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Republican presidential candidate former U.N. Ambassador Nikki Haley speaks at a town hall campaign event Dec. 12, 2023, in Manchester, N.H. (AP) Republican presidential candidate former U.N. Ambassador Nikki Haley speaks at a town hall campaign event Dec. 12, 2023, in Manchester, N.H. (AP)

Republican presidential candidate former U.N. Ambassador Nikki Haley speaks at a town hall campaign event Dec. 12, 2023, in Manchester, N.H. (AP)

Grace Abels
By Grace Abels December 19, 2023

Haley is correct that fentanyl deaths top casualties from 3 wars combined

If Your Time is short

  • About 65,300 soldiers died in Vietnam, Iraq, and Afghanistan combined. 

  • About 127,000 Americans died from drug overdoses involving a synthetic opioid other than methadone in 2020 and 2021, federal data shows. These deaths are primarily because of fentanyl. 

  • War deaths are often used as a way to illustrate the scale of a public health crisis. U.S. health officials typically track opioid deaths alongside deaths from other public health causes like heart disease or cancer.

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.

"We’ve 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 Hampshire’s chief medical examiner show. The state’s 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 Haley’s 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.

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 and drug overdose deaths

Military data from the Defense Department’s 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 agency’s reports say that 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.

We have seen this war death comparison before 

This is not the first time we have seen war deaths used to illustrate a public health issue’s 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. 

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"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 aren’t as useful as a benchmark."

The CDC 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.

Fentanyl as a Chinese threat

Haley’s other comments hint at why she’s 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.

Our ruling

Haley said, "We’ve 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 claim True.
 

Our Sources

Email Interview with Dr. Ryan Marino, associate professor at Case Western Reserve University School of Medicine, Dec. 17, 2023

Email interview with David Herzberg, History Professor at the University at Buffalo, Dec. 17, 2023

Interview with David Luckey, Senior International and Defense Researcher at the RAND Corp., Dec. 19, 2023 

National Institute on Drug Abuse, "Fentanyl DrugFacts" June 2021

Centers for Disease Control and Prevention, "Fentanyl Facts," Sept. 6, 2023

Drug Enforcement Administration, "Facts about Fentanyl," April 2021

New Hampshire Office of Chief Medical Examiner, "2022 NH Overdose Deaths," March 10, 2023

National Institute on Drug Abuse, "Drug Overdose Death Rates," June 30, 2023

U.S. News and World Report, "New Hampshire: Ground Zero for Opioids," June 28, 2017 

WMUR, "Fatal drug overdoses increasing in NH faster than rest of country," July 5, 2023

Defense Casualty Analysis System, "About the Data," accessed Dec 14, 2023

Defense Casualty Analysis System, "Conflict Casualties" accessed Dec 14, 2023

Centers for Disease Control and Prevention, "NVSS - Drug Overdose Deaths," Sept. 19, 2023

Centers for Disease Control and Prevention, "Data Brief 457. Drug Overdose Deaths in the United States, 2001–2021," Dec. 2022

The Washington Post, "Booker’s claim: More people have died from ‘gun violence’ in his lifetime than in all U.S. wars," Nov. 7, 2019

PolitiFact, "PBS commentator Mark Shields says more killed by guns since '68 than in all U.S. wars," Jan. 18, 2013

PolitiFact, "More Americans killed by guns since 1968 than in all U.S. wars, columnist Nicholas Kristof writes," Aug. 27, 2015

The Washington Post, "Biden’s messed-up math comparing war deaths to covid deaths," Feb. 23, 2021

TIME Magazine, "How the Coronavirus Death Toll Compares to Other Deadly Events From American History," Sept. 1, 2021

NBC News, "Nixon launched the war on drugs 50 years ago. Who won?," July 21, 2021

Vera, "Fifty Years Ago Today, President Nixon Declared the War on Drugs," June 17, 2021

Centers for Disease Control and Prevention, "FastStats - Leading Causes of Death," Jan. 18, 2023

U.S. Department of Veterans Affairs, "Vietnam Veterans," accessed Dec 18, 2023

PolitiFact, "PolitiFact | Gallagher misrepresents China’s role in US fentanyl crisis," June 27, 2023

Congressional Research Service, "China Primer: Illicit Fentanyl and China's Role," Sept. 28, 2023

PolitiFact, "Gov. Greg Abbott says fentanyl is the leading cause of death for Americans 18 to 45. Is that true?," April 24, 2023

Centers for Disease Control and Prevention, "Drug Overdose Mortality by State," March 1, 2022

The Washington Post, "Cause of death: Washington faltered as fentanyl gripped America," Dec. 12, 2022

USA Today, "GOP debate fact check: Separating fact from fiction on Republican candidates' claims," Sept. 27, 2023

U.S. News and World Report, "U.S. Military Deaths by War Since WWI," May 26, 2023

U.S. Census Bureau, "QuickFacts: United States," accessed Dec. 19, 2023

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Haley is correct that fentanyl deaths top casualties from 3 wars combined

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