Fentanyl is 50 to 100 times more potent than morphine. Users quickly develop a deadly tolerance. Over 50 percent of opioid-related deaths involve fentanyl. At least 25% of addicts commit suicide.
The real-life Walter White is a mild-mannered worker at an industrial materials company, who enjoys driving his white Jeep around town. His online name is Benjamin Chen, and he lives in the Ningxia region of northwest China. He sells the building blocks for illegal labs to make the suicide drug known as fentanyl.
According to the U.S. government-run DrugFacts website (www.drugabuse.gov), fentanyl is “a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.” It has valid uses, such as dealing with severe surgical pain, or to treat patients who have developed a tolerance to other opioids. I have personally seen it used to treat severely injured medical patients, through use of transdermal patches. The personalities of people I’ve known who were on fentanyl changed. They became moody, paranoid, and aggressive.
Even for legal, prescribed users, getting off fentanyl is no easy feat. The high is addictive, and users develop a tolerance very quickly, requiring more and more to achieve the desired high.
Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body's opioid receptors, which are found in areas of the brain that control pain and emotions.8After taking opioids many times, the brain adapts to the drug, diminishing its sensitivity, making it hard to feel pleasure from anything besides the drug. When people become addicted, drug seeking and drug use take over their lives.
It’s easy to overdose on fentanyl. Illegal labs produce it as a powder, which is dropped onto blotter paper, hidden in eye droppers and nasal sprays, or disguised in pill form as other prescription medicines. Just two milligrams can kill you. DEA analysis of counterfeit pills has found more than twice the lethal dose in a single tablet. Taking a pill—any pill—to get high is flirting with suicide. Trying to get out of the life, spent fighting the habit and seeking new supply, is also, for many who fail one too many times, a fight that ends in suicide.
Fentanyl is killing Americans by the tens of thousands, and the toll is increasing by double-digit rates. Any illegal drug can contain fentanyl because it has become so available.
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Dealers frequently cut fentanyl with heroin, cocaine, MDMA, or methamphetamine, creating a deadly cocktail of drugs that can kill a first-time user. Even a single shot of the anti-overdose drug naloxone (NARCANⓇ) may not be effective against a fentanyl overdose.
26% of tablets tested for fentanyl contained a lethal dose.
Drug trafficking organizations typically distribute fentanyl by the kilogram. One kilogram of fentanyl has the potential to kill 500,000 people.
It is possible for someone to take a pill without knowing it contains fentanyl. It is also possible to take a pill knowing it contains fentanyl, but with no way of knowing if it contains a lethal dose.
According to the CDC, synthetic opioids (like fentanyl) are the primary driver of the increases in overdose deaths in the United States, increasing 38.4 percent during the 12-month period ending May 2020. During this period:
37 of the 38 U.S. jurisdictions with available synthetic opioid data reported increases in synthetic opioid-involved overdose deaths.
18 of these jurisdictions reported increases greater than 50 percent.
10 western states reported over a 98 percent increase in synthetic opioid-involved deaths.
Source: CDC
In 2019, President Xi Jinping’s CCP banned fentanyl sales, which were primarily headed to the U.S. through the mail. Now, that channel has largely dried up, but suppliers are dealing in the base compounds that make up the powerful painkiller.
According to an NPR investigation published in November of 2020:
"You can do this sort of business from anywhere," said a salesperson at Crovell Biotech Co. Ltd., a fentanyl-analog vendor in Shijiazhuang. To keep operations secure, Crovell employees said they market and export their drugs in-house from Shijiazhuang, but the riskiest part — manufacturing the synthetic compounds themselves — was done by Crovell employees "not near here."
During the Trump administration, federal prosecutors opened a criminal investigation into large drug companies skirting regulations to pump up sales of addictive opioids, including fentanyl. The New York Times reported:
At least six companies disclosed in recent regulatory filings that they received grand jury subpoenas from federal prosecutors in Brooklyn: Johnson & Johnson, Teva Pharmaceutical Industries Ltd., Mallinckrodt PLC, Amneal Pharmaceuticals Inc., AmerisourceBergen Corporation and McKesson Corporation.
Travesties like Miami-Luken, Inc. distributing 2.3 million oxycodone pills to a single pharmacy in a town with about 1,400 residents drew charges for the company and two of its former officials, along with two pharmacists. Yet as early as 2016, U.S. authorities knew that China was the primary source of a flood of narcotics led by pill-form fentanyl disguised as Oxycontin or Xanax.
There were over 81,000 deaths resulting from opioid overdose in 2020, an 18.1 percent increase over 2019, after two years of declines. You might think this is a small number compared to the 600,000 deaths from COVID-19 in America, and you’d be right in terms of raw scale. But opioid deaths aren’t distributed in the same way as COVID-19, which primarily hit older Americans, and COVID-19 is an event with a clear beginning, a few waves, and hopefully, an end. For addiction and death, there is no vaccine.
