The story of how America got hooked on fentanyl is a classic economic story of supply and demand creation. It began in the mid-1990s, when pharmaceutical companies like Purdue aggressively upended the rules of medical marketing to flood doctors’ offices and medicine cabinets across the country with revolutionary pills called Oxycontin. Not only did they come to end the pain once and for all, but they did not engage, they said.
When that sensational offer fell, an army of addicts took to the streets with a demand that seemed to be outdated: they were looking for heroin, cheaper and also more dangerous. By the middle of the last decade, the opioid epidemic was already an unprecedented crisis when history took another unexpected turn with the arrival on the scene of a very powerful drug that few outside the operating room had heard of until then. Fentanyl swept away all previous habits; in 2022, it caused around three-quarters of overdose deaths, which, as announced by the US authorities this week and in the absence of a final count, is expected to set a new record, with close to 110,000 casualties. This is: more than 2,000 per week.
Sam Quinones, investigative journalist and writer, is the great chronicler of what the narcotics agencies already consider “the worst crisis in the history of drugs in the United States.” He took up the first part of the tale in Dreamland (Captain Swing), a successful National Book Award-winning essay that dealt with the ravages of painkillers across vast stretches of the Midwest. That book led to another, The Least of Us (The most insignificant of us, still without translation into Spanish), which portrays the country “in the times of fentanyl and methamphetamine.”
Journalist Sam Quinones.SAM QUINONES
This last substance, he recounts in The Least of Us, prepared the ground: thanks to it, the Mexican drug traffickers embraced the miracle of the synthetic drug and “were able to stop being mere errand boys for Colombian traffickers.” At first, they imported the fentanyl from China. When Beijing announced in 2019 that it was banning it, its chemical companies began selling them the precursors needed to make the potent painkiller. “This is how they became the major producers and distributors of the drug, first in powder, and then disguised as fake pills. Realizing its enormous potential, they refocused their business and flooded the United States,” Quinones explains in a telephone interview. Again, supply and demand.
The father of fentanyl is a Belgian chemist named Paul Janssen. His invention (more effective and less expensive than morphine) began to be used in cardiac surgeries and revolutionized medicine. In 1985, Janssen opened the first Western lab in China to make fentanyl.
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Away from the supervision of an anesthesiologist, it is a highly deadly substance. The first blow hit the streets of Chicago in 2006, where it was known by the nickname “lethal injection.” It happened when a chemist named Ricardo Valdez-Torres and nicknamed El Cerebro convinced the men of Joaquín Guzmán Loera, El Chapo, that, rather than ephedrine, they should manufacture fentanyl (fetty, in slang). He only had time to send 10 kilos to the United States before his arrest in Mexico. He told the police that he did it with the warning that these powders had to be diluted up to 50 times before being sold. Perhaps those instructions never reached their recipients. Or it may be very difficult to make an addict believe that what they are dealing with is too strong. “Part of the problem, then and now, is that traffickers don’t know how to use it, or how to cut it,” Quinones says. The police dismantled the laboratory and the contagion was nipped in the bud that time.
Create addicts
The second onslaught came around 2014 and nothing could stop it. The dealers began cutting other substances, like cocaine or methamphetamine, with much cheaper fentanyl, “so that thousands of people, the ones who didn’t die from an accidental overdose, ended up hooked on something they didn’t even know they were taking. ”. “Not only did they seek to increase their profits, the traffickers were also interested in creating addicts,” the journalist warns.
That was one of the reasons that helped the drug break down racial barriers. Quinones explains that the first wave of the opioid crisis, that of prescription pills, swept away a majority white population (as much as 90%). With fentanyl it was different: it spread like an invasive species through city corners across the country, taking heroin and other substances by storm, just as it caught on in African-American and Hispanic communities.
The book tells the case of the first black who died in the city of Akron (Ohio). His name was Mikey Tanner, he battled cocaine addiction for 10 years, but only lasted a couple of months when fentanyl came on the scene. His story is reminiscent of the first overdoses in Spain. At first, it was cover news. Over time, his dead had not even secured a place on the page of the obituaries.
The Least of Us is full of terrifying stories of consumers trapped in a statistic like Tanner’s, who end up forming the mosaic of a sick society, beset by grief and isolation. It also weaves together the story of the decline of the American 20th century through cities like Muncie (Indiana), which was the “world capital” of car gearboxes until everything went to hell, or Kenton (Ohio), a Rust belt town where high school sports stars who started taking pain pills ended up hooked on heroin.
The pandemic was the last straw. In 2020, overdose deaths grew by 20%, to 91,799 cases. In 2021, 106,699 were registered, according to the National Institute of Drug Abuse, 16% more. And in 2022, the DEA (acronym in English for the drug enforcement agency) seized 50.6 million fake pills and 4,500 kilos of fentanyl powder, the equivalent of “more than 379 million potentially fatal doses”; more than enough, therefore, to wipe out the entire US population. “The lockdown was terrible for those who were struggling with addiction,” recalls Quinones. “They recommend two things to those who try to get out: not to isolate themselves and to work. So the coronavirus was the perfect storm. It also didn’t help that the therapy was done overnight over Zoom.”
The alarming figures woke up the United States to a problem that has ended up becoming another political battleground, between the United States and Mexico, as well as internally, with the Republicans using fentanyl as a thrown weapon for the policies of the border of the Joe Biden’s administration or the management of the increase in crime in large cities, where they tend to vote Democratic. San Francisco has become the great symbol: twice as many people have died there since 2020 from overdoses (about 2,000) than from the pandemic. Quinones, who was a reporter for the Los Angeles Times, is “surprised” by these attacks, considering that “Donald Trump was president in the years when fentanyl spread across the country.” “Local authorities are simply overwhelmed,” he adds. “This is a problem that has to be dealt with as a national issue.”
In the book, Quinones asks two key questions: why would someone want to take something they know could kill them, and what would make a dealer give their clients something with a high chance of ending them (and their money).
To the first, the journalist, who interviewed prominent neuroscientists as fieldwork, replies: “That is the nature of addiction; reprogram your brain so that its mission is not to survive, but to get the drug”.
To the second, he answers: “Fentanyl became the most powerful drug in history. Anyone who was in the business knew that if they didn’t offer it, they would quickly run out of customers. The camels did not dare not to mix it with others. Soon, it became a market expansion tool.”
In the interview, Quinones highlighted another unexpected effect: “Fentanyl is killing recreational drug use in the United States, a use that has been around for at least half a century. No one dares to take a pill or a line at a party anymore for fear of dying.
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