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.

The result is a truly extraordinary and harrowing piece of journalism that is impossible to summarise.

Nevertheless, we need explanations.

Writing for Bloomberg, Justin Fox looks at the latest research. Elevated levels of mortality caused by suicide, drug overdoses and alcohol poisoning are often referred to as ‘deaths of despair’. The name suggests a particular direction of cause and effect – i.e. people are killing themselves (one way or another) out of desperation at the condition they find themselves in.

Furthermore, the phenomenon appears to have a disproportionate impact on middle aged, white Americans – especially those living outside the big urban centres. Thus the implication is that the ultimate cause of the despair is the loss of economic opportunity (and perhaps cultural status) caused by globalisation.

But does the new research support these assumptions?

“None of [the new] studies have refuted the key finding of the [original] Case-Deaton research, which is that something disturbing is going on with the mortality rates of middle-aged white Americans. But they do seem to be shifting the explanation away from an economic one to something more epidemiological. The really big driver of the mortality shift is the opioid epidemic, and many of these opioid overdoses may not be the direct result of economic troubles. They’re not really ‘deaths of despair.’”

If economic hopelessness really was the big driver, then why the dominant contribution of opioids to the mortality shift? Wouldn’t one expect equally-striking contributions from suicide and alcoholism (the other deaths of despair)? As for the notion that whites are reacting to the erosion of their position in American society, how does that explain the fact that “American Indians and Alaska natives have seen even bigger mortality increases”?

Then there’s the geographical distribution of the opioid epidemic:

“…it’s striking how different things look from state to state. In New York, it’s the New York City exurbs that have been hardest hit; in California, it’s rural mountain counties far from any big city; in Ohio, it’s everywhere. These seem to be patterns that can be better explained by peer effects and the shape of drug-distribution networks than by underlying economic conditions.”

In other words, it is supply that is creating the demand for opioids not any external factor – people are using these substances because they are readily available (from both legal and illegal sources). They don’t call them pushers for nothing.

This accords with the argument that Damian Thompson made in his book The Fix: How Addiction Is Invading our Lives and Taking Over Your World. Thompson contends that epidemics of addiction are created by deliberate supply not uncontrollable demand. Writing for the Spectator in 2012, he gives the example of previous American drug epidemic:

“In the late 1960s, new techniques for manufacturing pure heroin coincided with the arrival of bored, scared and disorientated troops in the Mekong delta. By 1970, 15 per cent of soldiers were snorting or smoking heroin. The Nixon administration panicked at the thought of thousands of helpless junkies arriving back home after their tours of duty… In the event, though, the near impossibility of scoring high-grade heroin in Middle America meant that the vast majority of GI heroin users became almost instantly un-addicted.”

Today, scoring high-grade heroin – and all manner of other opioids – is all too possible in Middle America, which is why the epidemic exists.