China's role in the U.S. fentanyl epidemic

https://news.yahoo.com/chinas-role-in-the-us-fentanyl-epidemic-152338423.html

by Eoan • 6 years ago

67 62 6 years ago

news.yahoo.com

olliej• 6 years ago

Um, American drug companies created the opioid epidemic, and then fueled it with aggressive marketing, kickbacks, and bribery.

Fentanyl is a relatively recent addition to a crisis those companies started in the early 90s.

Mountain_Skies• 6 years ago

Could someone explain what is incorrect about parent's statement for it to deserve downvotes? It seems to be in line with the prevailing narrative of the past decade or so.

nate_meurer4• 6 years ago

Maybe starting out a comment with "um..." as though everyone else is stupid, and then following up by merely restating the prevailing narrative, which has little to do with the assertions made in the article. Maybe that's a reason for some of the disagreement.

saber6• 6 years ago

It is a MVC: Minimal Value Comment

happytoexplain• 6 years ago

There are many ways in which a post can have low, or even negative, value. Being "incorrect" is only one, and a relatively rare one.

Eoan2• 6 years ago

Jingoism

nate_meurer4• 6 years ago

So, do you have anything substantive to say about the article? Do you disagree with anything in it? Did you notice that the article actually agrees with you?:

And so, when we're talking about who's to blame for the fentanyl crisis, we've got to start at home. Why is the demand so high? But in terms of China, and that's what I really focused on in my book in large part, China is not only doing a poor job stopping fentanyl from getting exported to the US, they are even encouraging it in a lot of ways, through the tax code and all these complicated ways that add up to a really troubling situation.

Do you disagree with any of that? Do you believe that China's massive and uncontrolled supply had no effect on the opioid epidemic?

DanBC• 6 years ago

Do you believe that China's massive and uncontrolled supply had no effect on the opioid epidemic?

That's not a bizarre position to take when most addicts started on prescribed meds, whether those meds were prescribed for them or diverted from friends and family members. People move onto fentanyl when they've developed a tolerance for prescription meds and can no longer get higher doses.

Why don't other places have such a big problem with fentanyl?

dntbnmpls2• 6 years ago

Do you disagree with any of that? Do you believe that China's massive and uncontrolled supply had no effect on the opioid epidemic?

There isn't a fentanyl epidemic in japan, sweden, etc. So can't blame the "supply" here. "China" isn't making and sending these drugs for the hell of it. Somebody is ordering it and someone is distributing it. And it ain't the chinese.

mindslight• 6 years ago

The author left out the necessary first step, which is the local government preventing Americans from straightforwardly buying opiates in stores, where incentives are aligned for utility and purity. The grey/black market only exists as a direct result of criminalization, rather than treating addiction as a personal health problem.

onetimemanytime• 6 years ago

Hi, can I please have a dose of fentanyl?

Sure, how will you be paying for it sir? https://www.drugabuse.gov/drugs-abuse/fentanyl

carapace6• 6 years ago

See also "Opium Wars".

https://en.wikipedia.org/wiki/Opium_Wars

Don't do drugs.

agumonkey2• 6 years ago

Don't do drugs.

Don't get prescribed drugs

-- 2000s variant

carapace6• 6 years ago

(Random aside: For like three years I thought your username was arguemonkey, with an 'r' & 'e'. Derp) :-)

That's an insidious aspect here: people trust doctors, the drug dealers found an angle that blindsided the system.

DyslexicAtheist5• 6 years ago

linking this to the Opium Wars might lead people to make incorrect links between cause and effect. This isn't some pay-back for the crimes the East-Indian Company and the West committed against China back then.

It's simply a few bad apples in an illegal market responding to the demand of the West and seriously why would anyone in China care as long as they don't sell this in China. It is bad-apples who want to get rich quickly but from a suppliers perspective it's short sighted because a dead addict isn't going to come back for more.

The real criminals to blame here are those that get people hooked on pharmaceuticals and then stop giving them the prescription for what they got them hooked on. No wonder they move from pain killers to heroin (or its substitutes).

edit: I highly recommend the excellent "Louis Theroux: Dark States" (episode Heroin Town). He gives a very empathic non-judgemental look into the tragedy of addiction in the US.

dependenttypes4• 6 years ago

This isn't some pay-back for the crimes the East-Indian Company and the West committed against China back then.

