More than 70,000 Americans died from drug overdoses last year, and a growing number of those deaths are attributed to the powerful synthetic opioid fentanyl. Journalist Ben Westhoff says the drug, while an important painkiller and anesthesia medicine in hospitals, is now killing more Americans annually as a street drug than any other in U.S. history.
"Fentanyl was originally formulated as a medical drug, something that was used in ... open heart surgery and in end-of-life care," Westhoff says. "It's an opioid that is 50 times stronger than heroin, 100 times stronger than morphine."
Westhoff's book Fentanyl, Inc. examines the manufacture, sale and use of fentanyl and other synthetic drugs. Over the course of his research, he visited two factories in China that make synthetic opioids and ship them to the U.S. or to Mexican drug cartels for distribution.
Westhoff notes that the synthetic opioids, which are sold over the "dark Web," are often cut into other drugs, including heroin, cocaine and even prescription pills.
"Basically, it's so cheap to produce and it's so powerful, that drug dealers began realizing it was a way to increase their profits," Westoff says.
He adds: "Since only 2 milligrams of fentanyl is enough to kill you, just the slightest miscalculation can make people overdose and die. ... If fentanyl starts taking over prescription pills and other drugs, the problem could get even worse."
On how Belgian physician Paul Janssen invented fentanyl
In 1959, he was monkeying around with the chemical structure of morphine and he came upon fentanyl and it had some advantages: It acted faster, it was stronger, and so it quickly became an important medical drug. ... He started his own company and then, not too long afterward, it was sold to Johnson & Johnson, and Johnson & Johnson today makes the fentanyl patch from the drug that Paul Janssen invented. ... It is also a medical drug. [For] people who have cancer, people who have serious pain, it's used for pain management.
On how fentanyl is different from heroin
They're both extremely addictive and they both sort of satisfy the same cravings; but the problem with fentanyl is that it's just much more likely to make you overdose and die. ... It's getting to be that fentanyl can be in almost any drug. We're even seeing cases where ecstasy pills taken by ravers now sometimes have fentanyl. So it's getting to be that almost all drugs are unsafe. ...
Fentanyl, in places like St. Louis (where I'm from) is actually starting to catch on as a drug unto itself. And it is so much stronger that longtime addicted users who don't even get high on heroin anymore ... with fentanyl, they can actually feel that feeling again of being high.
On contacting a U.S. fentanyl dealer on the dark Web
He was [an] addicted opioid user himself. And he actually claimed to be doing some good in the world, if you can believe that. He was selling a nasal spray with a type of fentanyl and it was very cheap. And, despite the fact that he was selling this type of fentanyl over the dark Web, his contention was that he was helping addicted users like himself maintain their addiction affordably. ...
Even the slightest miscalculation can have fatal consequences. ... And he said he had anxiety issues and [that] starting to use these exotic opioids relieved his stress, and he has kind of a blue-collar job that doesn't pay the bills. He originally tried street dealing but that didn't make the money compared to the sort of worldwide potential customer base that he found on the dark Web. ...
I think it's fair to say that a lot of dark Web dealers really don't care who they're selling to. They don't care what it's being used for, the amounts. But at the same time, there are other dark Web dealers I talked to who specialize in psychedelics. They specialize in drugs they think should be legal medical drugs to help people with things like PTSD. ... So, it's a whole wide swath of different types of people on there.
On how fentanyl from the dark Web is shipped to users
It's surprisingly easy to send these drugs through the mail, and that's been another big bone of contention that President Trump has been tweeting a lot about recently. The amounts needed are so small that just a tiny amount, hundreds of doses, can fit in an envelope. And it's often mislabeled. ... It doesn't say what it really is on the customs declarations, and also it's often hidden inside other products. So this guy [I] was talking to ... said that he received his in, like, a cleaning product I think, something like an Ajax can, and from the outside it just looked exactly like a cleaning product and you would have had to open it up to see what was inside. ... He showed me the little nasal spray mister that he sends and it does looks like something you would buy at CVS or Walgreens; it has a little label and it looks totally innocuous.
