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ATKINSON, N.H. Addressing a conference room full of New Hampshire voters, Republican presidential candidate Nikki Haley shared a grave statistic about the synthetic opioid fentanyl.

Weve had more Americans die of fentanyl than the Iraq, Afghanistan, and Vietnam wars, combined, the former South Carolina governor said Dec. 14 at the Atkinson Resort and Country Club in Atkinson.

Fentanyl is a potent synthetic opioid. It is used legally in pharmaceuticals, but most deaths are connected to its illegal manufacture and distribution. Small amounts can be lethal. The opioid factored in nearly 400 New Hampshire deaths in 2022, numbers from New Hampshires chief medical examiner show. The states high rate of opioid-related deaths have been a leading public health concern for several years, just as national overdose deaths have also climbed.

Federal data shows Haleys math is accurate when measuring national fentanyl deaths against U.S. military deaths. About 127,000 Americans died from drug overdoses involving a synthetic opioid other than methadone (primarily fentanyl) in 2020 and 2021 alone compared with 65,278 U.S. military personnel who died in Iraq, Afghanistan and Vietnam.

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Although public officials have long compared drug deaths with war fatalities, U.S. health officials approach addiction issues as public health matters and typically compare opioid deaths with deaths from other public health causes.

Military data from the Defense Departments Defense Casualty Analysis System shows 65,278 people died during the three conflicts when counting hostile battles and other nonhostile, in-theater situations. These figures include deaths from accidents, illness, injury and or self-inflicted causes.

In 2021 alone, the National Center for Health Statistics reported more than 106,000 drug overdose deaths. Of those, 70,601 involved synthetic opioids other than methadone. Fentanyl overdoses are not specifically separated out, but the agencys reports say the fatalities in this category are primarily because of fentanyl. That was up from 2020, when 56,516 people died from drug overdoses involving synthetic opioids other than methadone.

With just a few years worth of data, it is clear that the fentanyl death toll surpasses the wartime death toll Haley specified.

This is not the first time we have seen war deaths used to illustrate a public health issues direness. Politicians and television commentators have used military conflicts to illustrate the toll of gun violence, and more recently President Joe Biden used them to quantify deaths from COVID-19.

Drugs-and-war parallels have been hard to avoid since 1971, when President Richard Nixon declared a war on illegal drugs.

Comparing deaths linked to public health crises to war deaths, and especially the Vietnam War, is a pretty common thing, said David Herzberg, a drug historian and professor at the University at Buffalo. And on its face it is a reasonable strategy for conveying gravity, or seriousness of a crisis.

Fentanyl has taken a deadly toll, especially on younger adults. A Washington Post analysis found that fentanyl overdoses are the leading cause of death for American adults aged 18 to 49.

Drug overdose deaths are counted among the entire U.S. population of over 330 million people; casualties of soldiers occur within a smaller population, so deaths will never surpass the number of people who serve in a given conflict. For Vietnam, that was about 2.7 million, according to the Department of Veterans Affairs. But experts like David Luckey, a senior international and defense researcher at the global policy think tank Rand Corp., said that this sort of comparison can show the scope of this problem and put the scale of the illicit fentanyl crisis in a perspective that people can understand.

Comparing the fentanyl death toll to other public health crises such as heart attacks or car accidents, would technically be more accurate, said Herzberg, but might not get the idea across because the public may not know whether those other things are really big problems or not so they arent as useful as a benchmark.

The Centers for Disease Control and Prevention counts drug overdose deaths in the category of accidents (unintentional injuries). In 2021, heart disease, cancer and COVID-19 claimed more lives than those who died in accidents. The CDC reported that 695,547 died from heart disease, 605,213 from cancer and 416,893 from COVID-19. The overall number of death counts from accidents was 224,935, of which opioid deaths made up a major portion.

Haleys other comments hint at why shes invoking war numbers. She said fentanyl deaths are among many reasons why she believes China is the United States leading national security threat. China has been preparing for war with us for years, Haley said.

China was the primary source of illicit fentanyl early in the U.S. opioid epidemic, we found. But when the Chinese government banned fentanyl production in 2019, producers switched tactics.

A 2022 Congressional Research Service report found that Chinese traffickers no longer send fentanyl directly to the U.S. Instead, chemists send the materials to Mexican criminal organizations who then produce the fentanyl. Data shows that the vast majority of people sentenced for fentanyl trafficking are U.S. citizens.

Haley said, Weve had more Americans die of fentanyl than the Iraq, Afghanistan, and Vietnam wars, combined.

Her numbers are right. About 127,000 Americans died from drug overdoses involving a synthetic opioid other than methadone (primarily fentanyl) in 2020 and 2021 compared with 65,278 U.S. military personnel who died in Iraq, Afghanistan and Vietnam.

We rate this statement True.

By Grace Abels, PolitiFact staff writer

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Nikki Haley is correct that fentanyl deaths top casualties from 3 wars combined - The Dallas Morning News