Following the abrupt ending of the highly anticipated second bilateral summit between President Donald Trump and North Korean leader Kim Jong-un in Hanoi, APARC and CISAC scholars evaluate the result of the summit, its implications for regional relations in Northeast Asia, and the opportunities moving forward towards the goal of denuclearization of the Korean peninsula.

This Q&A with Noa Ronkin features Andray Abrahamian, the 2018-19 Koret Fellow in Korean Studies at APARC, whose work with the nonprofit Choson Exchange has taken him to the DPRK nearly 30 times; Siegfried S. Hecker, top nuclear security expert, former Director of the Los Alamos National Laboratory, Research Professor of Management Science and Engineering, Emeritus, and Senior Fellow at CISAC/FSI, Emeritus; and Gi-Wook Shin, Professor of Sociology, William J. Perry Professor of Contemporary Korea, Director of APARC, and founding Director of the Korea Program.

We sat down with our 2018-19 Koret Fellow in Korean Studies Andray Abrahamian to discuss North Korea denuclearization and the approaching Trump-Kim second summit in Hanoi; Abrahamian's work with the nonprofit organization Choson Exchange that took him to North Korea nearly thirty times; his book that compares North Korea and Myanmar; and his fellowship experience. Watch: 

This post was originally published on Axios.

Where it stands: Trump and Kim each face immense pressure, both international and domestic, to make progress.

• Trump needs to earn political trust back in Washington to continue negotiating with North Korea. His strategy so far has been to convince Kim that North Korea’s denuclearization would bring the country a “bright future.”
• At the same time, Trump must address Kim’s concerns about whether any agreement reached with his administration will withstand the Democrat-controlled House and survive the post-Trump era.

Between the lines: Successful diplomacy sometimes entails purposeful ambiguities, and the ambiguities of the first Trump-Kim summit might indeed have been strategic. At this critical juncture, however, a failure on Trump’s and Kim’s part to commit to defined objectives could hurt the bilateral relationship.

The bottom line: Trump and Kim need support more than ever to advance their diplomatic endeavors. While spectators have good reason to be skeptical, and one can only be cautiously hopeful with North Korea, a return to confrontation or "strategic patience" is in no one’s interest.

Gi-Wook Shin is the William J. Perry Professor of Contemporary Korea and director of the Walter H. Shorenstein Asia-Pacific Research Center at Stanford University.

What does it take to make progress on the denuclearization of the Korean Peninsula? Five FSI scholars offer their perspective.

Siegfried S. Hecker, FSI Senior Fellow Emeritus, with Elliot A. Serbin, at the Center for International Security and Cooperation (CISAC)
Looking back at 2018, we judge the first Trump-Kim summit in Singapore to have been a step in the right direction and bought time and space for diplomacy. But since the first summit, little progress has been made toward new relations and a peace regime in part because the Trump administration continues to insist on maximum pressure and sanctions until North Korea denuclearizes, in contrast with Pyongyang’s insistence on a step-by-step process requiring corresponding U.S. actions. At the same time, North Korea has not denuclearized, but it has halted key elements of what was a rapidly expanding nuclear and missile program in 2017. This halt represents an important step in the right direction as explained in our recent update on North Korea’s nuclear history, which examines the trade-offs and interplay between key components of the nuclear program. Our findings show that North Korea has been expanding its bomb fuel inventory, allowing it to potentially increase the size of its arsenal. But the end of nuclear and missile testing has reduced the overall threat posed by the North’s arsenal, significantly limiting the potential sophistication, destructive power and reach of the arsenal by impairing the North’s ambitions for hydrogen bombs and nuclear-tipped intercontinental ballistic missiles, both of which are still very much in the developmental stage. At the upcoming summit Washington should push to further reduce the threat posed by North Korea’s arsenal. A key goal is to lock in the end of nuclear and missile testing and have North Korea agree to end the production of bomb fuel in a verifiable manner. Clearly, this will require Washington to move decisively toward normalization, with some form of sanction relief.