On the Chinese government's attitude toward fentanyl
China has big problems with drugs like heroin and meth and ketamine but they don't have a fentanyl problem like we do in the U.S. And so a lot of people think this is why they haven't sufficiently cracked down on this huge industry that they have. ...
The big problem in China is that a lot of these drugs which are banned in the U.S. are still legal in China. And so the companies can make them with the full support of the government and have them basically smuggled into the U.S. ... The biggest and most disturbing revelation from my book was that not only is China not doing enough to contain this industry, they're actually encouraging this industry through a series of tax breaks, subsidies and other grants.
On how the rave scene is piloting ways to detect fentanyl-laced drugs
When I got started in this story, I started hearing about all this adulterated ecstasy, and since then there have been some really sophisticated test kits that can check to see: Is this drug what you think it is, or is it something else? And this was developed out of the rave scene, and now fentanyl test strips are providing this same sort of service for drugs that may be adulterated with fentanyl. So if you have a longtime user of heroin, and they're able to check their heroin to see if there's fentanyl, if they discover it, studies have shown that they're less likely to use it or to use as much or to use as quickly — and therefore overdose rates are likely to drop. ...
There are also city governments, even certain states, that are providing funding for public health organizations to dispense these kits. At the same time, in some states, including Pennsylvania, fentanyl test strips are actually illegal, and so that's really hindering and making things worse.
Sam Briger and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for Shots.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. Nearly 70,000 Americans died from drug overdoses last year, and a rapidly growing number of deaths are attributed to the powerful synthetic opioid fentanyl. Our guest, journalist Ben Westhoff, says fentanyl is now killing more Americans annually than any other drug in American history. Dealers are adding fentanyl to heroin and other drugs, and users often have no idea they're getting it or how much they may be using. In a new book, Westhoff explores the manufacture, sale and use of fentanyl and other synthetic drugs. He says they're often made in China and easily purchased over the Internet. The Pablo Escobars of today are coming out of China, he writes. And they often operate free and in the clear within the boundaries of their country's own laws.
In researching the book, Westhoff interviewed dealers operating on the dark web and visited companies in China making fentanyl and its chemical components. Ben Westhoff has written about culture, drugs and corruption in The Wall Street Journal, Rolling Stone and other publications. He spoke to FRESH AIR's Dave Davies about his new book, "Fentanyl, Inc.: How Rogue Chemists Are Creating The Deadliest Wave Of The Opioid Epidemic."
DAVE DAVIES, HOST:
Well, Ben Westhoff, welcome to FRESH AIR. Let's start with a basic. What is fentanyl exactly?
BEN WESTHOFF: Fentanyl was originally formulated as a medical drug, something that was used in stuff like open heart surgery and in end-of-life care. It's an opioid that is 50 times stronger than heroin, 100 times stronger than morphine. But how we hear about it most now is as an illicit narcotic that is sold and used illegally.
DAVIES: Yeah. I mean, you make a point early in the book that there's a distinction between opiates - that's O-P-I-A-T-E-S - which are derived from the poppy plant and opioids, which - what? - I guess hit the same receptors in the brain as opiates.
WESTHOFF: Yes. The difference is that they're manufactured in labs. So they're completely synthetic. And nowadays, almost all of the illicit fentanyl is made in China.
DAVIES: This was invented by a guy named Paul Janssen when?
WESTHOFF: That's correct. In 1959, he was monkeying around with the chemical structure of morphine. And he came upon fentanyl, and it had some advantages. It acted faster. It was stronger. And so it quickly became an important medical drug.
DAVIES: Right. And when we say he was monkeying around with them, he was a legitimate chemist - right? - working for a pharmaceutical company - his own company, right?
WESTHOFF: That's right. He started his own company. And then not too long afterwards, it was sold to Johnson & Johnson. And Johnson & Johnson today makes the fentanyl patch from the drug that Paul Janssen invented.
DAVIES: And what is it used for? What are the legitimate uses of it?
WESTHOFF: It is also a medical drug. And people who have cancer, people who have serious pain, it's used for pain management.
DAVIES: Right. So it relieves pain. How did it get to be a drug of choice for opioid users?
