Stop Using A Behavioral Health Disease As A Core Justification For Tariffs
While no expert on the economics and geopolitics of tariffs, we do spend much time working with, thinking and writing about alcohol and other drug use, abuse and addiction. We are here to say that curbing supply of drugs at the border, interdiction, is at best a partial answer. Further, if the supply problem were so easy to solve, then we would have solved it previously. Now expecting another country to do so is at best ineffective and at worst disingenuous. Either way, using drug abuse as a core justification for tariffs seems not logically connected.
To be clear, supply is part of America’s drug problem and interdiction is important. Writing in the Stanford Institute for Economic Policy in 2018, Matthew Gentzkow et al found that nearly one-third of opioid abuse can be pinned to relative availability of drugs by location. Others have written about how illicit drug sources from international cartels and national criminal organizations sustain drug use and that is reasonable to conclude from the factors discussed in the Stanford study. On the other hand, sadly, the experience of Portsmouth, Ohio is instructive as they recently had multiples in the national rates of opioid use and deaths beginning with economic despair leading to drug use that was then fueled by illegal supply.
The problem with interdiction at our borders has to do in great part with the ease of smuggling fentanyl and its chemical precursors. Writing for the Council on Foreign Relations in December 2023 Mariell Ferragamo and Diana Roy note that “As little as two milligrams of fentanyl, equivalent to between ten and fifteen grains of table salt, can be lethal. Because fentanyl is often transported in small, hard-to-detect quantities—and because substantially less fentanyl needs to be smuggled into the United States to meet demand—some experts say that relying on catching it at the border is futile.” This applies to legal crossing points thus the problem is exacerbated by the additional, illegal crossings with such an easily transported substance. That doesn’t mean we give up on interdiction but that we are realistic about the prospects.
Following Gentzkow’s analysis, two-thirds of the drug crisis in America is demand driven. This means that interdiction, as important as it may be, and if its challenges were overcome, cannot succeed alone. Alcohol and other drug abuse causes are many and usually not singular in an individual. Genetic predisposition is certainly a factor as is recreational use, but causes are often related to despair such as financial stress, abuse, adverse childhood events, unemployment, homelessness and mental health issues to name a few.
In terms of reducing consumption/demand our national response continues to be startlingly inadequate. Writing in a “Research Letter” in the Journal of the American Medical Association in January 2025 Ligang Liu and colleagues report, “Despite increasing treatment needs, the percentage of participants receiving treatment (all drugs including alcohol) decreased from 9.3% in 2013 to 6.5% in 2020. SUD (substance use disorder) treatment rates rebounded to 14.9% in 2022. AUD (alcohol) treatment decreased from 6.3% in 2013 to 4.3% in 2020, recovering to 7.6% in 2022. OUD (opioid) treatment decreased to 11.2% in 2020, rebounding to 22.1% in 2021 and decreasing to 18.3% in 2022.” Despite this recent rebound in treatment availability these data tells us that between 7.6% and 18.3% of those in need ever find treatment. Clearly, we are not attending to the “demand” side of the equation. If addiction is a disease as the AMA defines it, then name the other disease where we would tolerate less than 20% of the victims receiving treatment. We are turning our heads on treatment for a disease with available, successful, clinical treatment. We are doing far too little on the demand side of this issue.
While relatively uninformed of the larger economic and geopolitical issues at play in current tariff discussions, and grateful for awareness of the importance of drug interdiction by national leadership, it seems to us that we are using a behavioral health disorder, recognized as a disease by the American Meical Association since 1956, as a cudgel for larger purposes. The logical connection is at best not readily apparent. When we become serious at treating alcohol and other drug abuse and addiction, demand being two-thirds of the equation, then we will have a national strategy. Until then, we should stop using a behavioral health condition as a core justification for tariffs.
Gene Gilchrist
March 2025
