By Debbie Koenig
Overdoses have always been possible with illicit drug use, but synthetic versions of drugs like heroin, ecstasy, and marijuana have caused skyrocketing overdose deaths in recent years. Inexpensive and incredibly powerful, fentanyl is the worst offender, claiming more than 28,000 lives in 2017. In Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic, reporter Ben Westhoff shows how dangerously strong substances created in sparkling-clean Chinese labs are endangering even first-time drug users.
WebMD spoke with him about what he found going undercover as a dealer, why these drugs are so deadly, and what we can do to protect our loved ones.
Our interview has been edited for clarity and length.
WebMD: What made you want to investigate the world of synthetic drugs?
Westhoff: I had a friend who died from fentanyl in 2010 when nobody really knew what it was, included myself—the book is dedicated to him. But I didn’t start digging until I became music editor at LA Weekly four or five years ago. I was investigating why so many people were dying at raves. Every time there was a big rave one or two people died, and it was usually attributed to ecstasy or molly. But I knew that pure ecstasy didn’t usually kill people. What I found was that there are all these adulterated new drugs coming out of China, drugs nobody had ever heard of. That inspired a deep dive into the subject, and it turned out the worst of these drugs was fentanyl.
WebMD: What was the most surprising thing you uncovered in your research?
Westhoff: I always knew drugs came from places like Mexico, Afghanistan, and Colombia, but all these new drugs—including fentanyl—come from China. I went undercover to Chinese drug labs, pretending to be a drug dealer. I expected to find seedy underground labs with guys holding AK-47s guarding the door, but they were all clean, above-board labs. It turns out that most of them operate legally. I discovered that the Chinese government actually subsidizes a lot of these operations, including companies exporting fentanyl to the U.S. This to me was very shocking.
WebMD: You describe fentanyl as worse than crack, worse than meth, worse than heroin. What makes it so deadly?
Westhoff: It’s basically synthetic heroin. Dealers prefer it because it’s so much cheaper to make, and it’s so much more powerful than heroin. It’s about 50 times stronger. You only need two grains of rice-worth to overdose. People think they’re getting heroin, but when just a little fentanyl is cut into that unbeknownst to them, they overdose.
WebMD: Some faulty news reports have claimed that it’s dangerous to even be in the vicinity of fentanyl—that even skin contact could trigger an overdose. Can you shed some light on that?
Westhoff: There are a lot of misconceptions about that. I think a lot of law enforcement officers are worried to touch it, but that kind of overdose doesn’t happen. Fentanyl is super strong, so if you ingest a tiny amount you can overdose – but not from touching it. The most disturbing thing is it’s being cut into what appear to be prescription pills. Some boys in Seattle died recently because they thought they were taking oxycontin pills.
We live in this new era of drug use where no pills or powders are safe, because anything could be cut with fentanyl. We’ve been telling our kids about the horrors of drug use for a long time, but now things are to a point where you can’t trust anything, pill or powder.
WebMD: Why are synthetic drugs so much more dangerous than plant-based varieties?
Westhoff: All these drugs can be safely used, even fentanyl, as long as you have the right dose. But there are all these synthetic drugs replacing not just heroin—there’s fake LSD, fake ecstasy, fake marijuana. These aren’t regulated by the FDA. They’re street drugs. Nobody knows the proper dose, so people take too much and overdose. Traditional plant-based drugs like cocaine, marijuana, heroin—even ecstasy is often made from a natural plant—they’re time-tested drugs. People have been using them for decades, if not centuries. People know the proper dosages, generally. The problem with synthetic drugs is there’s often no usage history at all. People are basically human guinea pigs.
WebMD: The DEA said fentanyl wasn’t going to be a problem just a few years ago. How did they miss the signs?
Westhoff: In 2015 in their annual drug threat assessment, the DEA said fentanyl was not going to be a big problem, but one year later it was killing more Americans annually than any drug in history. In the DEA’s defense, it wasn’t just them. Lots of scientists underestimated, too. People thought users wouldn’t want fentanyl, it would be too strong, too risky. The therapeutic window, the difference between a safe dose and a lethal one, is too small. What the DEA and others didn’t realize is that the scourge of fentanyl isn’t based on people taking it on purpose. It’s people not even realizing they’re taking it.
WebMD: How does the Dark Web figure into the problem?
Westhoff: The Dark Web is one way new drugs are trafficked. Basically, it’s a disguised internet protocol, so you have all these markets selling drugs and guns and everything else. They function like Amazon. Different marketplaces have star rating systems, and they will send drugs right to your door using the Postal Service, UPS, or FedEx. There’s no way of knowing if the person running the market is next door or on the other side of the world. That makes it really difficult for law enforcement to catch up with these markets—they basically have to slip up. And their transactions use cryptocurrency, which are very hard to trace.
WebMD: Many of these drugs are legal in China, and that’s where they’re manufactured. If we can’t go after the people responsible, how will we stop the flow?
