Fentanyl killed their kids, and they're desperate for change. Can Trump help?

Susan Ousterman lost her son, Tyler, in October 2020 from an overdose of fentanyl, heroin and xylazine after years of desperately trying to get him help.

She's not alone. Yearly, over 100,000 people die from drug overdose deaths in the United States, with almost 70% of these deaths caused by fentanyl and other synthetic opioids.

Throughout the 2024 election, Trump promised to end the fentanyl crisis, pledging to crackdown on illegal immigration and strengthen border control. For many grief-stricken families, his messaging resonated.

“It offers a clear and decisive strategy," Ousterman says. "Especially at a time when other leaders have provided no adequate response to the mental health and overdose crisis, or even acknowledged it during their campaigns."

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"Voters are really fed up with broken promises and heartbroken and people just want something to change," says Kassandra Frederique, the executive director of the Drug Policy Alliance, a national nonprofit that works to end the war on drugs.

However, Frederique cautions that Trump's plan may not help in the way some families hope. Trump's efforts to secure the southern border during his first term and “only made the landscape more dangerous,” she argues.

The drug and public health experts we spoke to agree we need to shift the focus away from politicizing the issue of fentanyl use and instead refocus the conversation on the best way to handle those who become addicted, a subject that's still hotly debated.

While Ousterman sees border control as a piece of the puzzle, the lack of access to mental health care and treatment is a deeper challenge to her. Other mothers like Cara Wykowski, who lost her oldest son, Eric, to an accidental drug overdose in late 2023, want to see harm reduction at the forefront of any intervention.

Tyler Cordeiro walked his mother, Susan, down the aisle on her wedding day in 2019. Cordeiro died the next year of an overdose.
Tyler Cordeiro walked his mother, Susan, down the aisle on her wedding day in 2019. Cordeiro died the next year of an overdose.

The fentanyl crisis, explained

Fentanyl is a synthetic opioid drug that is used to relieve pain, often in medical settings under doctor supervision. But in relation to the opioid crisis, people are often referring to street fentanyl – an illicitly manufactured fentanyl. Most illegal fentanyl is shipped from China to Mexico and Canada, and then smuggled across the border into the United States.

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In some parts of the country, particularly the Northeast and Midwest, fentanyl is mixed into the heroin and counterfeit pill supply. So, not everyone who consumes fentanyl knows they are taking it.

In 2022, more than 200 lives were lost every day to fentanyl. Drug overdose deaths decreased by 3% in 2023, marking the first annual decrease since 2018, but states like Alaska, Washington, and Oregon experienced notable increases of at least 27%.

Cara Wykowski poses with a photo of her son, Eric, who died by an accidental drug overdose in late 2023.
Cara Wykowski poses with a photo of her son, Eric, who died by an accidental drug overdose in late 2023.

Immigration, border control and the opioid crisis get intermingled

Despite Trump's focus on securing the border, studies show that 86.4% of people convicted of fentanyl smuggling are U.S. citizens. Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, says the amount of fentanyl being smuggled into the U.S. is "too small an amount to keep out." Given its high potency, only a small amount of fentanyl is needed to produce an effect. Just 2 milligrams — roughly the size of a few grains of sand — is enough to cause an overdose. All American consumption of illegal fentanyl — estimated to be in the single digit metric tons — could fit on a single truck.

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Connecting drug laws to border control policy is an “old playbook," Frederique says.

“People lost their loved ones. People want someone to blame,” she says. “Today it's illegal immigration. Five years ago, it was pharmaceutical executives, right? It's whoever you put in front.” But, some of the families the Drug Policy Alliance works with have expressed frustration with “the politicization of the deaths of their loved ones."

Wykowski says when illegal immigration and the opioid crisis get “co-mingled,” people fail to look at the crisis from a “systemic failure” point of view.

At first, Wykowski had an “abstinence-only” mindset when it came to drug use, but when she learned about harm reduction, she was finally able to give her son the help he would accept. Harm reduction reduces the risks associated with drug use, including overdose and the spread of infectious diseases, by providing free syringe service programs, overdose prevention sites, fentanyl tests, naloxone kits and training and sterile injection or smoking equipment.

Wykowski says that policies like California Proposition 36, which passed in November and increases criminal penalties for certain drug offenses, create a “revolving door back to prison." Her son, Eric, had been in county jail numerous times and to prison once while struggling with addiction.

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"People are scared that if they ask for help," Frederique says. "They're going to get handcuffs."

