(Bloomberg) — To understand the 2024 US presidential election, it is essential to understand the politics of fentanyl.

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Americans have been traumatized by a years-long wave of overdose deaths caused by the synthetic opioid. Once rarely used outside hospitals, fentanyl has become a ubiquitous street drug made by criminal gangs, often in Mexico, from cheap chemicals typically manufactured in China. It frequently is a hidden ingredient in other illicit drugs and can have fatal consequences for unsuspecting users.

Ending the scourge, voters indicate, is a high priority.

About 8 in 10 voters in seven swing states say fentanyl misuse is a “very important” or “somewhat important” issue when deciding who to vote for in November — more than the number who cite abortion, climate change, labor and unions, or the wars in Ukraine and Gaza, according to a recent Bloomberg News/Morning Consult poll of almost 5,000 registered voters.

Fentanyl has come up repeatedly in a campaign unfolding after an especially deadly phase in the US opioid epidemic. From just before the start of the Covid-19 pandemic in November 2019 to October 2023, about 270,000 people died of an overdose from a synthetic opioid, according to the most recent provisional data from the Centers for Disease Control and Prevention. Those fatalities account for the vast majority of overall opioid overdose deaths, which have climbed to about 80,000 a year.

The crisis has received increasing attention on cable news, is the target of scores of bills in Congress and has become a rallying cry from statehouses to school-board meetings across the country. And while ideas range from ramping up treatment options to waging war on cartels, voters appear united by a desire to break fentanyl’s grip on American society.

Presidential candidates are seizing on the issue to firm up support from party faithful and woo voters whose allegiances may have shifted due to the crisis. For President Joe Biden, a Democrat, and former President Donald Trump, the presumptive Republican nominee, fentanyl is also a way to talk about everything from immigration and border security to China and crime.

Early in his term, Biden made addressing the epidemic the first pillar of his “Unity Agenda” intended to bring Democrats and Republicans together. Yet during this year’s State of the Union address, a gap was on display, as Biden chastised GOP lawmakers for not taking a harder stance. “Strengthen penalties on fentanyl trafficking — you don’t want to do that, huh?” he said.

For his part, Trump has blamed Biden’s immigration policies for the rise in overdoses. He has called for deploying the US military to Mexico and for using the death penalty as a punishment for drug smugglers.

“Our country is being poisoned from within by the drugs and by all of the other crime that’s taking place,” he has said. A Republican National Committee spokesperson said Trump would “make America safe again” if reelected.

Registered voters were most likely to hold US drug users and Mexican cartels responsible for the epidemic, according to the Bloomberg/Morning Consult poll. Voters from both parties agree the US should work with Mexico and Canada to combat drug trafficking.

Drug-overdose deaths broadly are a problem across the US, with recent surges in places like Alaska, Washington state and Alabama. More than 4 in 10 Americans personally know someone who has died from a drug overdose, according to a study by the nonprofit Rand Corp.

Just 2 milligrams of fentanyl, equivalent to 10 to 15 grains of table salt, is considered a lethal dose. Traffickers tend to distribute it by the kilogram, which is enough to kill 500,000 people, according to the Drug Enforcement Administration. The drug’s street value varies — one pill can cost less than a dollar, while a pound of powder can cost well more than $10,000.

Since Biden took office, the US has seized more than 100,000 pounds of fentanyl and 150 million fentanyl-laced pills, according to data from the DEA and the Department of Homeland Security. The White House said it has denied drug traffickers billions of dollars in profits.

In Arizona — a swing state along the Mexico border that has seen a recent rise in synthetic opioid overdose deaths — fentanyl’s intersection with US political divisions is plain to see. Emergency medical services in Tempe, home to Arizona State University, receive roughly two calls a day, on average, related to opioids. Wastewater surveillance shows pervasive fentanyl use in the city of roughly 186,000 people just east of Phoenix. Last year, local law enforcement said they helped seize 4.5 million fentanyl-laced pills and 140 pounds of fentanyl powder that federal officials said was being distributed by the Sinaloa drug cartel.

