement. Prohibition backed by a baseline level of enforcement drives up the prices 

of illegal drugs far, far beyond what they would be if drugs were legal... Cocaine, heroin, meth 

all cost [the] user many times their weight in gold.”284 Moreover, the idea that legalization 

would eliminate the “black market” is contested by Dr. David Murray who asserted in a recent 

Committee roundtable, “Colorado has now become a national as well as international center for 

drug smuggling.”

285

iii. Supervised Injection Facilities

A Supervised Injection Facility (SIF), also known as a drug consumption facility or safe 

injection site, is a place where people can legally use illicit drugs under medical supervision.286

Today, there are approximately 100 supervised injection facilities across 66 cities and nine 

countries (Switzerland, the Netherlands, Germany, Spain, Norway, Luxembourg, Denmark, 

Australia, and Canada).287 

In 2003, the first SIF opened in North America.288 Located in Vancouver, Canada, the 

Insite clinic hosts 600 to 900 users per day to inject heroin, cocaine, or methamphetamine.289 

Clients are checked in by nurses, given sterile supplies, and are allowed to inject their drugs 

under the careful supervision of medical staff.290 Recently, Health Canada gave the Insite clinic 

a four-year exemption from drug laws.291 Thomas Kerr, director of Urban Health Research 

Initiative at the British Columbia Centre for Excellence in HIV/AIDS, co-authored a study 

showing that overdose deaths in the area near Insite dropped 35 percent within two years of the 

clinic opening.292 Kerr also noted more than 30 peer-reviewed studies that concluded that Insite

 

284 America’s Insatiable Demand for Drugs: Hearing Before the S. Comm. on Homeland Security & Governmental 

Affairs, 114th Cong. (2016) (statement of Jonathan P. Caulkins, Ph.D., Stever Professor of Operations Research & 

Public Policy, Heinz College, Carnegie Mellon University).

285 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. 

on Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of David Murray, Senior Fellow, 

Hudson Institute).

286 Supervised Injection Facilities, Drug Policy Alliance, http://www.drugpolicy.org/supervised-injection-facilities. 

287 Id.

288 Id. 

289 Douglas Quan, Vancouver’s Supervised Injection Site, The First in North America, Opened 13 Years Ago. What’s 

Changed?, THE NATIONAL POST OF CANADA (Mar. 20, 2016), 

http://news.nationalpost.com/news/canada/vancouvers-safe-injection-site-the-first-in-north-america-opened-13-

years-ago-whats-changed.

290 Id.

291 Id.

292 Kerr T. et al, Reduction in Overdose Mortality after the Opening of North America’s First Medically Supervised 

Safe Injecting Facility: A Retrospective Population Based Study, THE LANCET (Apr. 18, 2011),

http://www.communityinsite.ca/injfacility.pdf. 
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reduces the spread of disease and health care costs, provides access to addiction treatment 

programs, and prevents overdose deaths.293 

Currently, there are no SIFs in the United States, but pilot programs are being considered 

in a few cities.

294 According to the Drug Policy Alliance, the benefits of SIFs include counseling, 

sterile equipment, and access to medical care and information concerning the safety of drugs.295 

As MacDonald told the Committee, “[w]ithout our treatment, [addicts’] only option would be 

illicit opioids through the narco-capitalist networks.”

296

Those opposed to SIFs say that the government should not be facilitating drug use and 

these sites do nothing to help addicts end the addiction cycle or deter drug use.297 In response to 

a plan to open a clinic in Toronto, the Toronto Police Association argued “[w]e would rather see 

money being spent in getting people off drugs and getting them away from drugs, and drug 

treatment rather than these injection sites.”298 John Walter, former Director of ONDCP, likewise 

argues:

There are no “safe heroin injection sites.” The only “safe” approach to heroin is 

not to take it. For addicts, the humane public health response is to help them get 

and stay sober, or at the very least, opioid replacement therapy in sustained 

treatment. Any approach without these goals is cruel and dehumanizing—not 

healing, but perpetuating harm.