WESTHOFF: This was really a long time coming, and it's something that nobody really saw coming, including the DEA. As recently as 2015, they didn't think fentanyl would be a problem. But basically it's so cheap to produce and it's so powerful that drug dealers began realizing it was a way to increase their profits. And so they started cutting it in to heroin. And nowadays, it's almost impossible to find pure heroin on the street. And fentanyl is also being cut in to cocaine, prescription pills. And that's how Prince died. And it's a terrible scourge.
DAVIES: Right. And do people know what - know they're getting fentanyl or how much?
WESTHOFF: Most people do not want fentanyl. They don't realize that it's in their heroin or it's in these fake prescription pills. And oftentimes, even if they do know there's fentanyl, they don't know how much. And since only two milligrams of fentanyl is enough to kill you, just the slightest miscalculation can make people overdose and die. And fentanyl in places like St. Louis where I'm from is actually starting to catch on as a drug unto itself. It is so much stronger that longtime addicted users who don't even get high on heroin anymore - it just sort of maintains them and stops them from getting sick - now with fentanyl, they can actually feel that feeling again of being high.
DAVIES: What's the appeal to dealers and manufacturers of this?
WESTHOFF: The appeal is that it's so much cheaper to make, and it's so much more powerful. So while the cartels in Mexico have these fields of opium poppies, it's very exposed to law enforcement. It takes a long time to grow, and it costs more to make whereas fentanyl in a Chinese lab can be made quickly. It's very hard for law enforcement to crack down on it as well.
DAVIES: Right. And a lot lighter and simpler to ship, I suppose.
WESTHOFF: Exactly. And so it's generally either shipped through the mail from China directly to U.S. dealers or consumers or else the fentanyl ingredients or the fentanyl itself is shipped to the Mexican cartels, who then send it north through the border into the U.S.
DAVIES: So give us a sense of the scale of the problem. How many people are overdosing because of fentanyl?
WESTHOFF: When it comes to the opioid epidemic, there are signs that it's maybe kind of leveling off. And deaths from prescription pills and heroin are actually down in recent years, but fentanyl deaths keep climbing. And it's up around 30,000 a year for estimated statistics for 2018.
DAVIES: Wow. And that's because people - fentanyl is in so many other products and it's sort of replacing heroin because of its convenience and potency.
WESTHOFF: Exactly. And it's getting to be that fentanyl can be in almost any drug. We're even seeing cases where ecstasy pills taken by ravers now sometimes have fentanyl. So it's getting to be that almost all drugs are unsafe.
DAVIES: You said that the fentanyl scourge represents the third wave of the opioid epidemic. What are the other two?
WESTHOFF: The opioid epidemic began with prescription narcotics like OxyContin. And doctors started prescribing those at a really high rate in the '90s and the 2000s. And oftentimes, when people's prescriptions ran out, they were addicted. And so in order to maintain their addictions, these were law-abiding citizens who turned to buying street heroin. And that was the second wave of the opioid epidemic. And now fentanyl represents the third wave.
DAVIES: So fentanyl is a synthetic drug - right? - part of a class of drugs that kind of are known in the business as NPS. That's novel psychoactive substances, right?
WESTHOFF: That's right.
DAVIES: Who came up with these drugs? I mean, they're all different molecular formulas, right?
WESTHOFF: Ironically, almost all of these new drugs were made by legitimate scientists for medical and scientific purposes. In the days before the Internet, it was kind of hard to track down their research. You had to go to university libraries and places like that. But in the Internet age, all of these papers and their chemical formulas became available to anybody. And so rogue chemists began scouring the scientific literature and appropriating these medical drugs for use as recreational drugs. And they began to be sold over the Internet and - whereas there were only, you know, a handful - a few handfuls of drugs a hundred years ago, now there's literally a hundred new drugs or more every year.
DAVIES: Yeah, there are 50 listed in an appendix to your book.
DAVIES: This part of your book has some really interesting characters in it - these chemists who followed up on the leads of academics and began developing various kind of classes of synthetic drugs. Give us a sense of what their motives were. Like, one of them was this guy Alexander Shulgin - went by Sasha, right? What was he up to? What did he want to do?