Gi-Wook Shin, FSI Senior Fellow, Director of the Walter H. Shorenstein Asia-Pacific Research Center (APARC) and founding Director of the Korea Program
The leaders of the United States and North Korea should use the Vietnam summit as an opportunity to minimize existing ambiguities and divergences in central questions, before they can make any meaningful progress toward denuclearization and whatever measures for the progress of denuclearization. The most basic yet urgent task is to come to a shared understanding of what denuclearization would entail. The ambiguity and obscurity of the term “denuclearization” only exacerbates the skepticism about both the U.S. and North Korean commitments to denuclearization. The future of the U.S.-Republic of Korea (ROK) alliance is another critical issue that needs to be addressed, not avoided, in Hanoi. The Vietnam meeting should leave no ambiguity in its affirmation that the U.S.-ROK alliance is not to be jeopardized in the context of U.S.-DPRK (Democratic People’s Republic of Korea) rapprochement; nor is it to be used as a reward for North Korea’s denuclearization. Lastly, the Trump administration’s vision for a “more stable and peaceful, and ultimately, a more legal peace regime” in Korea will need to be explained fully to, and understood clearly by, the North Korean leadership. Whether the means used to establish this regime will be a peace treaty, a formal end to the armistice, a combination of both, or something yet unknown is an issue that needs to be discussed and agreed upon up front in order to avoid further confusions and complications. Only bold and meaningful moves that resolve these ambiguities will enable a timely, historic breakthrough on the Korean Peninsula and will add much-needed momentum to the diplomatic endeavors of all countries involved.

Yong Suk Lee, SK Center Fellow and Deputy Director of the Korea Program at Shorenstein APARC
To hypothesize about the outcomes of the second Trump-Kim summit and what lies ahead for U.S.-North Korea relations, we should reflect on how the two leaders met in the first place. One could argue that their first meeting was somewhat accidental, an artifact of Trump’s spontaneity following a period of heightened hostility between the U.S. and North Korea. The first summit between the two leaders was historic in its own right and it put on a good show. However, there hasn’t been much progress on denuclearization since then. Despite little progress the two are meeting again, and this second meeting is no accident. After their first meeting Trump and Kim must have struck a chord. In fact, Trump mentioned that the two had “fallen in love” after receiving a “beautiful” letter from Kim last October. What triggers their mutual attraction? Certainly not their distaste for nuclear weapons. The common interest that brings the two together is their desire for development – economic development in the case of Kim Jong Un and property development in the case of Donald Trump. Of the many unconventional aspects in the Trump-Kim relationship, what I find most extraordinary is Trump’s showing of a short film on North Korea’s potential for property development during their first summit meeting. It was truly an unusual diplomatic pitch. I believe that economic and property development will be on their agenda when they meet in Hanoi. There may even be a sequel to that short film. Trump and Kim may emerge with a joint property development agenda, while deferring denuclearization to be sorted out by their diplomatic teams.

Colin Kahl, FSI Senior Fellow and Co-director at CISAC
Diplomacy is essential for resolving the nuclear crisis on the Korean Peninsula, and President Trump should get credit for keeping the high-level dialogue with Kim Jong Un going. However, last year’s Singapore summit, while producing great theater, produced little of substance. North Korea has frozen its missile and nuclear testing, but its program continues to grow. In the eight months since the two leaders met in Singapore, little tangible progress has been made, and the two sides still appear very far apart on basic concepts like the meaning of “denuclearization” and the proper sequencing among nuclear steps, moves toward normalization, the signing of a peace treaty and sanctions relief. The big worry going into the summit is that it will produce either “too little” or “too much.” One fear is that President Trump will accept “too little” – that is, more diplomatic symbolism to continue the appearance of progress while North Korea takes few concrete steps to roll back its nuclear program. Another risk is that President Trump will give “too much” in exchange for North Korean actions, in particular by taking steps that weaken the alliance with South Korea or drastically downsize the U.S. military presence on the Peninsula (which Trump has never liked).

Thomas Fingar, Shorenstein APARC Fellow
The issues dividing the United States and the DPRK are so complicated and our mutual animosity so deep that resolution will take time and require extensive negotiations to build trust and deepen understanding of one another’s concerns and objectives. The most that should be expected from the Hanoi summit is agreement – and commitment – to continue the process of engagement by instructing and empowering subordinates to meet regularly, listen carefully and seek ways to both build a better relationship and to resolve specific issues in the context of transforming the relationship from one of distrust and animosity to one that identifies mutual interests and manages issues that cannot be resolved immediately.

