The Lethal Business of Synthetic Drugs Like Fentanyl
A new book shows that the shift to opioids manufactured internationally in labs has created a deadly drugs crisis
In 2014, two 18-year-old roommates in Grand Forks, North Dakota, named Bailey Henke and Kain Schwandt, were unraveling from opioid addictions. Over Christmas vacation, they took a road trip, trying to kick their habits. They brought along Suboxone, a drug that helps ease withdrawal. And it seemed to work. They both came home clean.
Within days, though, they relapsed. A friend procured a dozen grams of heroin and a gram of fentanyl — both bought from the now defunct darknet site Evolution. This fentanyl wasn’t the pharmaceutical-grade version that had been around for decades. Rather, it was made thousands of miles away, in a Chinese lab run by a chemist named Jian Zhang. Shortly after ingesting the drug, Henke slumped over, and suffered a fatal overdose.
Henke’s death sparked an international investigation that led to 32 arrests, including that of his darknet dealer. But Zhang, the chemical manufacturer based in Shanghai, called the “kingpin” of the drug, was off-limits — China officials said he didn’t break any of their laws. Fentanyl abuse, they insisted, was an American crisis — not theirs.
Henke’s story is just one of many recounted in Ben Whitehoff’s finely-crafted and alarming new book, Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic, which chronicles the rise of a group of narcotics called “novel psychoactive substances” (NPS), like illicit fentanyl, and draws on troves of source material and interviews with 160 people.
Over the course of his reporting, Whitehoff convinced a darknet dealer to meet with him at a fast-food chain. He traveled to Slovenia to talk with one of the main sellers of a drug that mimics cocaine called “ice cream,” dubbed with that name because it’s cut with vanilla protein powder. Most impressively, he traveled to China, posed as a fentanyl buyer, and penetrated two massive drug operations.
Westhoff says he first stumbled upon the spike of NPS accidentally. In 2013, while he was still the music editor of LA Weekly, he began investigating an increase in fatalities at electronic dance music festivals. Much of the blame fell to “Molly,” a drug being touted as unadulterated MDMA, otherwise known as ecstasy. Westhoff says that the allegation seemed off — among other reasons, ecstasy overdose deaths were exceedingly low.
Molly, it turned out, stood for whatever dealers wanted it to be. Sometimes it carried a trace of MDMA, says Westhoff, but “most likely [contained] a hodgepodge of bizarre drugs with complicated chemical names users have never heard of, including so-called ‘bath salts.’”
A kilogram of heroin is purchased for approximately $6,000 and sold for approximately $80,000. A kilogram of fentanyl is purchased for approximately $6,000 and sold for approximately $1.6 million.
Indeed, almost every drug has been remanufactured as a “novel psychoactive substance” at this point. That includes marijuana, which has been turned into synthetic cannabinoids — a drug that doesn’t contain THC but still acts upon cannabinoid receptors, and can cause an overdose (unlike conventional marijuana). A drug called 25C-NBOMe, a synthetic hallucinogen nicknamed “N-bombs,” which often gets falsely touted as LSD and can be fatal.
The spike of NPS partly stems from how cheaply they can be made. Manufacturing cocaine, for instance, requires the organic base of coca, which takes time to grow, ample property, and the right climate. The same with opium poppy, which produces heroin.
But laboratories can crank out synthetic analogues out with relatively little overhead. According to the Minnesota Department of Health, a “kilogram of heroin is purchased for approximately $6,000 and sold for approximately $80,000. A kilogram of fentanyl is purchased for approximately $6,000 and sold for approximately $1.6 million.”
The NPS business, in other words, is very good.
Fentanyl was first synthesized in 1959, and over the next four decades, its most common use was as an anesthetic. Trouble came early: at the tail end of the 1970s, a weird and mystifying drug called China White emerged on the market, promoted as “the finest heroin available — pale in color and originating in East or Southeast Asia.” But China White, also called “Persian Heroin” and “Gasoline Dope,” didn’t contain any of the plant-based opiate heroin does. Rather, it was an analogue of fentanyl.
“China White represented a fish-crawling-onto-land moment,” Westhoff writes. “It was the first popular, illicit drug synthesized by a rogue chemist that was new, rather than simply a copy of something already on the medical market.” That also meant that it was initially legal in the United States.
An ongoing theme with the synthetic drug industry is the ability of NPS to weave in-and-out of legality. As soon as one NPS is banned, chemists can simply alter a couple of molecules and reintroduce it to the market. According to Westhoff, “when it comes to creating synthetic drugs, the mathematical possibilities are endless.” This cycle is often likened by law enforcement officers to a “game of whack-a-mole.” You knock one drug down, another one immediately rears its head.
Fentanyl is known for being cut with, or for being falsely sold as, heroin. Increasingly, it’s also being camouflaged as pain medication tablets — complete with authentic-looking logos. Bogus Xanax bars, increasingly cut with fentanyl, even feature legit-looking scores on the pill that allow it to be broken into smaller doses.
