Lessons from ‘Fentanyl, Inc.’

By Roger Chriss, PNN Columnist

The new book “Fentanyl, Inc.” by investigative journalist Ben Westhoff takes a close look at illicit fentanyl, synthetic drugs and the overdose crisis.

Westhoff tracks the history of fentanyl, interviews “Dark Net” drug dealers and infiltrates Chinese chemical manufacturing firms as a prospective buyer. He explores how the production, sale and use of illicit drugs has evolved with the creation of fentanyl and other new psychoactive substances (NPS).

Westhoff starts with a brief history of opioids and the overdose crisis, saying that the “vast majority of legitimate users of OxyContin and other opioid medicines receive the intended benefit.”

But addiction and overdose became real problems, due in part to misbranding by Purdue Pharma, Insys Therapeutics and other drug companies, as well as missed regulation by the FDA and DEA.

Fentanyl itself was first developed by Paul Janssen in 1960 as a surgical anesthetic. As Westhoff notes, “Without this compound and its analogue, sufentanil, open-heart surgery would not be possible.”

But fentanyl and other newly developed synthetic compounds quickly escaped into the wild. Westhoff explains how fentanyl powder mixed with heroin became known as China White, “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.”

These new chemicals entered a changing world. Westhoff describes how the new drug trade grew for the same reasons the economy grew – the increased speed of communications, Internet technology, improved shipping, relaxed trade barriers and the relentless search for higher profit margins.

Illicitly manufactured fentanyl is produced, sold and used outside of standard medical care. In fact, most drug abusers don’t even want fentanyl, but it’s often cut into the drugs they seek, such as heroin, meth, cocaine and counterfeit pills. Other times they’ll get fentanyl because nothing else is available and they fear withdrawal.

‘Drug Policy In Shambles’

The supply lines for illicit fentanyl and other synthetic opioids are clear, too. A small amount is made in the United States or comes into the country on planes or boats. Most commonly, however, it enters in the mail from China or is smuggled across the border from Canada or Mexico.

Westhoff ultimately goes to the source, talking to Chinese manufacturers of fentanyl precursors and to Dark Net drug resellers. He listens to Chinese sales staff explain how the fentanyl precursors are not technically illegal in China and so can be sold as desired, and interviews a Dark Net dealer who justifies his work as a form of harm reduction.

Westhoff is unstinting in his criticism of China: “There is little doubt that China is undercutting its publicity stated goal of stopping the export of dangerous drugs for illicit use. That’s because the country actively encourages the export of fentanyl and fentanyl precursors—and even synthetic cannabinoids—through its tax code and high-tech subsidies.”

But other countries may be worse still. While China has been at least somewhat responsive to American requests to control its chemical industry, India has failed to schedule synthetics and fentanyl precursors to stop their production. Mostly, however, he says that America is not equipped to deal with synthetic drugs.

“Today, US drug policy is in shambles. Our laws—and those in countries around the world—simply weren’t ready for the NPS revolution,” he writes.

In other words, there is no way to control supply anymore. That leaves prevention, harm reduction, and treatment. Westhoff describes the efforts of drug education campaigns like DanceSafe, Energy Control and Drogart, and novel drug treatment ideas like safe injection sites and prescription-grade heroin.

“Curbing the tide of US opioid deaths will require sweeping new public-health initiatives, including treatment programs and campaigns to educate everyone, from users and medical providers to teachers and police, about the drugs’ dangers,” Westhoff says.

He also recognizes that drug use and addiction occur in a broader context. Many drug users are coping with childhood trauma or have a mental health disorder.

The main lesson of “Fentanyl, Inc.” is that we are facing a drug overdose crisis that involves new substances, new usage patterns and new drug markets. We’re not dealing with a single chemical like alcohol or a plant like cannabis. Nor are we just dealing with medical practice gone wrong. Instead, we’re facing something new, and we need to adapt.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.