Related: Andrew Kim on North Korea Denuclearization and U.S.-DPRK Diplomacy
Former head of the CIA’s Korea Mission Center Andrew Kim, currently the William J. Perry Visiting Scholar at APARC, provides insights into the process of diplomatic engagement with the DPRK and outlines a roadmap for achieving the U.S. goal of North Korea denuclearization.

This post is based on the Stanford News article What’s next for North Korea? Stanford scholars discuss the diplomacy of denuclearization, published February 25, 2019.

Opioids overdoses now kill more Americans than car accidents or guns, with more than 350,000 Americans having succumbed to the painkillers since 2000.

“The opioid misuse and overdose crisis touches everyone in the United States,” Health and Human Services Secretary Alex Azar said in this recent report. “The effects of the opioid crisis are cumulative and costly for our society — an estimated $504 billion a year in 2015 — placing burdens on families, workplaces, the health care system, states, and communities.”

Now, new research led by Stanford shows that not only have opioid-related deaths jumped fourfold in the last 20 years, but that those most affected by the epidemic, and where they live, has also shifted dramatically. In fact, the District of Columbia has had the fastest rate of increase in mortality from opioids, more than tripling every year since 2013.

“Although opioid-related mortality has been stereotyped as a rural, low-income phenomenon concentrated among Appalachian or midwestern states, it has spread rapidly, particularly among the eastern states,” writes Mathew V. Kiang, ScD, a research fellow at the Center for Population Health Sciences at the Stanford University School of Medicine, in an original investigation published in JAMA Network Open.

The study found the highest rates of opioid-related deaths and more rapid increases in mortality were observed in eight states: Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire and Ohio. Two states, Florida and Pennsylvania, had opioid-related mortality rates that were doubling every two years — and tripling in Washington, D.C.

Kiang and his co-authors, including Stanford Health Policy’s Sanjay Basu, MD, PhD,an assistant professor of medicine at Stanford Medicine, used data from the National Center for Health Statistics and corresponding population estimates from the U.S. Census. The other authors are Jarvis Chen, ScD, at the Harvard T.H. Chan School of Public Health, and Monica Alexander, PhD, in the Department of Sociology at the University of Toronto.

“It seems there has been a vast increase in synthetic opioid deaths in the eastern states and especially in the District of Columbia because illicit drugs are often tainted with fentanyl or other synthetic opioids,” Kiang said in an interview.  “People aren’t aware their drugs are laced and more potent than they expected — putting them at higher risk of overdose.”

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Synthetic opioid deaths now outnumber heroin deaths in these eastern states, which suggests fentanyl has spread to other illegal drugs and is no longer limited to heroin.

“The identification and characterization of opioid `hot spots’ — in terms of both high mortality rates and increasing trends in mortality — may allow for better-targeted policies that address the current state of the epidemic and the needs of the population,” the authors write.

The research suggests the opioid epidemic has evolved as three intertwined, but distinct waves, based on the types of opioids associated with mortality:

1. The first wave of opioid-related deaths was associated with prescription painkillers from the 1990s until about 2010.
2. From 2010 until the present, the second wave was associated with a large increase in heroin-related deaths.
3. And in the third and current wave, which began around 2013, the rapid increase is associated with illicitly manufactured synthetic opioids, such as tramadol and fentanyl.

“The evolution has also seen a wider range of populations being affected, with the spread of the epidemic from rural to urban areas and considerable increases in opioid-related mortality observed in the black population,” they write.

The Centers for Disease Control and Prevention reports that African-Americans experienced the largest increase in opioid overdose deaths among any racial group from 2016 to 2017, with a 26 percent surge.

“The identification and characterization of opioid ‘hot spots’ — in terms of both high mortality rates and increasing trends in mortality — may allow for better-targeted policies that address the current state of the epidemic and the needs of the population,” the researchers write.

States are trying to combat the epidemic by enacting policies, such as restricting the supply of prescription drugs and expanding treatment and access to the overdose-reversing drug naloxone.

“Treating opioid use as a disorder should be our top priority to curb the problem,” said Kiang. “Similarly, we have the ability that counteract the effects of an overdose — these life-saving drugs should be easily accessible and widely available.”