“The new drugs-trade is growing for the same reason the world economy is — increasing speed of communications and shipping; relaxed barriers to trade, and the pressure for higher profit margins.”
Fentanyl doesn’t discriminate, and recently claimed several high-profile victims. The musician Prince fatally overdosed from counterfeit Vicodin dosed with fentanyl. Rocker Tom Petty had fentanyl derivatives in his system when he passed, and the 21-year-old hip-hop artist Lil Peep died from a lethal cocktail of fentanyl and Xanax. And while the media has occasionally done a lackluster job getting facts right about the drug (such as falsely claiming that simply touching it can be fatal), illicit fentanyl is an outright health crisis in the United States.
Westhoff makes a convincing case that our problems with fentanyl and NPS are a story about global capitalism — one that is becoming unhinged. “The new drugs-trade is growing for the same reason the world economy is growing — increasing speed of communications, internet technology, and shipping; relaxed barriers to trade, and, of course, the ever-present pressure for higher profit margins.”
Take carfentanil, a fentanyl derivative. Carfentanil is so strong (roughly 100 times more than fentanyl) that one of its main uses is by veterinarians as a tranquilizer for sedating elephants. As one official in Tucson put it, “[p]eople have to understand there’s absolutely zero use [for carfentanil] for humans. None.” But like most NPS, it’s a money maker. A kilo of carfentanil, Westhoff writes, can be snatched up for roughly $3,000 from China, or $3 per gram, and then flipped in the United States for $800 per gram.
“Today, U.S. drug policy is in shambles,” Westhoff writes, rightfully, towards the end of the book. “Our laws — and those in countries around the world — simply weren’t ready for the NPS revolution.” That’s an understatement, to be sure, and it’s hard to imagine a policy that could outright contain the global trade of NPS — especially since the current legislation largely governing drugs in the United States is a 1961 United Nations treaty called the Single Convention on Narcotic Drugs. “We have a regulatory system that’s designed for plant-based drugs,” Westhoff quotes a policy researcher as saying. “The 1961 convention was based on a collection of earlier international agreements and resolutions governing poppy, coca, and cannabis, and their derivatives.”
In a recent Twitter tirade about China, Donald Trump said fentanyl manufactured in the country kills more than 100,000 Americans every year. As per usual with him, that’s wrong. Still, the death-toll statistics are stark. In general, more than 70,000 Americans died from drug-related overdoses in 2017, and of those numbers, over 47,000 were fatalities from opiates, according to the National Center for Health Statistics. And roughly 28,000 of those deaths stemmed from fentanyl or its analogues.
As Westhoff has it, though, “those quick to blame China should bear in mind that the American government doesn’t have its hands clean.” Both global forces are pumping out opioids in massive, maddening numbers. “The U.S. generally does so legally, as medicine, while China also does so illicitly, as drugs, but the damage from each country fuels the other,” Westhoff adds. “Neither is taking sensible means to stop it. While they focus on blaming each other, the contagion continues to spread around the globe.”
Nonetheless, illicit drugs aren’t going away. And U.S. politicians still can’t wrap their heads around this fact. In a recent press release for Trump’s 2020 National Drug Control Budget, the failed war-on-drugs rhetoric is encapsulated in the statement that the increased budget is the administration’s “commitment to solving the addiction epidemic.”
That’s an outright bootless errand — a border wall won’t “solve” something like fentanyl (a drug where a huge amounts of doses can fit snugly in a shoebox and shipped Priority by the USPS). Nor will ramping up law enforcement. The zero-sum mindset of mass drug incarceration is what got the country here in the first place.
What’s more, the White House budget proposal includes drastic cuts to Medicaid, which some have called a “disaster for the crisis,” because so many Americans with an opioid dependence rely on the program for treatment.
A more sensible approach, one which Westhoff advocates, is harm reduction — making sure the drugs used are done so as safely as possible. Crucially, Westhoff points out that the stigma-laced idea that becoming dependent on an opioid is “an irreversible rewiring of the brain” — one that’s “impossible to break free” — is wrongheaded.
“The problem for many is that expecting them to get their lives in order and go through withdrawal at the same time is asking too much,” Westhoff contends. And while too many treatment providers still stress the abstinence-only attitude, medication-assisted treatment (or MAT) seems to be the more humane approach, such as providing buprenorphine, which is marketed as the above mentioned Suboxone and Subutex).
At one point, Westhoff talks with the head of a substance-abuse clinic, Dr. Jaye Shyken, who pushes for the use of MAT. “When people say, ‘Dr. Shyken, aren’t you just substituting one drug for another?’ I say, ‘Yes, what’s your point?’ It’s saving lives.”
The sensible approach, an idea that emerges from reading Westhoff’s book, is understanding that the production of NPS can’t be stopped. And, in the end, the abuse of them is a medical issue — not a criminal justice one. Dr. Shyken gets this, the United States still doesn’t.