299

The North American Opiate Medication Initiative (NAOMI) was the first clinical trial of 

prescription heroin in North America.300 The study took place in Vancouver and Montreal.301 

From 2005 to 2008, researchers tested the effects of diacetylmorphine, the active ingredient in 

 

293 Dr. Thomas Kerr & Dr. Julio Montaner, An Overview of Insite – 10 Years Later, Vancouver Coastal Health (July 

23, 2013), available at http://supervisedinjection.vch.ca/media-centre/an-overview-of-insite---10-years-later.

294 Lisa W. Foderaro, Ithaca’s Anti-Heroin Plan: Open a Site to Shoot Heroin, THE NEW YORK TIMES (Mar. 22, 

2016), http://www.nytimes.com/2016/03/23/nyregion/fighting-heroin-ithaca-looks-to-injection-centers.html?_r=0.

295 Supervised Injection Facilities, Drug Policy Alliance, http://www.drugpolicy.org/supervised-injection-facilities 

(last visited June 6, 2016).

296 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. 

on Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Scott MacDonald, Lead 

Physician, Providence Crosstown Clinic, Vancouver, British Columbia) (sic).

297 Wendy Stueck, The Arguments For and Against Vancouver’s Supervised Injection Site, THE GLOBE AND THE 

MAIL (May 11, 2011), http://www.theglobeandmail.com/news/british-columbia/the-arguments-for-and-againstvancouvers-supervised-injection-site/article596153.

298 Toronto Policy Publicly Opposed Supervised Injection Sites, NEWS 1130 (Mar. 14, 2016), 

http://www.news1130.com/2016/03/14/toronto-police-supervised-injection-sites/.

299 John P. Walters, Heroin Injection Sites Perpetuate Harm: Opposing View, USA TODAY (May 16, 2016), 

http://www.usatoday.com/story/opinion/2016/05/16/heroin-injection-sites-drug-control-editorialsdebates/84455286/. 

300 Result of North America’s First Heroin Study (NAOMI), Providence Health Care 

http://www.providenceresearch.ca/naomi-study.html (last visited June 7, 2016).

301 Id.
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heroin, and methadone on chronic heroin users who were not responsive to traditional 

treatments.302 The study concluded that subjects given injectable diacetylmorphine stayed in 

treatment and reduced their use of illegal drugs with greater frequency than those treated with 

methadone.303 During the NAOMI study, a small number of the participants were given 

hydromorphone (HDM), a legal pain medication, which was found to be as effective as 

diacetylmorphine.304 This finding was the basis for the Study to Assess Longer-term Opioid 

Medication Effectiveness (SALOME).305 In 2015, SALOME concluded that HDM was equally 

as effective as diacetylmorphine in treating severe opioid addiction.306 Since HDM is legal, it 

could be used as an alternative treatment for heroin addiction. 

V. CONCLUSION

There are no easy solutions to these complex problems. In the case of America’s current

drug epidemic, it is clear that the over-prescription of pain medications has led to an entire

generation of people who have become addicted to and dependent on opioids. While the United

States focused on access to prescription pain

medications, we failed to address the

underlying addiction of those relying on the

medications. Recognizing a business

opportunity, the Mexican cartels flooded the

market with heroin. The result has been

catastrophic. Those who thought they would

never turn to heroin began buying this

powerful drug, sometimes for as little at $10 a

hit. As the cartels competed for business by

offering higher and higher purity levels,

overdoses drastically increased, particularly

when the cartels began cutting heroin with

fentanyl. 

The good news, according to Director Botticelli, is that the reliance on prescription pain

medication has declined.307 Unfortunately, there are laws on the books today that continue to

encourage the over-prescription of pain medications. To eliminate this incentive, on April 7,

 

302 Id.

303 About SALOME, Providence Health Care, http://www.providencehealthcare.org/salome/about-us.html (last 

visited June 6, 2016). 

304 Id.

305 Id.

306 SALOME: Outcomes, Providence Health Care, http://www.providencehealthcare.org/salome/outcomes.html (last 

visited June 6, 2016).

307 America’s Insatiable Demand for Drugs: Assessing the Federal Response: Hearing Before the S. Comm. on 

Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of Michael P. Botticelli, Director, 

Office of National Drug Control Policy). 