Certainly, but with fentanyl specifically it would not surprise me if some of the Chinese smugglers thought that they do a heroic patriotic act.

carapace6• 6 years ago

linking this to the Opium Wars smells like a conspiracy theoroy. This isn't some pay-back for the crimes the East-Indian Company and the West committed against China back then.

Sorry! I just wanted to point out some of the historical context. I don't have a particular fish to fry here.

why would anyone in China care as long as they don't sell this in China.

That's a bit uncharitable, eh? There are a billion and a half people people in China, they can't all be moral cretins, can they?

corporateslave5• 6 years ago

The ones truly at fault are the doctors. They follow “procedure”, which says that a patient under pain is treated with opiates. And so, to avoid any mal practice, they prescribe. And the patient has been told that doctors are the smartest, most prestigious individuals in our society. What’s not to trust? What do we do when societal structures built upon reputation and legitimacy fall victim to profit taking and legal threats? There’s no failure mechanism when a reputed institution fails from the inside.

dependenttypes4• 6 years ago

which says that a patient under pain is treated with opiates

Do you have a better solution? For some people the pain can be unbearable.

ssivark• 6 years ago

Do you have a better solution? For some people the pain can be unbearable.

Fair point, but the same (edit: “unbearable” cost) applies to wasted lives.

I don’t claim to have a general answer, but it’s important to keep the pros and cons in context.

Unfortunately one half of the balance sheet is an externality, and our incentive system is set to exploit those ruthlessly.

gherkinnn• 6 years ago

For some opiates are might very well be the right tool. Just as you said.

There are some questions to which I’m in no position to give an answer:

- is a little temporary pain really problem?

- are there less invasive measures?

- what preventative measures do we have?

- are opiates just an easy way to cover up symptoms that could/should be treated properly?

mnm12• 6 years ago

Blaming China for our failed drug war and idiotic drug policies is like blaming gun companies for WWII. The only way to help opioid addicts is to help them improve their lives while providing low cost, safe opioids to them until they are ready to quit. If doctors in the US could prescribe appropriate opioids for addiction, if we had safe use sites, and if we helped people find jobs, community, and purpose, we wouldn't have this epidemic. Until we're ready to accept that and while this idiotic drug war continues, thinking that drugs can be stopped despite over a hundred years of evidence to the contrary, people will continue to die in masses. And the only people that deserve the blame are the police, DEA, and lawmakers who are murdering addicts in their crusade against something they are too stupid to understand. The drug war is a crime against humanity, one that will likely go unpunished like so many others.

nate_meurer4• 6 years ago

I strongly agree with everything you just said, but is there possibly some benefit in also trying to control the huge flow of fentanyl from China? That's really all TFA is saying.

DyslexicAtheist5• 6 years ago

I think this is literally impossible because of costs to produce / distribute fentanyl compared to opioids. There will always be people who are skint enough to buy the cheapest thing they can find and there will always be bad apples greedy enough to stretch their produce with Fentanyl.

Then there are those that mean well and spike their produce successfully for a few runs, ... forgetting that it takes only 1 mistake and many will be dead as a result.

mnm12• 6 years ago

Yes, totally, but the only way to do that successfully is to regulate supply at home: legalization. Anything short of that will not control fentanyl from China or anywhere else, not even decriminalization. Black markets or even gray markets cannot be controlled. I think the last hundred years or so of prohibition has proven that over and over again. This applies to drugs, guns, etc.

Stierlitz• 6 years ago

"Tracing the US opioid crisis to its roots"

https://www.nature.com/articles/d41586-019-02686-2

andrekandre• 6 years ago

from you link, the key stand out paragraph for me was...

Because many doctors are in private practice, they can benefit financially by increasing the volume of patients that they see, as well as by ensuring patient satisfaction, which can incentivize the overprescription of pain medication.

whiddershins2• 6 years ago

What I think is odd is that it is so outrageous and conspiratorial sounding to even consider malicious intent on the part of the Chinese government.

I’m not saying I have any idea what the real impactful decisions that fuel this problem even are, much less who is making them, triple much less what their intention is.

I’m not sure it is clear what is really fueling the opioid epidemic, many theories of causation are plausible.

But it seems hopelessly naive to discard outright the possibility that aggressive intention by the Chinese Government is a factor here.

Countries have done much, much, worse to each other (and their own people) in pursuit of various strategic objectives throughout all of recorded history. Why should we flat out assume that has somehow fundamentally changed?