WESTHOFF: Yeah. Sasha Shulgin started his career working for Dow Chemical. But he - his real interest was in psychedelics, and he thought they could be used as tools to help with medical science, psychiatry, even religion. And so he began tinkering with these different psychedelic chemical structures. And eventually, Dow had enough of him, so he worked on his own piece of land. And all day long, he created these new psychedelics and then sampled them himself to see if anything happened. He started by taking a very tiny dose and worked his way up until he felt an effect.
Eventually, he created so many new drugs that he released a couple of books that are basically cookbooks for how to synthesize these drugs, and his popularity really exploded. He also popularized MDMA, also known as ecstasy, and became known as the godfather of ecstasy.
DAVIES: Right. And did he imagine, you know, hundreds of thousands of young people taking this stuff? Was he cool with that?
WESTHOFF: He was, and that's why he published these books. He wanted everybody to have access. Now, in his defense, psychedelics are much less toxic and much less likely to cause overdoses than the narcotics that we've been talking about. But as you can imagine, the DEA did not take too kindly to this and ended up raiding his facility.
DAVIES: Right. And nowadays a lot of those psychedelics are being laced with fentanyl, and they can be deadly, right?
WESTHOFF: Well, there's a lot of problems with the techniques that he created because that's exactly the same techniques that these rogue chemists all over the world are using to develop drugs that are less benign. And the - not just fentanyl, but there are dozens and dozens of fentanyl analogues, as they're called, which are made by just barely tweaking the chemical formula of fentanyl to create something new that's now legal.
DAVIES: Right, which makes it hard to regulate, right? You make a slight change in the formula, and suddenly, it's not an illegal drug anymore, right?
WESTHOFF: Exactly. And in China, they've had the biggest problem with this, whereas in the U.S., they sort of have a blanket ban of everything that's anything like fentanyl. In China, until recently, they had to regulate each drug, one by one, and that's been the source of all this friction with President Trump and China's President Xi. And it plays in with the trade war, and it's really caused a lot of problems.
DAVIES: We're speaking with Ben Westhoff. His new book is called "Fentanyl, Inc." We'll talk more after a short break. This is FRESH AIR.
(SOUNDBITE OF MATT ULERY'S "GAVE PROOF")
DAVIES: This is FRESH AIR. And we're speaking with journalist Ben Westhoff. He has a new book about the drug fentanyl, which is responsible for thousands of overdose deaths. The book also deals with other synthetic drugs. It's called "Fentanyl, Inc.: How Rogue Chemists Are Creating The Deadliest Wave Of The Opioid Epidemic."
You know, one of the things that's interesting about using fentanyl is that you don't necessarily need a street dealer to get it; a lot of it can be gotten on the dark Web. I mean, for those that aren't savvy, explain what the dark Web is.
WESTHOFF: The dark Web consists of Web pages that use a disguised protocol, and so it's impossible to know who's making the pages, and it's very easy to send these disguised messages. So it's impossible to know where they're coming from, and it's impossible to read them unless you have the code to unscramble them.
DAVIES: But it's not hard for anybody who's interested to get there and look for stuff, right?
WESTHOFF: No, it's not hard to use at all. You can do it from your smartphone.
DAVIES: So you explored this world a bit - found, you know, open marketplaces of drugs, right? And you reached out to a dark Web dealer who goes by the name U4IA. You traded some encrypted messages, I think, and then, eventually, he agreed to meet with you, right?
DAVIES: Why would he do that? (Laughter).
WESTHOFF: I was surprised, too. I think, for him, he was a addicted opioid user himself. And he actually claimed to be doing some good in the world, if you can believe that. He was selling a nasal spray with a type of fentanyl, and it was very cheap. And, you know, despite the fact that he was selling this type of fentanyl over the dark Web, his contention was that he was helping addicted users like himself maintain their addiction affordably.
DAVIES: And do we have any idea about how safe or dangerous this mist is?
WESTHOFF: I can't imagine it's very safe. I mean, I would not - certainly never trust something like that to someone I didn't know, were I user, because even the slightest miscalculation can have fatal consequences. But I was actually able to meet him in person. He was kind of a physically big guy, and I was a little intimidated (laughter) when I saw him. But he was there with his little daughter, and he obviously cared about her. And that's why he said - another reason he was doing what he was doing was to support his family.