“This problem knows no boundaries. All 

demographics of people are affected in 

one way or another, no matter their 

income, no matter their race, no matter 

whether they’re from an urban community 

or rural community.” – John Nygren, 

Wisconsin State Representative, District 

89, Border Security and America’s Heroin Epidemic: The 

Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. 

Comm. on Homeland Security & Governmental Affairs.
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2016, Chairman Johnson, along with Senators Manchin, Barrasso, and Blumenthal, introduced

the Promoting Responsible Opioid Prescribing (PROP) Act, prohibiting pain management

questions on patient surveys from being factored into Medicare reimbursement calculations. 

During the Committee’s field hearing in Wisconsin, Dr. Timothy Westlake, the Vice Chairman

of the State of Wisconsin Medical Examining

Board, testified that the PROP Act is “the

single-most important piece of legislation

reform that [policymakers] could do.”308 In

July 2016, HHS announced its plan to

implement the PROP Act.

To address the larger issue of

America’s insatiable demand for drugs—

whether cocaine use in the 1980s,

methamphetamine use in the 1990s, or heroin

and opioid use today—the United States must

rethink its current strategy. At this juncture, it

is far from clear whether the various

approaches discussed in this report do more

harm than good. However, what is clear is

that our current approach to the war on drugs

is not working. We have a responsibility to

examine the impact of alternative approaches,

no matter how controversial.

In 2014, each day an average of 129

Americans died of an overdose.

309 One of

those senseless losses was Lauri Badura’s son, Archie. During the Committee’s field hearing in

Wisconsin, Committee Members had the opportunity to meet with Ms. Badura and learn about

her son and his tragic death from a heroin overdose. In her testimony, Ms. Badura lamented the

lack of outrage and attention being paid to this killer: “for moms and dads like us, we’ve lost our

children to this opiate addiction and this epidemic. The lack of attention on this ridiculously

large number of deaths, 47,000 in a single year, we do not always understand . . . .”

310

 

308 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Timothy Westlake, Vice Chairman, State of Wisconsin Medical Examining Board, 

and Chairman, Controlled Substance Committee). 

309 Rudd et al., Increases in Drug and Opioid Overdose Deaths-United States, 2000-2014, MORBIDITY AND 

MORTALITY WEEKLY REPORT (Jan. 1, 2016), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm.

310 Border Security and America’s Heroin Epidemic: The Impact of the Trafficking and Abuse of Heroin and 

Prescription Opioids in Wisconsin: Hearing Before the S. Comm. on Homeland Security & Governmental Affairs, 

114th Cong. (2016) (statement of Lauri Badura, mother of Archie Badura).

“I came from a good family. I married 

a beautiful, kind, and talented wife. 

Had a successful career, participated 

in varied philanthropic works and had 

acquired many other ‘things’ as 

symbols of financial and personal 

achievements. By every measure this 

country accepts as a gauge for success,

I had it. Four years after leaving the 

[Wall Street] trading position I was 

living on the streets of Phoenix. I had 

lost everything to addiction. Drug 

addiction does not discriminate. It can 

happen to anyone.” –Jeff Taylor, The 

Salvation Army, America’s Heroin Epidemic at the 

Border: Local, State, and Federal Law Enforcement 

Efforts to Combat Illicit Narcotic Trafficking: Hearing 

Before the S. Comm. on Homeland Security & 

Governmental Affairs.
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It is vital that America as a whole shares the sense of urgency to resolve this public health

crisis that is taking the lives of countless Americans and threatening the security of this nation. 

Much more must be done to address America’s insatiable demand for drugs.
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APPENDIX A: TABLES AND STATISTICS 

Table 1: Federal Drug Control Spending by Agency (in Millions)