RealityVoid• 6 years ago

Possibly because of a lack of obvious advantage this would bring to China. I can not fathom what they could hope to gain by planning this.

frozenport• 6 years ago

Ironic reversal of a supposed century of humiliation. A weakening of a hostile hegemony?

mperham• 6 years ago

You should read about the Opium Wars. Britain literally went to war with China so they could sell opium to the Chinese. Pretty clear parallels here.

dajohnson89• 6 years ago

precedent: opium wars?

whiddershins2• 6 years ago

Do you feel you have a good sense of what things “help” the Chinese government?

Do you feel clear on what their short, medium, and long term objectives are?

I’m sure I don’t.

It seems obvious there is at least some potential benefit to causing your biggest competitor for military and economic influence a bunch of costly problems ... but I truly have no idea what any of these leaders are thinking about.

DeonPenny• 6 years ago

Motivation seem the most obvious think. The opium wars and they say openly they don't like the west and are openly competing with them

DiogenesKynikos• 6 years ago

It's pretty serious to accuse a foreign government of intentionally helping in the poisoning/killing of your citizens. Especially in the current atmosphere of growing anti-Chinese paranoia in the US (which predates the Coronavirus outbreak), people shouldn't be throwing around such accusations without solid evidence.

In the article, Ben Westhoff gives a much less conspiratorial explanation of why China was slow to crack down on fentanyl:

China does not have a fentanyl crisis nearly the scope that the US does, or Canada, also has a really big problem. And so to a lot of people, this is why China hasn't really cracked down on its fentanyl industry, because its own people aren't dying from it. And so the way the Chinese government works is, fentanyl is illegal there, but it's not so much just the laws on the books, it's what resources the government dedicates to cracking down on different problems. And so when it comes to meth, which is a huge problem among Chinese citizens, the government has really focused on trying to stamp it out, take drug dealers down, disrupt operations. But when it comes to fentanyl being made there, that's just not the case.

Eoan2• 6 years ago

How many governments has the US sold military weapons to?

Even the Islamic State (Isis) was mostly using US-produced bullets.

SkyMarshal• 6 years ago

I am not a medical or public health professional, but my understanding from various medical podcasts [1] and reporting is, the source of the epidemic is over-prescription of opioids as a cure-all, even for non-physical pain and psychological maladies like anxiety. Similar to over prescription of antibiotics, except that opioids are addictive.

China didn’t cause this, we did, but there are suppliers in China cashing in on it. But so are other suppliers in the US and elsewhere.

[1] http://freakonomics.com/podcast/opioids-part-1/

[1] https://sph.umich.edu/podcast/season1/opioids.html

datashow• 6 years ago

Not really that simple, medicine supply can change doctors' behavior. And massive amount of fentanyl are illegally smuggled into the US. You can't simply pick a middle point in the chain of events and claim that point is the cause.

philipkglass2• 6 years ago

There was (is?) a substantial online trade in psychoactive "research chemicals" starting in the early 2000s -- stimulants, hallucinogens, cannabinoids, and anything else you can imagine. They were recreational drugs that were not yet formally scheduled in many countries [1], often resembling existing molecules, sometimes mined from academic literature or from enthusiasts experimenting with unpublished analogues based on intuition or SAR predictions. This started out in the US and Europe. Operation Web Tryp [2] is the first major action I recall against these vendors. European countries without the equivalent of the Analogue Act continued to play whack-a-mole against new substances, which meant that vendors could keep going as long as they didn't foul afoul of scheduling updates or of the much-blunter American Drug Enforcement Agency.

Around 10 years ago, maybe a bit earlier, risk-averse European psychonauts started outsourcing the synthesis of novel molecules to labs in China, much like larger pharma research organizations were doing for basic synthetic work. Mine the literature, come up with some targets and proposed synthesis outline, outsource to Chinese vendors. The only work necessary on the buyer's end was to run analytical chemistry to ensure they were getting what was planned, then consume the drug to see how it behaves in vivo. Some of the more successful drugs that were sampled this way escaped the tight knit psychonaut groups and started popping up as items of commerce; does anyone remember the explosion of JWH series synthetic cannabinoids? (Fortunately, those strange brews seem less popular in the US since states started legalizing ordinary cannabis.)

The first really alarming substance I saw coming from these small custom synthesis vendors just has the code name U-47700 [3]; it's an opioid with a weird structure, never tested in humans until gray and dark market vendors put it on the map. I also saw opioid dependent chemists researching modifications of the OTC drug Loperamide [4] so that it could cross the blood brain barrier and satisfy their craving.