DAVIES: Right. How did he get into this - he was a user and needed income?
WESTHOFF: He has been a user of a number of drugs over the years, and I believe he was also addicted to meth at one point. And he said he had anxiety issues and starting to use these exotic opioids relieved his stress. And he has kind of a blue-collar job that doesn't pay the bills, and he originally tried street dealing, but that didn't make the money compared to the sort of worldwide potential customer base that he found on the dark Web.
DAVIES: Do you have a sense of the scale of his operation - how much he ships, how much he makes?
WESTHOFF: The profit margins are astronomically high. So he bought just a very small amount of this fentanyl analogue from China and was able to make something like a hundred times or more profit based on what he was selling. And so far, he had only sold a few thousand dollars' worth of this new batch. So I didn't get the sense that he was a big kingpin, but it was certainly a lot of money being exchanged.
DAVIES: You know, when you connected with him and asked him to meet and he agreed, he said, you know, I think I'd like to have a voice. Does he see himself as different from other dealers on the dark Web?
WESTHOFF: I think he does. And I think it's fair to say that a lot of dark Web dealers really don't care who they're selling to; they don't care what it's being used for - the amounts. But at the same time, there are other dark Web dealers I talked to who specialize in psychedelics. They specialize in drugs they think should be legal medical drugs to help people with things like PTSD, like I talked about before. And so it's a whole wide swath of different types of people on there.
DAVIES: How do they ship stuff without putting themselves or buyers at risk?
WESTHOFF: It's surprisingly easy to send these drugs through the mail. And that's been another big bone of contention that President Trump has been tweeting a lot about recently. The amounts needed are so small that just a tiny amount - you know, hundreds of doses can fit in an envelope. And it's often mislabeled, for starters; it doesn't say what it really is on the customs declarations. And also, it's often hidden inside other products.
So this guy I was talking to, U4IA, said that he received his in, like, a cleaning product, I think something like an Ajax can. And from the outside, it just looked exactly like a cleaning product, and you would have had to open it up to see what was inside.
DAVIES: That was the material he got from - what? - a Chinese manufacturer?
WESTHOFF: Yeah, exactly.
DAVIES: Right. And then when he ships his stuff - I'm assuming he was in the United States, sending it here and elsewhere?
WESTHOFF: Yes. And he showed me the little nasal spray mister that he sends, and it does look like something you would buy at CVS or Walgreens. It has the little label, and it looks totally innocuous.
DAVIES: Right. What do you need to make fentanyl? You know, anybody who saw the TV series "Breaking Bad" knows that, you know, getting the raw materials for making that was a chore. But what are the chemicals you need to make fentanyl?
WESTHOFF: Fentanyl is similar to meth in that you really need a specific precursor chemical, is what it's called. So for meth, you might remember that all these sort of backwoods American cooks were using Sudafed. And so they would go to a local drugstore and walk out with all of the Sudafed in the store, and then they would harvest the pseudoephedrine from those pills to make meth.
And it's the same thing with fentanyl. You need a different precursor chemical. But without that chemical, you can't make fentanyl. And so that's why China plays in so heavily because even though the Mexican cartels are ultimately sending so much fentanyl into the U.S. they rely on the precursor chemicals made in China.
DAVIES: So the pattern is that the components of fentanyl are manufactured in China, shipped to Mexico, where then the cartels actually synthesize the fentanyl itself and ship it to the United States?
DAVIES: And do people get fentanyl directly from China, too, either dealers or users?
WESTHOFF: Yes, dealers and users get it also directly from China, right through the U.S. mail and even FedEx and UPS.
GROSS: We're listening to the interview FRESH AIR's Dave Davies recorded with Ben Westhoff, author of the new book "Fentanyl, Inc." After a break, Westhoff will talk about visiting Chinese companies that make and export fentanyl and its components, some of them subsidized by the Chinese government. And Maureen Corrigan will review "The Yellow House," a memoir that tells the story of one New Orleans family. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF DOMINIC MILLER'S "CHAOS THEORY")
GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to the interview FRESH AIR's Dave Davies recorded with journalist Ben Westhoff about fentanyl, the powerful synthetic opioid that's responsible for tens of thousands of drug overdose deaths. For his new book, "Fentanyl, Inc.," Westhoff spoke to dealers selling the drug on the dark web and visited Chinese labs that export fentanyl and its chemical components.