FY2015

Final

FY2016

Enacted

FY2017

Request

Department of Agriculture

U.S. Forest Service 12.4 12.3 17.9

Court Services and Offender Supervision Agency for the District of

Columbia

52.6 58.1 58.7

Department of Defense

Drug Interdiction and Counterdrug Activities/OPTEMPO 1,409.3 1,343.3 1,222.0

Defense Health Program 73.5 75.5 75.5

Total DoD 1,482.8 1,418.8 1,297.5

Department of Education

Office of Elementary and Secondary Education 50.2 50.1 50.1

Federal Judiciary 1,158.9 1,210.6 1,246.7

Department of Health and Human Services

Administration for Children and Families 18.6 18.5 60.0

Centers for Disease Control and Prevention 20.0 75.6 85.6

Centers for Medicare & Medicaid Services2 8,230.0 8,760.0 9,140.0

Health Resources and Services Administration 27.8 129.0 164.0

Indian Health Service 111.3 114.7 140.9

National Institute on Alcohol Abuse and Alcoholism 59.5 54.2 54.2

National Institute on Drug Abuse 1,015.7 1,050.6 1,050.6

Substance Abuse and Mental Health Services Administration3 2,460.4 2,512.2 2,986.0

Total Health and Human Services 11,943.3 12,714.7 13,681.3

Department of Homeland Security

Customs and Border Protection 2,423.0 2,664.9 2,655.7

Federal Emergency Management Agency 8.3 8.3 6.2

Federal Law Enforcement Training Center 46.8 44.1 43.6

Immigration and Customs Enforcement 467.9 485.8 527.0

United States Coast Guard 1,265.7 1,616.1 1,269.0

Total Homeland Security 4,211.5 4,819.1 4,501.6

Department of Housing and Urban Development

Community Planning and Development 463.5 486.9 589.1

Department of the Interior

Bureau of Indian Affairs 9.7 9.7 9.7

Bureau of Land Management 5.1 5.1 5.1

National Park Service

Total Interior

3.3

 18.1

3.3

 18.1

3.3

 18.1
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1Detail may not add due to rounding.

2The estimates for the CMS reflect Medicaid and Medicare benefit outlays for substance use disorder treatment; they do not reflect 

budget authority. The estimates were developed by the CMS Office of the Actuary.

3Includes budget authority and funding through evaluation set-aside authorized by Section 241 of the Public Health Service (PHS) Act.

4The FY 2016 funding level represents the FY 2016 President’s Budget request.

5VA Medical Care receives advance appropriations; FY 2016 funding was provided in the Consolidated Appropriations Act, 2014 

(Public Law No: 113-76).

FY2015

Final

FY2016

Enacted

FY2017

Request

Department of Justice

Assets Forfeiture Fund 284.1 238.7 243.1

Bureau of Prisons 3,491.0 3,672.4 3,491.8

Criminal Division 40.0 39.0 39.9

Drug Enforcement Administration 2,373.1 2,426.5 2,485.6

Organized Crime Drug Enforcement Task Force Program 507.2 512.0 522.1

Office of Justice Programs 260.9 280.2 275.6

U.S. Attorneys 76.8 72.6 75.9

U.S. Marshals Service 270.4 278.1 289.9

U.S. Marshals Service - Federal Prisoner Detention 498.0 510.0 505.5

Total Justice 7,801.7 8,029.6 7,929.4

Department of Labor

Employment and Training Administration 6.0 6.0 6.0

Office of National Drug Control Policy

High Intensity Drug Trafficking Areas 245.0 250.0 196.4

Other Federal Drug Control Programs 107.2 109.8 98.5

Salaries and Expenses 22.6 20.0 19.3

Total ONDCP 374.8 379.9 314.2

Department of State4

Bureau of International Narcotics and Law Enforcement Affairs 446.1 434.7 382.4

United States Agency for International Development 95.5 136.2 131.9

Total State 541.6 570.8 514.3

Department of Transportation

Federal Aviation Administration 30.7 31.5 31.6

National Highway Traffic Safety Administration 2.7 11.5 11.5

Total Transportation 33.4 43.0 43.1

Department of the Treasury

Internal Revenue Service 60.3 60.3 95.8

Department of Veterans Affairs

Veterans Health Administration5 671.8 682.4 707.6

$28,882.9 $30,560.8 $31,071.4
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Table 2: Historical Federal Drug Control Spending (Budget Authority in Millions)311

Table 3: U.S. Border Patrol Drug Seizures by Fiscal Year312

Table 4: Office of Field Operations Drug Seizures by Fiscal Year313

 

311 Exec. Office of the President, National Drug Control Budget, FY 2017 Funding Highlights (Feb. 2016) 

https://www.whitehouse.gov/sites/default/files/ondcp/press-releases/fy_2017_budget_highlights.pdf.