“We used to deal with traditional drugs and traditional crises,” said Sergeant Rob Ferraro, a Tempe police officer who helped set up a program that trains cops on administering overdose antidote naloxone. In the past four years, city police have saved 330 lives with the therapy, and helped get half into treatment through a partnership with a local health organization, according to Ferraro. Yet the success of such efforts hasn’t always resonated with voters, he said.

“There are different beliefs about how fentanyl is getting here. People blame Trump, they blame Biden,” Ferraro said. “It’s no different from anything else in our country: It’s very polarizing, very binary.”

About one-third of swing-state voters trust neither Biden nor Trump to handle the crisis, according to the Bloomberg News/Morning Consult poll, which has a margin of error of one percentage point.

Some people who have been directly affected by the crisis say that neither candidate did enough to get fentanyl under control during their time in the White House.

“It’s becoming an issue in the election because it’s been ignored by both administrations,” said Jim Rauh of Akron, Ohio, who lost his 37-year-old son to fentanyl in 2015 and now runs an advocacy group called Families Against Fentanyl.

“The Trump administration ignored it, the Biden administration is now turning a blind eye,” said Rauh. “They’ve both evaded their duties.”

The Biden reelection campaign said the two administrations have taken drastically different approaches to navigating the epidemic.

“Trump was all talk and no action on the opioid crisis, declaring an emergency and then failing to allocate additional resources or even to develop a national opioid strategy as required by law,” said spokesperson Lauren Hitt. Meanwhile, the Biden administration has focused on solutions that are popular among both Democrats and Republicans, she said.

Democrats were more likely than Republicans to want to see the US make overdose antidotes more available and provide treatment for opioid-use disorder. Republicans, meanwhile, wanted in greater numbers to increase security at the US-Mexico border and limit migration, the Bloomberg/Morning Consult poll found. Harm-reduction strategies such as needle exchanges and efforts to decriminalize recreational fentanyl use were broadly unpopular with voters overall.

Progressive cities like Portland, Oregon, and San Francisco have seen a backlash against relaxed drug laws. Oregon’s Democratic governor, Tina Kotek, has said she will sign a bill to make possession of illicit drugs a crime again, while in San Francisco, voters backed a measure sponsored by Democratic Mayor London Breed that would make welfare recipients suspected of using drugs undergo screening and enroll in a treatment program.

Mentions of fentanyl on three major cable news networks began rising in 2021 and peaked in March 2023, when the networks referred to fentanyl in about 1,900 15-second clips, according to closed-captioning data from the Internet Archive’s TV News archive. Fox News referred to fentanyl about three times as often as CNN in March 2023, and about 13 times more than MSNBC, according to the Internet Archive, a nonprofit that maintains a digital library of web pages, books, videos and software.

US Google search interest for the term fentanyl, meanwhile, has generally surpassed interest for its broader class of drugs, opioids, since early 2022 and hit an all-time high in September of that year, according to data from Google Trends.

“It’s a bigger issue than you might think,” said Chris Ager, chairman of the New Hampshire Republican Party, a few days before the state’s primary election in January. “Even though we’re thousands of miles away from the southern border, where it’s coming from, everybody in New Hampshire, I believe, knows someone who’s been impacted by a fentanyl overdose.”

Congress has also been paying greater attention to fentanyl. Lawmakers in the House and Senate introduced more than twice as many bills and resolutions that mentioned fentanyl in 2023 than a year earlier.

For much of the past decade, Congressional Democrats and Republicans proposed roughly the same number of fentanyl-related bills and resolutions, but in the past two years, Republicans introduced more than two-thirds of all legislation mentioning the drug.

State legislatures meanwhile introduced more than 600 bills about fentanyl in 2023 and enacted at least 103 laws, according to a report by the National Conference of State Legislatures.

@rileyraygriffin has more on the story https://t.co/Umldivgwux pic.twitter.com/hjKuCyvlXe

— Bloomberg (@business) March 21, 2024

Partisan wrangling over how to address fentanyl worries some drug-policy experts, as well as immigration advocates and local officials.

“When I started working on this issue, it wasn’t as politicized as it is today,” said Regina LaBelle, director of the Addiction and Public Policy Initiative at the O’Neill Institute at Georgetown University, who helped lead opioid strategy in the Biden and Obama administrations. It can be hard to get voters excited about public-health measures like prevention and treatment, she said.