DAVIES: China is a huge player in the world of fentanyl and other synthetic drugs. And it's interesting. I know you traveled there and you did a lot of research. It's not a narco-state, you said, where, you know, leaders are corrupted and bought by cartels. What is the Chinese government's attitude towards drug sales and use among its own citizens?
WESTHOFF: China has big problems with drugs like heroin and meth and ketamine. But they don't have a fentanyl problem like we do in the U.S. And so a lot of people think this is why they haven't sufficiently cracked down on this huge industry that they have. It's a massive chemical and pharmaceutical industry, the biggest in the world. And a small part of it - but still very large - is dedicated to illicit fentanyl.
DAVIES: Right. But the government itself has imposed serious punishment on drug dealers in China, right? I mean, apart from the fentanyl manufacturer...
WESTHOFF: Oh, yeah. Yeah.
DAVIES: I mean, in terms of people who use drugs in China or who deal locally, that's not tolerated by the government, right?
WESTHOFF: Yes. There are certainly harsh drug punishments in the U.S., but in China, they're much harsher. And even possessing a very small amount of drugs can get you the death penalty.
DAVIES: Right. So the manufacturers that make fentanyl and fentanyl analogs - fentanyl-like substances - and others, do they do it legally in China?
WESTHOFF: That's the big problem in China is that a lot of these drugs, which are banned in the U.S., are still legal in China. And so the companies can make them with the full support of the government and have them basically smuggled into the U.S.
DAVIES: Right. So are they encouraged by the government? I mean, do they - are they just flying under the radar? I mean, it is a country with a huge legitimate generic drug industry, too.
WESTHOFF: That was sort of the biggest and most disturbing revelation from my book was that, not only is China not doing enough to contain this industry, they're actually encouraging this industry through a series of tax breaks, subsidies and other grants.
DAVIES: So they are literally rewarded and encouraged for doing what they're doing?
WESTHOFF: Yeah. China has sought to encourage its exports. That's seen as a very important part of the economy. And to grow these exports, they started offering these subsidies and tax breaks for chemical companies that were exporting drugs all over the world. And so the idea, I'd imagine, was to go to legal, legitimate chemicals. But companies that are making these illicit drugs are also receiving these government benefits.
DAVIES: So you went to China and you visited two companies - one small, one huge. The smaller one was by a guy who called himself Dowson. Is this right?
WESTHOFF: That's right.
DAVIES: Tell me about meeting him. Was he suspicious of you?
WESTHOFF: He was suspicious of me. He asked me numerous times if I was a journalist, and I had to keep saying no. We had met over the Internet. And I pretended to be a customer. And he said I was welcome to visit the lab. We met in Shanghai. And he sized me up for a while. And it took him a few hours before he decided he trusted me enough. And the whole thing was pretty nerve-wracking because with him was his driver. He was kind of a big, beefy guy, who I thought might be the muscle of the operation.
And so I was kind of nervous getting into the car with them and driving to the distant outskirts of Shanghai. But it all worked out. And I was able to see the lab where he was synthesizing fentanyl-like drugs, fentanyl analogs, synthetic cannabinoids, which are known as K2 and Spice, sometimes called synthetic marijuana. And it was really shocking to see all of it.
DAVIES: Were they clean? I mean, did it look like a place where, you know, good product - whatever that means - would be made?
WESTHOFF: They weren't as clean as, say, an American university lab. But it did, for the most part, look like it was done with - it was - the lab was run with care. And the amount of chemicals they were making was so large, though, that they were just sort of sitting around in piles. There was one lab station that was piled high with these chemicals. And it reminded me of the scene in Scarface, where Al Pacino is sitting at the table full of massive piles of cocaine.
DAVIES: And he was actually shipping fentanyl, not just the components of fentanyl, right?
WESTHOFF: Right. He was shipping fentanyl analogs. And even though fentanyl was banned in China at the time, these analogues, which are made by just slightly tweaking the chemical formula of fentanyl, these were still legal. And not only were their effects like fentanyl, but in a lot of cases, they're much stronger.
