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The US government is earnestly trying to tackle the opioid crisis, which is killing tens of thousands of Americans each year, but there’s no easy way to tell whether its efforts are even working, says a new report by a federal watchdog agency.

On Thursday, the Government Accountability Office released a new report that assessed how major federal agencies, including the Department of Homeland Security and the Drug Enforcement Administration, have responded to the explosive rise of illicit synthetic opioids like fentanyl and its analogs.

Ultimately, it found that federal agencies have become more dedicated to combating fentanyl use in recent years. Customs and Border Protection are screening more international packages that pass through shipping ports for fentanyl, using new technologies that can detect opioids from afar without endangering officers. Law enforcement agencies within the Department of Justice are coordinating with public health agencies to better investigate and trace outbreaks of overdose deaths to their source. And public health agencies are creating and expanding treatment and prevention programs, such as safe needle exchanges and better access to overdose-reversing drug naloxone. Many agencies are also sharing information with other governments and international organizations to stem the shipments of fetanyl from major suppliers and distributors within China and Mexico.

But almost none of these groups, the authors concluded, have developed ways to track their progress in real-world terms, such as reducing opioid deaths.

“While federal agencies have in many ways enhanced their approaches to limit the production, availability, and demand for potent synthetic opioids, further efforts are needed to assess the effectiveness of these approaches and to ensure that the invested resources are yielding intended results,” they wrote.

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The report also detailed some specific problems these agencies are dealing with. Customs and Border Protections currently has eight major labs across the country where testing can be done to confirm the presence of fentanyl and other opioids in packages. But while some labs have enough staff and resources to send back results within a day, others are short staffed and overwhelmed with requests, and it can take weeks to months to hear back from them.

Aside from its general recommendation that agencies develop measures to track their progress in stopping deaths or cutting down the supply and demand of fentanyl, the report offered specific steps agencies could take to improve their response. Customs and Border Protection should figure out which shipping ports are at highest risk of having fentanyl pass though, then allocate more staff to meet testing demands, for instance. And the Office of National Drug Control Policy should conduct a review on how to streamline the “timeliness, accuracy, and accessibility of fatal and non-fatal overdose data” from hospitals and law enforcement agencies.

Some agencies, like Customs and Border Protection, have largely agreed with these recommendations, but not all. The Department of Justice responded that finding a way to measure a real-world impact from its increased enforcement would be too challenging, given how the opioid crisis affects states and cities differently and how difficult it would be to measure any one program or initiative in isolation from other strategies going on at the same time.

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“[W]hile we acknowledge in our report that it may be difficult to single out an individual agency’s contribution to these activities, we continue to believe that finding meaningful ways to measure any federal strategy designed to combat it is important, particularly because the threat is imminent and evolving,” the GAO authors responded.

Fentanyl and its analogs are thought to have sparked the ongoing and largest wave of deaths seen during the crisis starting around 2013, aided by the fact that fentanyl is often much cheaper and up to 100 times more potent than opioids like morphine. In many cases, people have died from doses no bigger than a grain of sand. In 2016 alone, fentanyl and related drugs were responsible for almost 20,000 deaths—double the amount seen in 2015. These deaths accounted for nearly a third of all overdose deaths that year.

[GAO]

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