“It’s simpler in a sound bite to say ‘China’s killing our people’ or ‘it’s immigrants coming across the border,’” she said.

Fatima Saidi, the national campaign director for We Are All America, which advocates for immigrant and refugee rights, said politicians are conflating criminals with people seeking safety. “When you’re angry, you need something to punch — and it’s the most vulnerable who are taking the punching,” she said. “Immigrants and refugees at the border should not be their punching bags.”

Seeing politicians use fentanyl to push border control isn’t surprising to Lane Santa Cruz, a Democrat on the Tucson, Arizona, City Council. “We see that time and time again with the war on drugs and the oversimplification of how drugs get to the US,” she said.

Cruz ran for office in part because after she lost her brother to a fentanyl overdose in 2016, she wanted to protect young people in her community. She considers casting fentanyl as a border issue a fear tactic. “Blaming things on the border doesn’t address the root cause of why demand for drugs exists,” she said.

In an interview steps from the White House’s West Wing, Rahul Gupta, the director of National Drug Control Policy, said Biden is focused equally on stopping traffickers and treating addiction. Those are “two sides of the same coin,” Gupta said.

The death toll from the opioid crisis has been slowing but remains near all-time highs. Reported opioid overdose fatalities were down about 2.3% in the 12 months through October, according to provisional data from the CDC, and deaths from synthetic opioids like fentanyl, a subset of opioid-related deaths, were down about 0.3%.

The administration continues to push to make naloxone more accessible, Gupta said, and has taken steps to ensure people with opioid-use disorder can continue to get treatment from home, as they were throughout the pandemic. The opioid epidemic, Gupta said, “is like a large ship. We’ve been able to slow it down and stop it. We have to now turn it around.”

The US is targeting accountants, real-estate agents, wealth managers and lawyers that enable the drug trade, Gupta added. The administration also wants to ramp up searches of vehicles crossing into the US. Some 90% of all interdicted fentanyl is stopped at these ports of entry, primarily in vehicles driven by US citizens, according to the Department of Homeland Security. Gupta said it is difficult for officials to catch because fentanyl, which is 50 times more potent than heroin, is often moved in small quantities.

Biden has blamed Trump for encouraging conservative lawmakers to hold up a bipartisan border-security bill that would install 100 inspection machines at the Southwest border and strengthen US authority to sanction foreigners involved in fentanyl trafficking.

“This bill would save lives and bring order to the border,” Biden said in this year’s State of the Union speech.

Still, some voters in his own party are skeptical of Biden when it comes to handling the challenges posed by fentanyl. About six in 10 Democrats in swing states said they trust him more than Trump to navigate the crisis, according to the Bloomberg/Morning Consult poll.

Among swing states surveyed, at least two — Nevada and Arizona — recorded an increase in overdoses from synthetic opioids in the 12-month period through October, according to the CDC, a sign that fentanyl is likely to remain a pivotal issue for voters until Election Day.

Eight in 10 voters in Arizona see fentanyl as a very important or somewhat important issue when deciding who to vote for later this year, according to the Bloomberg/Morning Consult poll. They were more likely to blame US drug users and Mexican drug cartels for the crisis than any other entity. More said working with Mexico and Canada to combat drug trafficking or targeting foreign synthetic drug suppliers would be effective than said so about public-health measures.

Near the outset of the pandemic, Theresa Guerrero of Tucson, lost her 31-year-old son, Jacob, to a fentanyl overdose. At first, Guerrero didn’t want family or friends to know how he died.

Soon, however, Guerrero said she realized that the problem was only getting worse, and threw herself into raising awareness about fentanyl. She recently appeared in a video about the drug’s toll on families for Pinal County Sheriff Mark Lamb, who is seeking a US Senate seat by promising to bolster border security — an issue Guerrero said wasn’t important to her before Jacob died.

“We are a superhighway in Arizona, with a crazy amount of pills coming through,” she said. “Our kids are not overdosing. They’re being poisoned.”

–With assistance from Nancy Cook and Allan James Vestal.

(Corrects the amount of fentanyl seized by the Biden administration in 14th paragraph.)

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