Xi Jinping and Joe Biden had their much-awaited summit in San Francisco. There were three main items on the agenda: restoring diplomatic and military communication, cooperation on the subject of climate change, and the fentanyl crisis. Fentanyl is a synthetic opioid.
Opioids are used in prescribed pharmaceuticals like morphine, tranquillisers but the stronger ones are mostly used for pain control.
In America, there’s been a controversy that opioids are being over-prescribed — especially to rich patients carrying comprehensive insurance which pays for it — by doctors who are in cahoots with the pharmaceutical industry that makes these opioids.
The larger controversy, however, is not about the natural opioids but a new category of illicit drugs called synthetic opioids, which are created using chemicals. Fentanyl and other synthetic opioids accounted for more than 77,000 overdose deaths in the US between May 2022 and April this year.
Important to note also is that 69 percent of the 1.06 lakh drug overdose victims in the US in 2021, were men. Most of these victims were in the 18-49 age bracket. Such is the situation that fentanyl has now emerged as among the largest cause of fatalities among Americans.
Since it is produced in a lab, fentanyl is very potent. According to a report by The Wall Street Journal, it is so powerful that “in pure form the amount in roughly two sugar packets can provide a year’s supply for a user”.
Also Read: Threat for India, advantage China — what Thai PM’s ‘doodle’ at BRI Forum signifies for the 2 nations
Why are Americans worried?
Why are the Americans so worried about this vis-à-vis China and why can’t they control the circulation of fentanyl in their own country?
That’s because fentanyl is not produced in a factory. It has precursors, the two main ones being N-Phenethyl-4-piperidone (NPP) and 4-anilino-N-phenethylpiperidine (ANPP), which have now been put under international control. These are used to synthesise fentanyl.
They are banned under the scope of the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988.
These precursors are not made in America, but smuggled into the country — mostly through the porous southern border with Mexico — but also through legitimate transshipment channels. Most of these originate from China owing to its thriving chemical industry which by some estimates, makes up more than 40 percent of the global chemicals market.
China is also one of the largest manufacturers of active pharmaceutical ingredients, or APIs, in the world.
For the Americans, the catch is that they cannot sanction Chinese makers since it’s very difficult to prohibit the inflow of a basic chemical which is used to manufacture medicines, or for other legitimate purposes.
Cocktail of death
According to The WSJ report quoted earlier, fentanyl can be used as an injection shot, or a skin patch, or as lozenges that one can chew. It can also be sprayed in the nose or under the tongue. The report quotes the American Society of Health-System Pharmacists Inc. to say that it can also be mixed with other drugs like Xylazine, a veterinary tranquiliser.
This cocktail is doubly potent and cheaper than pure fentanyl. In addition, fentanyl is also mixed with baking soda, starch sugar, etc.
In March this year, America’s Drug Enforcement Administration (DEA) revealed that Xylazine was found in nearly 23 percent of fentanyl powder and 7 percent of fentanyl pills seized in 2022.
The Centers for Disease Control and Prevention (CDC) says fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.
What’s worrisome is that the use of adulterated fentanyl is so widespread that authorities in Columbus, Ohio, have actually started giving out strips one can use to check whether a drug is adulterated. And in New York, 81 percent of the 980 deaths caused by cocaine overdose involved fentanyl.
Fentanyl works by binding itself to the brain’s opioid receptors — parts of the brain that control pain and emotions. Studies have shown that the addiction to this synthetic opioid becomes so strong that, after a point, the human body is unable to feel any sensation without its usage.
At the same time, as one would expect in the American system, antidotes have come up and are now part of government literature aimed at curbing drug abuse. But these are expensive — a ‘broken window economics’ trap.
US sanctions & Chinese defence
Also worth reading on this subject is a congressional research service report from 28 September this year, and a report by The New York Times from June detailing charged four Chinese firms with ‘selling chemicals to make fentanyl’.
There is also a statement by the US Treasury Department dated 3 October 2023 — a little over a month before Biden’s meeting with Xi — which says that 28 individuals and entities, mostly based out of China, were sanctioned for “manufacturing and distribution of ton quantities of fentanyl, methamphetamine, and MDMA precursors”.
Another important material on the subject is a press release by the US Department of Justice — also from 3 October — which marks the unsealing of eight indictments charging “China-based companies and their employees with crimes relating to fentanyl and methamphetamine production, distribution of synthetic opioids, and sales resulting from precursor chemicals”.
Finally, there is an editorial by the Global Times from June this year which presents the other side of this story. The editorial accuses the US Justice Department of charging “Chinese individuals related to fentanyl problems that were ensnared through US’ sting operation in a third country”.
It goes further to add that the US has been “playing the fentanyl card for some time” and that Washington is merely using this issue as an excuse to slap uncalled-for sanctions against Chinese businesses and individuals.
The Chinese — who suffered greatly as a result of the Opium Wars — are the last people one would expect to ignore a drug problem, it adds.
The editorial goes on to argue that fentanyl precursors are “ordinary commodities that are not controlled under international drug conventions and Chinese law”. This is followed by the usual condemnation of the US: “Why is it that with 5 percent of the world’s population, the US consumes 80 percent of the world’s opioids?”
Happening Now: President Biden holds a press conference following the U.S.-PRC Summit. https://t.co/XUxgS6sAYa
— The White House (@WhiteHouse) November 16, 2023
In conclusion, the Chinese have rejected these charges and it seems that once again, assurances were exchanged during the Biden-Xi meeting.
If the Chinese really want to fix this problem, they can do it. But at the same time, if they think they have leverage, which is not corrupting their society, they can take their time with resolving this issue.
This means that while this has become a pain point for Americans, particularly the Democrats, this is a bargaining chip for the Chinese.
This is the edited transcript of ThePrint Cut The Clutter Episode 1349, published on 18 November 2023, on the role of fentanyl in America’s opioid crisis & why it figured in US President Joe Biden’s meeting with Chinese President Xi Jinping earlier this week.
Also Read: Origins of US-Israel ties & why this enclave has been vital to Western interests in Middle East