Commentary: States Must Act Now to Save Rural Lives from Fentanyl Crisis

Heidi Heitkamp
by Heidi Heitkamp


Across rural America, the expanding crisis of fentanyl-fueled overdoses is ravaging a generation. According to the Centers for Disease Control and Prevention, fentanyl deaths in the U.S. have tripled since 2016, and initial data from 2022 indicates that synthetic opioids cause about 90% of all opioid overdose deaths – which translates to nearly 75,000 Americans killed in that year alone. Rural communities, where hundreds of hospitals have already closed and more are on the chopping block, are bearing the additional weight of overdoses. We need states to do more to protect Americans and ensure access to all overdose reversal agents that have been approved by the U.S. Food and Drug Administration. 

According to the U.S. Drug Enforcement Administration, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. Hidden in counterfeit prescription pharmaceuticals like Adderall, Xanax, and Oxycontin, it’s so lethal that just two milligrams, the size of a pencil tip, can kill. 

One of the most devastating aspects of synthetic opioids is that they may stay in the system longer than legacy overdose agents used to try and save lives. That means multiple doses of reversal agents are required, if first responders even have them on hand.

The flood of fentanyl coming into our country is overwhelming. In fact, the Department of Homeland Security’s 2024 Threat Assessment states that illegal drugs produced in Mexico and sold in the United States will continue to kill more Americans than any other threat. Fentanyl has even been called a weapon of mass destruction by frontline leaders in U.S. Customs and Border Protection policy, the Postal Service, Homeland Security, and public health.

Without access to the most effective resources, more Americans will die unnecessarily from fentanyl – even as new FDA-approved medicines to save lives become available. We need to address the sources of these dangerous substances, but also equip communities to respond. Unfortunately, on both fronts, we have come up short.

During my time as North Dakota’s attorney general, I led North Dakota’s efforts to combat the growing use of illegal drugs in our state. A vigorous effort to stop the illegal importation and sale of dangerous drugs is critically important. However, it is equally important to curtail the demand. Legal and diverse products that assist individuals in “kicking the habit” and assist first responders in saving lives must be part of any comprehensive strategy to solve America’s illegal drug problem.

From my time representing North Dakota in the United States Senate to today, combatting opioid abuse has always been a priority for me 

I’m proud that North Dakota has already made every tool in the opioid overdose toolkit available, including overdose reversal products specifically indicated for synthetic opioids. What most people don’t know is that each state is required to issue its own individual policy or standing order to ensure first responders are able to access and administer FDA-approved reversal agents for opioid overdoses. That’s why every state in the union must act today.

With fentanyl responsible for over 150 deaths every day in the United States, we are facing a healthcare reckoning. There is literally no time to lose. Such a crisis demands a whole-of-government response, from local leaders to federal agencies.

We must ensure access to every innovation, including overdose rescue agents already approved by the FDA and specifically indicated for synthetic opioids. These resources are desperately needed, particularly in rural and remote communities without reliable healthcare infrastructure. Unfortunately, in many parts of our country, these lifesaving agents are not reaching enough first responders and frontline workers, including police officers, firefighters, personnel on college campuses, and emergency healthcare providers in rural areas.

We must act now to ensure that every state expands access to all FDA-approved overdose rescue agents and save American lives.

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Heidi Heitkamp has served as North Dakota’s tax commissioner, attorney general, and U.S. senator. She was the first woman elected to the U.S. Senate from North Dakota.
Photo “Heidi Heitkamp” by Heidi Heitkamp.






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