The opioid crisis has been going on for over 20 years and may be roughly divided into three distinct waves. The first wave started out with prescription pain relievers diverted onto the street market. If you are ever interested in what prescription medications can fetch in various American illicit markets, you can visit this website which, curiously, is a crowdsourced site maintained and funded by our government. The first wave lasted a good ten years and has died down, but never quite gone away.
Around 2010, heroin prices dropped and launched the second wave. No longer were diverted prescription opioids the hottest item in recreational drugs, people could now buy heroin at dollar-store prices.
(By the way, “opioid” refers to a whole class of drugs that includes prescription products such as morphine, oxycodone, hydromorphone, and others plus the illicit drug heroin. Heroin is chemically similar to morphine but it is not legal or legally manufactured in the United States. Fentanyl is a bit of an anomaly in that there is a legal version of fentanyl, mainly used in surgery, and then there is “illicit” or street fentanyl which is an impure and illegal street drug. This article is about illicit fentanyl.)
The second wave of cheap heroin meant that people who needed or wanted opioids could replace prescription products with a similar product at bargain-basement prices. It has been argued that some pain patients migrated to street heroin when their prescription pain killers became too expensive or too difficult to get, but the typical heroin customer was a recreational drug user rather than a patient with a prescription for pain relief. Cheap heroin still exists and the second wave rolls on, weakly. When illicit fentanyl entered the market around 2013, the third wave changed everything.
Fentanyl is a very potent drug and even low doses of the drug (compared to heroin or morphine) can be fatal. Illicit fentanyl was not only cheap, it represented a major economic edge for the Breaking Bad chemists and the street dealers making a living selling drugs. Only tiny amounts of fentanyl were needed to produce strong psychoactive effects and those amounts could be made for a few bucks. Innovative drug dealers would get some inert substance, such as powdered baby laxative or cornstarch, sprinkle some illicit fentanyl into the mixture, and then press this new product into pills that resembled prescription opioid products. You can buy pill presses online. Now a creative chemist could make up hundreds of counterfeit pills for a few bucks that could sell for $20 or more per pill on the open market.
This third wave of the opioid crisis was extremely profitable. About 1 kilogram (2.2 pounds) of illicit fentanyl purchased at the source in China for $5,000 can be mixed, chopped, pressed into pills, and sold for a total street value of about $1,500,000. A lot of people got very rich in the early days of the third wave.
At first, illicit fentanyl was mainly mixed with inert substances to pass as heroin, but today fentanyl is the active ingredient in all kinds of bogus pills sold on the street, from Viagra to Valium. And since a little fentanyl is all that is needed, it’s very easy to smuggle valuable amounts of illicit fentanyl in a vehicle or even a handbag. Illict fentanyl is also used to spike powders sold as heroin or cocaine. Low-quality drugs can be sprinkled with fentanyl to give them more psychoactive oomph. Fentanyl was suddenly like sugar in the processed food aisle—it was in everything.
Illicit fentanyl is both difficult and easy to make. Precursor chemicals are required and these mainly come from China and, to a lesser extent, India. Think of precursor chemicals as being similar to sourdough starter for making sourdough bread. The precursor chemicals are absolutely necessary and require laboratories and skills to manufacture. They are fairly expensive, but precursors are not illegal. China cranks them out and ships them over mainly to Mexico but also to Canada and the United States. These precursor chemicals are then transformed into fentanyl in a very simple process.
It would be a great exaggeration to call the labs where these precursors are transformed into illicit fentanyl as “low tech.” This clip is from a PBS documentary. Most of this final processing step is carried out in the open, such as in a pasture or the woods, by one guy who uses a big stick to stir a cauldron over an open fire. The “chemist” cooking up this brew usually wears no mask or protective gear and does not look like he has ever taken a chemistry class, nor is he familiar with Good Manufacturing Practices for pharmaceuticals. These manufacturing places are euphemistically called “clandestine labs” but they’re just a big pot on an open fire and a maskless man trying to figure out how to stay downwind.
Fentanyl offers dual layers of danger. The first is the danger inherent in taking a super-potent opioid drug. A high dose of any opioid drug—not just fentanyl—can produce respiratory depression. With opioid-induced respiratory depression, the body slows down. The heart rate drops dramatically. Respiration is very slow and breathing may stop and start again. The person falls unconscious and may even be unresponsive. If enough opioid is taken, the person’s respiration stops completely. The body shuts down. The person dies without ever waking up.