DAVIES: You also went to a much larger company that does a lot of different drugs. Yuancheng is the name of this company, right? And you talked to their sales people. What were they like?
WESTHOFF: Yuancheng's sales people were almost all recent college graduates in their 20s. And I first started communicating with them over Skype. And they would send me these sort of emoji-filled messages. And they tried to be friendly. They would communicate on social media, however you wanted. But at the same time, they were selling these precursors to make fentanyl. And their customers included the cartels in Mexico and basically anyone who wanted to buy it.
DAVIES: And they were pretty candid about talking about how to ship things illicitly, weren't they?
WESTHOFF: Yes. They offered to send these chemicals in fake packaging. So they showed me pictures of - they had these things that were like banana snacks. They had fake dog food bags. And they assured me they had people in the customs area, not just in the U.S. but in China, too. So they basically promised 100% satisfaction in getting these chemicals to me.
DAVIES: You know, when you spoke to the dark web dealers, you told them you were a reporter and that's what you were doing. With the Chinese manufacturers, you posed as a buyer. In some journalistic, you know, rulebooks, that's kind of a no-no. How did you consider whether to adopt this persona?
WESTHOFF: I certainly tried to admit that I was a journalist and get interviews that way, but it was not happening for obvious reasons. And I think there's a long journalistic history of, in cases like this, disguising your identity. And I certainly think that, in the midst of an opioid epidemic that's killing 70,000 Americans per year, it was justified for me to find out information about this industry about which people basically knew nothing.
DAVIES: Yeah. You know, I checked the Society of Professional Journalists' code of ethics and it says that undercover journalism is discouraged. But in circumstances where there's no other way to get critically important information, it's acceptable - so exactly such a circumstance, I guess. We're speaking with Ben Westhoff. His book is called "Fentanyl, Inc." We'll talk more after a short break. This is FRESH AIR.
(SOUNDBITE OF AVISHAI COHEN'S "GBEDE TEMIN")
DAVIES: This is FRESH AIR. And we're speaking with journalist Ben Westhoff. He has a new book about the drug fentanyl and the harm it's causing, also deals with other synthetic drugs in the book. It's called "Fentanyl, Inc.: How Rogue Chemists Are Creating The Deadliest Wave Of The Opioid Epidemic." The U.S. says that China is supplying these drugs that are killing U.S. kids. What do the Chinese officials say?
WESTHOFF: Chinese officials tend to blame the problem on the U.S. And they say that the demand here is what's fueling the epidemic. They talk a lot about the prescription pills that - like OxyContin - that were overprescribed. And there's certainly a lot to be said for this argument. There's no doubt that the U.S. has to focus on reducing demand here and increase what's known as harm reduction measures, which is basically understanding that people are always going to use drugs and we should try to help them do so as safely as possible.
DAVIES: And they say that they have, in fact, banned many substances - right? - that the U.S. wanted them to ban and, I guess, in December 2018, committed to banning all fentanyl and fentanyl-like drugs, right?
WESTHOFF: That's right.
DAVIES: Is that really going to happen, I mean, based on the experience? Or will there be some other way around it?
WESTHOFF: I think we can take China at its word that it has gone about banning all of the fentanyl analogs, the fentanyl-like drugs. Now, doing that on paper is one thing, but the enforcement is the part where China has really lagged. And they don't have enough people on the ground to enforce the laws they have on the book. And often there are competing layers of government that are at odds with each other. So you might have a provincial official who wants to let these companies keep doing what they're doing because it brings in more revenue for the area.
DAVIES: Right. And you also note that there are some cases where Chinese drugmakers or sellers had been indicted in U.S. courts and the Chinese government has not extradited them.
WESTHOFF: Yes. China doesn't really want to be told what to do. They don't want to be bossed around by the U.S. Yet, at the same time, they also don't want to be seen as the world's drug pusher. And so that's why you have kind of a push and pull situation, where China is willing to make these laws that are necessary, but they're not willing to do other things the U.S. has asked.