Eric died in San Francisco, where former Mayor London Breed said in 2023 that it is easier to access drugs than it is to access treatment.

Although the city added about 400 treatment beds from 2021-2024, the Department of Public Health estimated that during the second half of 2023, 15-20% of its short-term residential mental health beds went unused due to staffing shortages.

“I remember at one point we were searching for mental health care. The wait to get an appointment was something like 12 weeks,” Wykowski says. “So you lose hope, move on. You self-medicate instead.”

After finally finding a treatment center, Eric was able to reduce his fentanyl use over a three-month period of time. He was working full-time as a plumber’s apprentice and residing in a sober-living house in Pasadena before overdosing during his first visit home for Thanksgiving.

“It hurt even worse, because he had gotten his life back,” Wykowski says. “I see that lost potential. We have to look at this as a disease and stop the shaming.”

The issues behind drug use need to be addressed, she says, such as housing, expanding treatment options and access to mental health care: “Punishment just doesn’t work. Can we treat people and give them back their humanity so that they don’t seek out these substances? That’s where I would like to see more money applied.”

Cara Wykowski's son, Eric, died in San Francisco over Thanksgiving during his first visit home.
Cara Wykowski's son, Eric, died in San Francisco over Thanksgiving during his first visit home.

Harm reduction works, research demonstrates

Dr. Kimberly Sue, an assistant professor of medicine at Yale University School of Medicine within the Program in Addiction Medicine, has had many patients die of opioid overdose.

It’s a “lot easier to point the finger at supposed mules,” Sue says, than to look at public policies.

Currently, 80% of U.S. counties do not have access to methadone treatment, according to Sue. Methadone is administered through opioid treatment programs called OTPs, many of which have extensive waiting lists. Patients may have to travel one or two hours to reach a clinic, and that medication has to be taken in front of a nurse or doctor every day.

The drug, however, is lifesaving and can help individuals sustain recovery. Working as a long-acting full opioid agonist, methadone reduces opioid craving and withdrawal. Expanding access could transform the treatment landscape.

“If you came in for a heart attack, I would start you on six new medications, and you would be on those for the rest of your life,” Sue explains. “If you have an opioid overdose, I need to start you on (methadone) to cut your risk of dying of the same thing in half, potentially for the rest of your life. No questions asked. But there's so much stigma around these medications that it makes it very difficult for me, and for patients to accept the treatment."

The bipartisan Modernizing Opioid Treatment Access (MOTA) Act, which was introduced in 2023 but has yet to pass, would allow addiction medicine doctors like Sue to prescribe methadone in a regular clinic, where patients could pick it up at a regular pharmacy.

Will harm reduction programs also curb fentanyl use?

Any time that a healthcare intervention is offered it's an opportunity for people to make a decision to stop, Frederique says.

Most syringe service programs (SSPs), which provide sterile injection equipment, offer referrals to medication-assisted treatment; new SSP users are five times more likely to enter treatment, and three times more likely to stop using drugs than those who don’t use the program, according to the CDC.

Frederique also believes the conversation needs to point away from the supply and towards the demand.

“People are dealing with really hard issues and are not always finding other ways to cope with that,” she says. “How do we stop people from going into a place of struggle?”

No one should have to lose a child to overdose

Trump has been supportive of public health initiatives in the past, it remains to be seen if his stance has changed.

Potential cuts to Medicaid — "the backbone of treatment in a lot of our states," according to Humphreys — could pose a greater risk to limiting access to harm reduction and treatment. Nine states have trigger laws that would automatically end their Medicaid expansions if federal funding falls below 90% (80% for Arizona), putting approximately 3.7 million adults at risk of losing their health coverage.

It’s already difficult to lose a child, Wykowski says; It “goes against the natural order of life.”

“But when you lose a child to substance use,” she explains, “Your grief tends to be minimized or shadowed, because nobody wants to talk about that.”

Eric, son of Cara Wykowski, was able to reduce his fentanyl use over a three-month period of time before he died from an accidental overdose
Eric, son of Cara Wykowski, was able to reduce his fentanyl use over a three-month period of time before he died from an accidental overdose

"If we continue failing to address the widespread disenfranchised grief that has resulted from these tragic deaths, America should brace itself for a new epidemic," Ousterman cautions. "Leadership that understands our approach has been inadequate, prioritizes saving lives, modernizes systems, and rebuilds trust in government agencies can make meaningful strides in overcoming the despair many Americans face today."

This article originally appeared on USA TODAY: Trump and the fentanyl crisis: Will his plan work?