312 Information provided by U.S. Customs & Border Protection (Feb. 2016) (Notes on file with the Committee). 

313 Information provided by U.S. Customs & Border Protection (Mar. 2016) (Notes on file with the Committee). 

FY2008

Final

FY2009 

Final

FY2010

Final

FY2011

Final

FY2012

Final

FY2013

Final

FY 

2014

Final

FY2015

Final

FY2016

Enacted

FY2017

Request

Treatment 6,725.1 7,208.7 7,544.5 7,659.7 7,848.3 7,888.6 9,481.8 12,543.1 13,248.6 14,281.6

Prevention 1,848.1 1,961.0 1,573.4 1,483.9 1,346.2 1,274.9 1,316.9 1,341.5 1,496.2 1,544.7

Total 

Demand 

Reduction

8,573.2

 39.3%

9,169.7

 36.9%

9,117.9

 37.0%

9,143.5

 37.5%

9,194.4

 37.5%

9,163.5

 38.5%

10,798.7

 42.0%

13,884.6

 48.1%

14,744.8

 48.2%

15,826.3

 50.9%

Domestic Law 

Enforcement 8,293.9 9,463.0 9,245.5 9,217.3 9,439.5 8,857.0 9,348.8 9,394.5 9,699.1 9,525.5

Interdiction 2,968.7 3,699.2 3,662.4 3,977.1 4,036.5 3,940.6 3,948.5 3,960.9 4,479.9 4,138.5

International 1,998.5 2,532.6 2,595.0 2,027.6 1,833.7 1,848.5 1,637.1 1,643.0 1,637.0 1,581.1

Total Supply 

Reduction

13,261.1

 60.7%

15,694.9

 63.1%

15,502.9

 63.0%

15,221.9

 62.5%

15,309.7

 62.5%

14,646.1

 61.5%

14,934.4

 58.0%

14,998.3

 51.9%

15,816.1

 51.8%

15,245.1

 49.1%

Fiscal Year Marijuana (lbs.) Cocaine (lbs.) Heroin (lbs.) Methamphetamine (lbs.)

FY2012 2,299,864 12,161 430 3,715

FY2013 2,430,123 4,696 576 3,580

FY2014 1,922,545 4,554 606 3,930

FY2015 1,538,307 11,220 517 6,443

Fiscal Year Marijuana (lbs.) Cocaine (lbs.) Heroin (lbs.) Methamphetamine (lbs.)

FY2012 522,640 45,267 3,779 11,039

FY2013 477,070 38,929 4,248 17,021

FY2014 437,944 41,326 4,300 19,273

FY2015 602,743 38,218 5,509 25,581
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Table 5: Mexican Poppy and Heroin Production by Fiscal Year314

Table 6: Heroin Overdose Deaths in the U.S. by Fiscal Year315

Table 7: Fentanyl Encounters in the U.S. by Fiscal Year316

Table 8: Estimated Drug Expenditures in the U.S. (in billions)317

 

314 America’s Insatiable Demand for Drugs: Examining Alternative Approaches: Roundtable Before the S. Comm. 

on Homeland Security & Governmental Affairs, 114th Cong. (2016) (statement of David Murray, Hudson Institute).

315

 Centers for Disease Control and Prevention, Number and Age-Adjusted Rates of Drug-Poisoning Deaths 

Involving Opioid Analgesics and Heroin: United States, 2000-2014, available at

http://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf.

316 Information provided by U.S. Drug Enforcement Administration (June 2016) (Notes on file with the Committee). 

317Exec. Office of the President, What America’s Users Spend on Illegal Drugs: 2000-2010 (Feb. 2014) 

https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/wausid_results_report.pdf.