Opioid-, and specifically fentanyl-related deaths are more concentrated in poor communities, and highly correlated with high unemployment. Ohio and West Virginia in the rust belt have rates greater than 27.8 per 100,000 people, based on 2018 CDC data, joined by Massachusetts and New Hampshire, which have opioid addiction rates at epidemic proportions.
Further, the mortality per 100,000 is as high as 60.9 for Blacks, versus 41.7 for whites in West Virginia; 32.3 versus 25.4 in Pennsylvania; and a whopping 43.6 versus 16.5 in Missouri. Drug addiction, and inevitably, death, target the poor and disadvantaged. Those who don’t end up in prison, caught in a cycle of arrest, lockup, rehabilitation, release, and relapse, frequently die from one of the many “bad” batches made increasingly in Mexico, Columbia, and even in the U.S. from ingredients supplied by Chinese companies.
Surely the pandemic contributed to increases in overdoses, but worse than that is the number of suicides. One 2008 paper by a Cornell University Medical College researcher cited studies that put the number of of alcohol and drug-related suicides at over 50 percent, and the percentage of alcoholics and drug addicts who commit suicide at one in four. For every 20 people who get hooked on fentanyl-laced painkillers or recreational drugs, five will die by suicide, and several more will die by overdose. This happens day after day, and year after year, and after a few years of small but useful decreases, the pandemic has flushed all those gains down the proverbial toilet.
History suggests this problem cannot be solved by making drugs “more illegal” or locking up people who succumb to them. In the 1850s, China was captured by an opium trade with the west—primarily England. England and China actually fought two “wars” over opium, because the British were so attached to the profits dealing drugs brought them. British opium was grown in India, sold in China, in exchange for tea, silk and porcelain that were popular at home.
Of course, this led to the Chinese becoming addicted.
By the early 19th century, more and more Chinese were smoking British opium as a recreational drug. But for many, what started as recreation soon became a punishing addiction: many people who stopped ingesting opium suffered chills, nausea, and cramps, and sometimes died from withdrawal. Once addicted, people would often do almost anything to continue to get access to the drug. The Chinese government recognized that opium was becoming a serious social problem and, in the year 1800, it banned both the production and the importation of opium. In 1813, it went a step further by outlawing the smoking of opium and imposing a punishment of beating offenders 100 times.
After a punishing war in which England flexed her naval power, the Chinese were compelled to sign the Treaty of Nanjing, which ceded Hong Kong to the British Empire, while re-opening the opium trade after it was banned.
The lesson for today should be heard: consumption and demand for addictive drugs, despite them being illegal and carrying stiff penalties at home, are really foreign policy issues when a foreign power is your “pusher.” The Chinese legalized opium in 1858 after the second Opium War. One paper suggests that opium price and exports based on the amount imported had little effect on consumption in 19th century China.
Today, the roles have been flipped. China can’t fight the U.S. with military power, but the communist nation has a long memory of its drug war with the west. Despite a ban on selling fentanyl directly to the U.S., China is not aggressively pursuing firms finding loopholes big enough to drive a semi-truck through in moving fentanyl ingredients through its massive supply chain, into countries like Mexico and then into the U.S. China profits (and all companies in China are basically owned by the state), while Americans die of addiction.
Mexican cartels have also begun distributing fentanyl products, using ingredients largely made in China. "Now the role of China — and the growing role of India — is sending precursor chemicals directly to cartels in Mexico to produce the fentanyl in clandestine labs," the DEA's Donahue said. "You push on a balloon, it pops somewhere else."
If we shut down fentanyl, Chinese companies will simply pivot to benzimidazoles, which are largely unregulated. Read this warning on the synthetic compound called isotonitazene:
Pharmacological data suggest that this group of synthetic opioids have potency similar to or greater than fentanyl based on their structural modifications. Etonitazene is reported to be the most potent of the group followed by isotonitazene and metonitazene. The toxicity of isotonitazene has not been extensively studied but recent association with drug user death leads professionals to believe this new synthetic opioid retains the potential to cause widespread harm and is of public health concern. Isotonitazene has been identified in eight blood specimens associated with postmortem death investigations in the United States since August 2019. Isotonitazene was first reported in August 2019 based on the results from seized drug and toxicology casework in Europe (Belgium) and Canada (Alberta); the Canadian toxicology case was collected in March 2019.
We should be concerned about the origin of SARS-CoV-2 and its connection to a Wuhan BSL-4 lab that was conducting gain-of-function research on coronaviruses. We should be more concerned that China is ready to ship thousands of tons of suicide drugs into the U.S.
This is a major foreign policy problem, and one that deserves much more attention from our government than it has been given. Under President Trump, China banned fentanyl sales, though they continue to supply the ingredients to drug cartels. Now it’s President Biden’s turn to apply pressure on the Chinese government to end this new synthetic opium war that continues to rain death and tragedy on American families.
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For a deeper read on this subject, check out Sam Quinones "Dreamland"[1]:
"Ground zero for the pills is southern Ohio, West Virginia, Kentucky, places like this. In the mid-'90s, at that same time, across the Mississippi is coming the vanguard of a group of heroin traffickers out of a small town called Xalisco in the state of Nayarit in Mexico who are taking their drugs and looking for new markets. All of this kind of coincides."