DAVIES: So when we look at the circumstance we're in in the United States - I mean, you have fentanyl coming in, often included in other drugs, so users are misinformed about what they're getting. And the results are often tragic. And you write that some of the best solutions to the synthetic drug crisis are coming out of the rave scene, you know, these dance parties. What solutions do you mean?
WESTHOFF: When I got started in this story, I started hearing about all this adulterated ecstasy. And since then, there have been some really sophisticated test kits that can check to see, is this drug what you think it is or is it something else? And this was developed out of the rave scene. And now fentanyl test strips are providing this same sort of service for drugs that may be adulterated with fentanyl.
And so if you have a longtime user of heroin and they're able to check their heroin to see if there's fentanyl - if they discover it, studies have shown that they're less likely to use it or to use as much or to use as quickly. And therefore, overdose rates are likely to drop.
DAVIES: You know, there is a strong belief among a lot of people who study this problem that we need to treat, you know, addiction as a disease, not a crime and focus on treatment rather than punishment - and, of course, harm reduction. There was a huge verdict in Oklahoma against Johnson & Johnson that's now under appeal, which would require hundreds of millions of dollars in payments to deal with the opioid epidemic. And, of course, there are pending cases in federal court and elsewhere. Do you think this is a promising source of funding to deal with this problem?
WESTHOFF: I think that it is. And I think the closest comparison would be the big tobacco settlements from the '90s. It could be that the makers of these opioids, including, like you said, Johnson & Johnson - which, as we talked about earlier, is the parent company of Paul Janssen's company, the maker of fentanyl. And this funding could be used for all of these public health programs that include things like medication-assisted therapy, which is considered the gold standard, to use drugs that help people go off these very dangerous opioids, like fentanyl and heroin and take something that is still an opioid but helps them maintain their addiction while they get their lives in order and hopefully wean off altogether.
DAVIES: You note that the Trump administration's posture on this, kind of in a general way, is to provide treatment for users but bring the hammer down hard on dealers. And you make the point that there's not such a clear line between the two.
WESTHOFF: Yes. Often someone who's considered a dealer is really just an addicted user who started dealing in order to support their own habit. And so when we have these increasingly tough sentences for fentanyl dealers, a lot of times you're simply taking someone who needs care and locking them up.
DAVIES: So, I mean, as you look at where we are now with this problem, how optimistic or pessimistic are you?
WESTHOFF: Unfortunately, I still remain really pessimistic, specifically when it comes to fentanyl, because in the U.S., overdose death rates are still rising. And not only that, but there is a huge problem in Canada. There's problems in places like Australia, different parts of Europe. And fentanyl has not even begun to adulterate a lot of drugs that people use. So for example, in places like West Virginia, there's a big prescription pill underground culture. And so there are some cases where these fake prescription pills have been cut with fentanyl, but that market has barely been tapped. And if fentanyl starts taking over prescription pills and other drugs, the problem could get even worse.
DAVIES: So what should policymakers be doing? I mean, is enforcement and interdiction effective? Or - what should they be doing?
WESTHOFF: I think that decades of war-on-drugs policies have shown us that it just doesn't work. When Pablo Escobar was taken out, that didn't stop the flow of cocaine, certainly. The cocaine - there's more cocaine coming out of Colombia than ever. When El Chapo was arrested and tried, that hasn't stopped the flow of drugs from Mexico. It's clear to me that the focus needs to be on harm reduction and, like I said, being honest about the fact that people are always going to use drugs and try to make that as safe as possible. There is a type of facility that's in Canada and Europe that are called supervised injection facilities. And there, opioid users and others can shoot up, but they're provided with clean needles. They're overseen by medical professionals. And it's basically a safe environment. No one has ever died in one of these facilities. Yet in the U.S., they're illegal. And so we need to work on this type of solution.
DAVIES: Well, Ben Westhoff, thanks so much for speaking with us.
WESTHOFF: Well, thanks, Dave. It's been a pleasure.
GROSS: Ben Westhoff spoke with FRESH AIR's Dave Davies about his new book, "Fentanyl, Inc.: How Rogue Chemists Are Creating The Deadliest Wave Of The Opioid Epidemic." After we take a short break, Maureen Corrigan will review "The Yellow House," a memoir that tells the story of one New Orleans family.
This is FRESH AIR.
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