2011 2012 2013 2014 2015

Hectares under 

cultivation 12,000 10,500 11,000 17,000 28,000

Potential pure production 

(metric tons) 30 26 26 42 70

2008 2009 2010 2011 2012 2013 2014

3,041 3,278 3,0363 4,397 5,925 8,257 10,574

2009 2010 2011 2012 2013 2014 2015

584 640 624 644 934 7,864 13,001

DRUG 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Cocaine $55 $49 $45 $43 $44 $44 $43 $39 $34 $31 $28

Heroin $23 $23 $22 $23 $23 $22 $21 $21 $23 $26 $27

Marijuana $22 $24 $30 $30 $31 $30 $30 $30 $32 $35 $41

Meth $8 $11 $15 $17 $20 $23 $22 $20 $16 $15 $13
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APPENDIX B: CHAIRMAN’S FINDINGS OF FACT FROM COMMITTEE 

HEARINGS AND ROUNDTABLES

March 17, 2015 — Securing the Southwest Border: Perspectives from Beyond the Beltway

• Four out of five witnesses testified that the southwest border is not secure. 

• Chris Cabrera, a Border Patrol agent in the Rio Grande Valley sector, testified that 

Border Patrol agents have “a lot of problems” accessing Federal lands and Native 

American Reservations, which drug smugglers and coyotes use to their advantage. 

According to Cabrera, smugglers “know exactly what we can and cannot do, where we 

can and cannot go, and they exploit it.” 

• Cochise County, Arizona, Sheriff Mark Dannels confirmed that due to limited resources, 

some local jurisdictions along the border will not prosecute smugglers possessing less 

than 500 pounds of marijuana. Sheriff Dannels also testified that drug traffickers often 

use teenagers to smuggle drugs, as it is unlikely that minors will be prosecuted. 

March 24, 2015 — Securing the Border: Understanding the Presence of Transnational Crime

• According to former drug czar General Barry McCaffrey, the U.S. is only interdicting 5 

to 10 percent of illegal drugs crossing our southwest border. 

July 15, 2015 — Securing the Border: Understanding Threats and Strategies for the Maritime

Border

• The maritime border constitutes the United States’ longest border, and yet we have very 

little domain awareness of this environment.

• According to the U.S. Coast Guard, it only interdicts 11 to 18 percent of the estimated 

drug flow entering the United States from our maritime borders. 

September 14, 2015 —All Hands on Deck: Working Together to End the Trafficking and Abuse

of Prescription Opioids, Heroin, and Fentanyl (Manchester, New Hampshire)

• Heroin is not produced in America but instead is manufactured outside the country and 

smuggled across the U.S. border via Mexican Cartels, particularly the Sinaloa Cartel. 

• According to the DEA, “[t]he growing relationship between Mexican-based drug cartels 

and domestic street gangs, coupled with . . . an unlimited supply of illegal guns, has 

really created the perfect storm for law enforcement.” 

• Witnesses concluded that ultimately we must target criminal organizations, not people 

with substance use disorders. 

November 23, 2015 — America’s Heroin Epidemic at the Border: Local, State, and Federal 

Law Enforcement Efforts to Combat Illicit Narcotic Trafficking (Phoenix, Arizona)

• According to the Arizona HIDTA, “Arizona is a primary entry point, trafficking corridor 

and distribution hub for drugs transported from Mexico to the United States by the 

Sinaloa Cartel.”
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• Mexican DTOs are highly sophisticated—an Arizona sheriff testified that “[a]side from 

the normal use of human backpackers (mules), clandestine tunnels, and vehicles, the 

trafficking organizations have resorted to the use of ultra-light aircraft which cannot be 

detected by normal radar, cloned vehicles appearing to be law enforcement or other 

legitimate companies, and most recently the use of catapults which hurl bundles of 

marijuana into the U.S. to awaiting co-conspirators.”

April 13, 2016 — America’s Insatiable Demand for Drugs 

• According to General Kelly, the former Commander of the U.S. Southern Command, our 

borders are not secure. General Kelly also testified that the United States has visibility of 

90 percent of the production and flow of illicit narcotics coming into the country. 

• John Caulkins, a professor at Carnegie Mellon University, estimated the U.S. drug market 

to be $100 billion a year at retail level, with most of the price increase occurring inside 

the country. At the border, the drug market is closer to $10 billion a year. 

• While marijuana is a mass-marketed drug, “hard drugs” such as heroin, cocaine, and 

meth are used by only one percent of the U.S. population. 

• Cheryl Healton, former President and CEO of Legacy, the leading Foundation dedicated 

to tobacco control, explained that the Truth ads were not targeting existing users but were 

focused on preventing people from ever using cigarettes. 