"[Mexican drug cartels] used customer service, they deliver just like pizza delivery, and it really appeals to this new class of addict who were white, really kind of unfamiliar, maybe, a lot of times with the drug world."
"They don't want to get involved in Skid Row or some housing projects where everyone has always bought dope. A drug addict wants one thing above all and that's reliability. And these guys provided that above all. They relied on being very low-profile. They did not spend their money lavishly. They looked like the day workers outside your Home Depot. They drove old cars, they never used gunplay, drive-by shootings, any of that kind of stuff because, they didn't need to."
...
"All these guys don't like selling heroin. But here's the thing: Back in the town where they're from they have been humiliated all their lives. Their jobs are dead-end jobs. They work as bakers, they work as farm boys, they work as butchers — they don't have anything pushing them ahead."
"As this business model began to take hold, the effects were immediately seen in the town. People began to do better. They began to build big houses, they began to have nice trucks, nice cars. And all around them young men saw this. They saw that this was a route to real economic progress. One of the strangest things I encountered when I was doing this book was how Levi's 501s were these huge forces in pushing this system across the United States."
"They're these very well-made, very expensive jeans. Well, this system was a system for turning cheap heroin into ... stacks of Levi's 501s. The reason was that these dealers very quickly noticed that these addicts they were selling to were fantastic shoplifters."
"They would give these guys lists: 'I need Levi's 501s this size, this color,' because they would then take those jeans back home and act as Santa Claus. It was like this huge redemption: 'I left poor. And here I am bringing Levi's 501s for everyone.' And there was nothing cooler than walking around town during the fiesta or late at night on a Friday in your beautiful dark, blue Levi's 501s. For a person who comes from the smallest, most humble origins in these towns — that is a narcotic itself." [2]
I don't know to what extent things have changed since this 2015 book (my understanding is that the business has become more violent), but alongside with confronting China on this issue, improving the economy of our southern neighbors HAS to be part of the approach, otherwise, we'll just be playing Whack-A-Mole as the industry shifts around geographically, but there's still demand for the product and the jobs for young men supplying that demand.
For a deeper read on this subject, check out Sam Quinones "Dreamland"[1]:
"Ground zero for the pills is southern Ohio, West Virginia, Kentucky, places like this. In the mid-'90s, at that same time, across the Mississippi is coming the vanguard of a group of heroin traffickers out of a small town called Xalisco in the state of Nayarit in Mexico who are taking their drugs and looking for new markets. All of this kind of coincides."
"[Mexican drug cartels] used customer service, they deliver just like pizza delivery, and it really appeals to this new class of addict who were white, really kind of unfamiliar, maybe, a lot of times with the drug world."
"They don't want to get involved in Skid Row or some housing projects where everyone has always bought dope. A drug addict wants one thing above all and that's reliability. And these guys provided that above all. They relied on being very low-profile. They did not spend their money lavishly. They looked like the day workers outside your Home Depot. They drove old cars, they never used gunplay, drive-by shootings, any of that kind of stuff because, they didn't need to."
...
"All these guys don't like selling heroin. But here's the thing: Back in the town where they're from they have been humiliated all their lives. Their jobs are dead-end jobs. They work as bakers, they work as farm boys, they work as butchers — they don't have anything pushing them ahead."
"As this business model began to take hold, the effects were immediately seen in the town. People began to do better. They began to build big houses, they began to have nice trucks, nice cars. And all around them young men saw this. They saw that this was a route to real economic progress. One of the strangest things I encountered when I was doing this book was how Levi's 501s were these huge forces in pushing this system across the United States."
"They're these very well-made, very expensive jeans. Well, this system was a system for turning cheap heroin into ... stacks of Levi's 501s. The reason was that these dealers very quickly noticed that these addicts they were selling to were fantastic shoplifters."
"They would give these guys lists: 'I need Levi's 501s this size, this color,' because they would then take those jeans back home and act as Santa Claus. It was like this huge redemption: 'I left poor. And here I am bringing Levi's 501s for everyone.' And there was nothing cooler than walking around town during the fiesta or late at night on a Friday in your beautiful dark, blue Levi's 501s. For a person who comes from the smallest, most humble origins in these towns — that is a narcotic itself." [2]
I don't know to what extent things have changed since this 2015 book (my understanding is that the business has become more violent), but alongside with confronting China on this issue, improving the economy of our southern neighbors HAS to be part of the approach, otherwise, we'll just be playing Whack-A-Mole as the industry shifts around geographically, but there's still demand for the product and the jobs for young men supplying that demand.
[1] https://www.nytimes.com/2015/04/19/opinion/sunday/serving-all-your-heroin-needs.html
[2] https://www.npr.org/2015/05/19/404184355/how-heroin-made-its-way-from-rural-mexico-to-small-town-america
The two I've know who used it are deceased. They were the children of friends and relatives.