This is all a long winded way of saying that Chinese vendors were deliberately sought out by self-experimenting psychonauts and people with drug dependencies years before news reports of Chinese fentanyl in the US. It didn't start with opioids, but it eventually ended there. The drug flow from Chinese laboratories started as a Western "pull" rather than a Chinese "push." Opioids were also among the last drugs to start flowing in volume. That's why I think that attributing the drug flow to a Chinese government plan for Opium War revenge is ridiculous.

I had access to invite-only psychonaut/chemist forums for years. I tried visiting one of them just now and it's now just a domain landing page. So no citations for the chronology of my story, sorry, but major parts of it should be corroborated by what you can find on more open forums like Bluelight.

[1] Though the Federal Analogue Act in the US meant that novel "fun" compounds being sold for human consumption were illegal without any new legislation being needed.

[2] https://en.wikipedia.org/wiki/Operation_Web_Tryp

[3] https://en.wikipedia.org/wiki/U-47700

[4] https://en.wikipedia.org/wiki/Loperamide

woah• 6 years ago

The bath salts were a similar story, right?

dragonwriter• 6 years ago

That's why I think that attributing the drug flow to a Chinese government plan for Opium War revenge is ridiculous.

But that conclusion doesn't even approximately follow from the preceding narrative, which just as easily could be seen as lending credence to the hypothesis you use it to reject, since it provides a very clear explanation as to how both the ground was laid off such an effort to be successful and how the Chinese government would become aware of that opportunity.

(The “Opium War” revenge is probably needlessly romanticized, even if the Chinese government did deliberately act on the opportunity, the motivation (even if the Opium War was part of the inspiration) was probably more prosaic geopolitical advantage by weakening rivals with costly internal problems, not revenge.

oceanghost• 6 years ago

I was lucky enough to be around for the MXE days, and I'd like to say you're absolutely correct.

The only thing that is odd to me is what is legal and illegal to manufacture in China. The common "reason" for MXE being unavailable is that it is no longer legal in China, yet, fentanyl is?

yumcimil• 6 years ago

Yes, but it's much more plausible that a fucked healthcare system does it on its own.

beenBoutIT• 6 years ago

Our backwards restrictions on what chemicals adults can and can't consume are to blame for this. When the US changes it's laws so that adults can legally buy opiates if they want to take opiates no one outside of medical professionals will have any interest in fentanyl.

pierman• 6 years ago

I recommend this podcast if your interested in learning more:

"Puzzled by rising drug deaths at raves in the United States, author and investigative journalist Ben Westhoff set out to find answers. A Google search for “Buy fentanyl in China” took him down a rabbit hole that led to a face-to-face meeting with the CEO of a company selling fentanyl on Skype “all day long” and a drug lab in Shanghai. Ben tells Jordan the remarkable story."

https://supchina.com/podcast/chasing-the-dragon-fentanyl-chi...

xorfish• 6 years ago

Switzerland had a open heroin epidemic around 30 years ago.

https://www.youtube.com/watch?v=3UYmaalotK0

Repression only made it worse and I can only imagine how much worse it would have been with the possibility that every shot may have something far more potent.

Maybe the important bit is also how it was resolved:

https://www.thelocal.ch/20120531/3427

In short, save injection sites, controlled diaphin or other opioid replacement therapies made the life of addicts livable and reduced the harm that happened.

lazylizard• 6 years ago

Yep. China makes all that but they dont have an opioid crisis. USA doesn't make the stuff yet has an opioid crisis. Naturally we don't ask why the USA cannot police opioid use like the chinese...

Why doesnt say, singapore have an opiod crisis? China won't export to singapore?

Hmmmmmmmm

teekert• 6 years ago

A Friend got a swathe of opioids for a cut in her thumb (in a US hospital), "Why?" she asked, turns out the hospital is sponsored by the producers. Buy hey! Nothing to see here! It's them Chiners!!

Perenti• 6 years ago

What I find interesting is that there is so little discussion of the demand for fentanyl. I know it's convenient to blame doctors and drug companies, but why is there such a high demand for fentanyl as a drug of abuse/intoxication in the USA compared to other countries?

By the way, I have fentanyl patch prescriptions, and have done for years, due to medical issues. I use maybe 7-10 doses per year, with no real urge to take more. I can see how it can be appealing to people, but there has to be something in US society that makes fentanyl and other synthetic opioids so enticing.

China's role in the U.S. fentanyl epidemic

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