Westhoff: One of my pessimistic conclusions is we’re not going to be able to stop the flow. The war on drugs generally, we’ve been at it for many decades, we’ve always been targeting the supply side and spending billions. Killing Pablo Escobar didn’t stop the flow of cocaine from Colombia; there’s more now than ever. Capturing and trying El Chapo hasn’t stopped the flow from Mexico.
We should encourage China to stop giving tax breaks to companies exporting fentanyl and to crack down on this industry, but we can’t control what China does. We need to get our own house in order, focusing on the demand side. We need more harm reduction programs, education programs. We need to figure out how to get people to stop using these terrible drugs, and to help people with addiction problems.
WebMD: Aren’t these drugs also killing people in China?
Westhoff: China has its own problems with drugs like heroin, meth, and ketamine, but no fentanyl problem at all. That has a lot to do with the opioid crisis. There have been three waves of the opioid crisis, which has most strongly hit U.S. and Canada—that’s where all the opioids like Oxycontin have been overprescribed. Prescription pills were the first wave. Then when users��� prescriptions ran out, a lot of people with legit medical problems were addicted. They turned to street heroin, which became the second wave of the opioid epidemic. Now fentanyl is the third.
That’s why fentanyl is so much more of a problem in the U.S. and Canada than other places in the world: They didn’t have the opioid prescription problem to begin with. But fentanyl is starting to show up in places like Europe. Ultimately nobody is going to be immune from this problem.
WebMD: Tell me about harm reduction techniques. If they’re working well in other countries, why aren’t we using them in the U.S.?
Westhoff: Harm reduction is the idea that people are always going to use drugs, so we just need to make sure they’re doing it safely. You can compare it to sex education—we can bury our heads in the sand and teach abstinence, but kids are always going to have sex so we should try to help them do so more safely. It’s the same thing with drugs.
There are things like fentanyl testing strips, which are very cheap, kind of like pregnancy tests—they can detect very quickly if fentanyl is in your drugs. If people realize it’s there, they’re less likely to use it and overdose. But fentanyl testing strips are illegal in places like Pennsylvania. We also need more Narcan, which is a miracle drug that reverses an opioid overdose. That should be available to all first responders, even firefighters and librarians, who confront opioid overdoses all the time. There are myriad harm reduction methods that could be legalized or have more funding.
There’s a puritanical attitude stopping it, this idea that we’re legitimizing drug use if we use the philosophy of harm reduction. We’re used to the “just say no” mentality, but it’s unrealistic. With the opioid crisis, the fentanyl deaths keep rising. We need to be more creative. Desperate times call for desperate measures. I think we need to try some new approaches.
I interviewed a lot of people for the book, and they kept going back to harm reduction. It used to be a left/right divide, but I think there’s going to be a consensus. We have to treat drug addiction as a disease. Instead of locking up drug users we should help people rehabilitate. That’s how we’ll help the crisis to stop getting worse and start getting better.
WebMD: What approaches are working here?
Westhoff: We are seeing a lot more needle exchange facilities. People who use heroin and fentanyl often trade needles, which leads to higher rates of HIV and other infectious diseases. Even in conservative states like Indiana and Kentucky we’re seeing exchanges. I’m a big fan of that. We’re also seeing more medication-assisted treatment—opioid blockers or low-level opioids like methadone and suboxone, to help people taper off drugs like fentanyl and heroin. That’s been encouraging, seeing more funding for these programs. I think that’ll prove to be really helpful.
WebMD: Are there other synthetic drugs on the horizon or gaining popularity that people need to be aware of?
Westhoff: There’s something called K2 or spice, which is sometimes known as synthetic marijuana, synthetic cannabinoids. Because of the name, people assume they’ll be chill, relaxed drugs but they’re not. They’re totally synthetic and they make your heart beat really fast. They cause people to overdose and die, and they don’t have much in common with regular marijuana at all. They interact with the same receptors as THC, which is in marijuana, but there’s no THC in them. The response is much stronger, and the way people react is completely different.
We’re seeing a huge overdose crisis all over the U.S., particularly in big cities, with synthetic cannabinoids. Those are all made in China, so it’s the same type of problem as fentanyl. People don’t know how to dose them properly. And it’s not just marijuana. For every traditional drug there’s a new synthetic version, and the synthetic version is almost always more dangerous.
WebMD: Is there anything readers can do to protect their loved ones?
Westhoff: That’s really important to me. I have young children. They’ll be teenagers before I know it. The drug landscape is completely different from when we were younger. Any pill you don’t get from a pharmacy could be cut with fentanyl, any powder too.
Now more than ever it’s important to be really honest with kids about drugs. With something like marijuana, if you can smell the buds, you can see it’s a plant. There aren’t instances of marijuana being adulterated with fentanyl. In general, marijuana is pretty safe. You don’t want your teen getting stoned all day long, but in terms of being honest about what drugs can kill you—that’s the approach I would take with my children.
I talk with parents all the time who’ve lost kids. Nobody ever saw it coming. It wasn’t like their kids were longtime drug addicts. Often it was the first time they tried a pill.