• Members questioned what the gateway drug to harder drug use was. Witnesses stated 

that some marijuana consumed today is much more potent than marijuana used in the 

1970s. 

April 15, 2016 — Border Security and America’s Heroin Epidemic: The Impact of the 

Trafficking and Abuse of Heroin and Prescription Opioids in Wisconsin (Pewaukee, Wisconsin)

• According to the Wisconsin HIDTA, in Milwaukee County, 109 heroin-related overdose 

deaths were reported in 2015.

• Statistics suggest that treatment is often only effective 10 to 20 percent of the time. 

• The average age to begin drug use is 11 to 12-years-old. 

• Dr. Timothy Westlake criticized the pain-scale system that could incentivize doctors to 

over-prescribe pain medications. He endorsed the PROP Act, sponsored by Chairman

Johnson, which would prohibit pain management questions on patient surveys from being 

factored into Medicare reimbursement calculations. 

• America’s insecure borders directly impact Wisconsin, according to the Wisconsin 

Attorney General, who testified that in the 1980s the purity of heroin was around 5 

percent. Today, because it is so easy to transport heroin into the country, the purity can 

range from 20 percent to 80 percent. 

April 19, 2016 — Preventing Drug Trafficking Through International Mail (public roundtable)

• According to the DEA, the abuse of fentanyl is the next step in the evolution of heroin 

and opioid addiction, which is primarily produced in China and easy to conceal/ship to

the United States. 
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• The DEA explained that fentanyl does not require traffickers to own large swaths of land 

to grow poppies; instead traffickers can order it on the Internet, ship it to the United 

States, export it to Mexico, then cut it with heroin, to later be smuggled back to the 

United States in its new form. 

• Canines are not trained to fentanyl, as just sniffing fentanyl could kill the dog. 

April 22, 2016 — Examining the Impact of the Opioid Epidemic in Ohio (Cleveland, Ohio)

• A comprehensive approach will be needed in order to effectively respond to America’s 

increasing demand for drugs. 

• “Changing prescribing practices alone also will not cure the problem,” noted the Acting 

U.S. Attorney for the Northern District of Ohio. 

• Ohio has become a case-study in the evolutionary nature of opioid addiction. According 

to the Medical Examiner of Cuyahoga County, Ohio’s largest county, there were 5 

overdose deaths in 2013 involving fentanyl, 37 overdose deaths in 2014, and 91 in 2015.

May 17, 2016 — America’s Insatiable Demand for Drugs: Assessing the Federal Response 

• GAO has found that ONDCP and federal agencies have made mixed progress toward 

achieving the goals articulated in the 2010 National Drug Control Strategy. As of May 

2016, none of the goals in the Strategy have been fully achieved.

• Federal drug control spending increased from $21.7 billion in FY2007 to approximately 

$30.6 billion in allocated funding in FY2016. Although total federal drug control 

spending increased from FY2007 through FY2016, spending on supply reduction 

programs, such as domestic law enforcement, interdiction, and international programs 

remained relatively constant at $13.3 billion in FY2007 and $15.8 billion in FY2016.

• SAMHSA initiatives to address the opioid epidemic include: (1) improving opioid 

prescribing practices; (2) increasing the use of naloxone; and (3) expanding the use of 

medication-assisted treatment (MAT) and recovery support services for individuals with 

an opioid use disorder. 

June 15, 2016 — America’s Insatiable Demand for Drugs: Examining Alternative Approaches

(public roundtable) 

• The issue of stigma is preventing people from seeking treatment. Not only is there a 

stigma with the use of illicit drugs, there is also a stigma with certain treatment options. 

• A treatment center in Canada is experimenting with prescribing diacetylmorphine, the 

active ingredient in heroin, as well as hydromorphone and methadone, synthetically 

produced opioids. 

• Use of prescription pain medication is declining; however, an entire generation has 

become addicted to prescription pain medication and is now turning to heroin, which is 

stronger today than it has ever been, as cartels cut heroin with fentanyl. 

• According to one witness: when researchers asked people addicted to heroin what is the 

toughest drug to quit, most said cigarettes. 

• Witnesses debated merits of decriminalization, legalization, and safe injection facilities.