That’s risk 1. Risk 2 is that fentanyl is not being cooked up in pristine pharmaceutical factories. They are no purity safeguards at all. A fruit bat from a tree might fall into the cauldron during manufacturing; dirt and dung are just about a given. Drug potency and adulterants are random. This illicit fentanyl is not tested or examined, but simply moves from the outdoor lab to upper-level bulk dealers who eventually hand it off to local dealers. The fentanyl may be used to spike cornstarch to create a sort of phony-baloney heroin or cocaine or it may be added to provide an extra kick to low-grade heroin. It may get mixed with inert ingredients and pressed into counterfeit pills. A counterfeit dilaudid tablet can go for $30 to $60 each, depending on the market. (Street drug prices fluctuate.)
Inventive street drug entrepreneurs may mix illicit fentanyl with imaginative ingredients, such as benzodiazepines or other opioids. (The benzo and opioid mix, called Benzodope, is particularly dangerous, since both drugs produce respiratory depression.) In Philadelphia, fentanyl is often found mixed with xylazine, a horse tranquilizer. Xylazine is a legal drug but it is intended for veterinary use only. When added to fentanyl, it produces a deadly drug called Tranq.
One reason that Tranq is so popular is that fentanyl has a brief but short duration of action that xylazine prolongs. The people taking Tranq are so high they can fall asleep standing up and have been called “zombies.”
The illicit fentanyl labs produce the drugs that find their way, sometimes through a chain of middlemen, to the street drug market in the United States and, to a lesser extent, Canada. Think of street dealers as the retail purveyors of fentanyl and fentanyl-laced products. This is a big-money industry but the money is unaudited, so nobody knows exactly how much these drugs are worth. This is an unreported, unrecognized massive portion of the American economy. American public health counts the fentanyl deaths (upward of 75,000 a year) more than the size of the fentanyl market, but the economics of the fentanyl business is a tremendous threat to this nation as well.
What people forget in the fentanyl market is that it is a major source of income for China, so much so that India is trying to muscle in on the action. Americans buy illicit fentanyl, fueling the cartel-run drug industry, but the cartels have to make regular payments overseas to keep the precursors flowing. This means that China is making us pay for the weapons it is using to destroy us. This reminds me of the bad old days under Chairman Mao when dissenters were not only executed, but their families were sent an invoice to cover the price of the bullet.
But it may be a grave mistake to think of this third wave of fentanyl as a business. It is a weapon. In 2022, law enforcement started to notice a surge of brightly colored fentanyl tablets hit the U.S. market. Dubbed “rainbow fentanyl” by the Drug Enforcement Administration (DEA), these tablets were designed to look like candy to attract children. Some youngsters may have known these colorful pills were drugs, but the bright colors were used to attract their and defuse a sense of danger. In other words, street drugs were just another type of candy. Other children may have thought they really were just candy.
Rainbow fentanyl is not some weird, one-off anomaly. In 2022, the DEA had found these candy-colored death pills in 18 states; in 2023, they are known to be in at least 26 states.
The reason that we must think of fentanyl as a weapon rather than a street drug in an illicit but capitalist market is simple. In the first and second waves of the opioid crisis, drug dealers tried very hard to keep their customers alive. True, a drug dealer had to deliver potent and potentially life-threatening drugs that produced a good high, but it was bad for business if their customers died. Drug dealing is a lucrative business when the old paradigm is followed: sell an addictive product to a person who keeps returning to get more and more. The new paradigm of selling an addictive product that kills the customer is not so lucrative. The third wave of the opioid crisis is by far the most deadly and that lethality is driven by fentanyl. Fentanyl dealers sell products that kill their customers. And they are not fine-tuning their business model—if anything, they are ramping it up.
So what is going on? The transition from the second to the third wave of the opioid crisis was like the magnetic poles of the earth reversing. It happened suddenly and it was cataclysmic. This is no longer about drugs. It is about an attempt to bring lethal weapons into America and deploy them—making the victims pay for their own demise.
Why would China, India, and Mexico be doing this? If money were the motivation, they would go back to the old business model and keep their customers alive as long as possible so they could keep using. Safer products could be developed. This sudden, dramatic spike in opioid-related deaths is intentional. But drug dealers are not only killing their customers, they’re killing their own business.
For some reason, “they” want us dead. I don’t think retail drug dealers want us dead. It is easier to get a customer hooked and keep selling to the same group of people than constantly have to attract new customers who meet a swift end. Follow the money and you end up in Mexico, India, and China, with the latter perhaps the most culpable.
There is an argument to be made that we are doing this to ourselves. After all, if nobody was interested in illicit fentanyl, this plan would not work. However, America has long been a society with an avid interest in intoxicants and a population rich enough to be able to indulge in drug-addled living. How we got here is an important question but not the paramount concern at this moment. At this moment, we’re at war.
We need to face facts. “They” want our children and young people dead. I leave you to speculate why China might want to kill us off (and make money while doing it) and how and why India and Mexico are playing along. But it would be foolish and incorrect to look at the fentanyl crisis and think it’s about drugs.
It’s narcoterrorism.