What’s really to blame for the opioid crisis?
Injecting fentanyl in the US. Credit: Spencer Platt / Getty   

The diplomatic breakthrough of the week had nothing to do with Brexit, you won’t be surprised to hear. In fact, Europe was barely involved. Rather it concerned the world’s most important international relationship – that between China and America.

The emerging superpower and the established superpower are currently locked in a sprawling trade dispute. One of many bones of contention is that a significant part of America’s opioid epidemic has its origins in China – specifically the labs that produce highly dangerous synthetic opioids, principally fentanyl, for export to the US.

At trade talks in December, the Chinese government promised a crackdown – and on Monday it announced that from next month all fentanyl-related substances would be designated as controlled substances.

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However, the issue isn’t just one of lax regulation at the Chinese end of the supply chain. The problem is with fentanyl itself, which is so powerful (legally-administered doses are measured in millionths of a gram) that quantities small enough to be distributed by post can generate enormous profits. The point is made in a report for The Economist:

“It can be disguised, for example, as the tiny sachets of desiccant used to stop many packaged goods from going soggy. In 2017 America’s Department of Justice guessed that fentanyl purchased in China for $3,000-5,000 could be worth around $1.5m on American streets.”

Writing about the issue for the American Conservative back in September, Charles Fain Lehman describes fentanyl as the third and so far deadliest phase of a “multipart drug-death boom”:

“First, prescription opioid deaths rose steadily over at least 15 years, as a result of uninhibited prescribing practices and negligent pharmaceutical firms. This eventually led to a government crackdown on prescriptions, which prompted users to switch to dirt-cheap Mexican black-tar heroin. As a direct result, heroin deaths almost quintupled between 2010 and 2016.”

The third wave – “predominantly fentanyl and its analogs” – struck in 2015:

“…deaths from synthetic opioids… suddenly doubled. In 2016, they doubled again, hitting 20,000. If CDC’s estimates are correct, they probably killed 30,000 people in 2017…”

Lehman argues that the switch to entirely synthetic drugs – i.e. those requiring no natural precursors, such as opium derived from poppies – transforms the drug trade:

“…synthetic drugs are cheap. The removal of organic factors from the drug production process… reduces the materials cost of the drug substantially, as well as the amount of space and manpower dedicated to its production. “

When the Chinese government really wants to stop something, it doesn’t pull its punches. But even if it does succeed in closing down the fentanyl factories, there’s a danger that similar operations could open elsewhere. Given the comparative ease with which synthetic drugs can be manufactured and distributed, it would seem that the main thing required of the country of origin is a lack of interference from the authorities – and that is always obtainable somewhere in the world.

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But if super-strength synthetics look set to overwhelm any attempt at prohibition, I don’t hold out much hope for the legalise-and-regulate approach either. The opioid epidemic shows that users will switch from a legal source of supply to an illegal one if they don’t get what they want when they want it.

A regulated supply of opioids would not only need to guarantee the (relative) safety of the product, but also be cheap, convenient, always available and sufficiently potent to meet user appetites. If those criteria were to be satisfied, then, in theory, fentanyl (and other substances adulterated with fentanyl) would have no market. However, that would mean the state becoming a supplier of hard drugs on a scale, and with a reach, that’s never been seen before – a sort of NHS of smack and crack. Would a government be able to sell the idea to the electorate or be willing to accept the blame should the experiment do more harm than good?

Charles Fain Lehman reminds us that while the “fentanyl wave could break”, the evolution of the synthetic drug buiness means we must prepare for the possibility of an “even bigger tsunami”.

But how?

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Liu Yuejin is the deputy director of China’s narcotics control commission. According to the BBC, this is what he told the press when the fentanyl ban was announced:

“We believe that the United States itself is the main factor in the abuse of fentanyl there… Some people link drug consumption with freedom, individuality, and liberation. If the US really wants to resolve the fentanyl substance problem they have more work to do domestically.”

Is a policy focused on reducing demand hopelessly naive? Perhaps, but arguably not as hopeless as trying to prohibit or regulate the supply of synthetics. Giving the minority of people who are vulnerable to these substances as much to live for as the majority who aren’t is something we should be striving for anyway.