— Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic, by Ben Westhoff (Atlantic Monthly Press, 2019)
Fentanyl, Inc. opens with the story of eighteen-year-olds Bailey Henke and Kain Schwandt as they go on a road trip across the snowed plains of North Dakota. Henke and Schwain plan on visiting family, but they have an ulterior motive: they hope their time on the road will help them kick their addiction to fentanyl, a drug they once discovered by buying medical patches on the black market.
Fentanyl is a derivative of morphine that was originally formulated as a medical drug. It can be fifty times stronger than heroin and a hundred times stronger than morphine. In Fentanyl, Inc., a sobering account of the rise of fentanyl and other synthetic drugs, investigative journalist Ben Westhoff narrates how Henke and Schwandt’s plight triggered “Operation Denial,” an international drug investigation that has netted more than 30 indictments. Westhoff also traces the history of synthetic drugs and their uneasy coexistence with both the medical community and regulatory agencies. Rounding up his investigation, Westhoff visits two Chinese factories that produce synthetic opioids distributed by Mexican drug cartels in the United States or sold through the so-called “Dark Web,” the part of the Internet that is not accessible through conventional search engines and web browsers.
Fentanyl, Inc. is global in scope because it deals with a global drug-addiction crisis. According to the Centers for Disease Control and Prevention, “… among the more than 70,200 drug overdose deaths estimated in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (other synthetic narcotics) with more than 28,400 overdose deaths.” Due to this boost in fentanyl-related deaths, deadly opioid overdoses are expected to increase 147 percent by 2025. Although fentanyl is used to ameliorate pain and as anesthesia in hospitals, it is now killing more Americans annually than any street drug in history.
How We Got Here
In 1959, Belgian physician Paul Janssen developed fentanyl while altering the chemical structure of morphine. He discovered that it acted faster and started his own company to develop other drugs, eventually selling his business to Johnson & Johnson. Incidentally, J&J is one of the companies currently facing lawsuits for their role in the opioid epidemic. A judge in Oklahoma ordered J&J in August to pay $572 million in a case alleging the company downplayed the dangers of fentanyl when marketing the drug.
During the 1970s, fentanyl made it to the streets as rogue chemists hijacked the formula. Known as China White, it was actively sought by heroin users. By 2015, fentanyl abuse had become an epidemic, and physicians prescribed it 6.5 million times that year alone. The increased demand for opioids was also met by synthetic fentanyl made in Chinese labs. While possession of fentanyl is illegal in China, the government subsidizes its manufacturers. As Westhoff writes, “The Pablo Escobars of today are coming out of China, and they don’t have to worry about being imprisoned by their own government.”
Fentanyl is also cheap to produce, incentivizing dealers to cut it into drugs like cocaine and heroin. Given fentanyl’s strength, the smallest miscalculation in dosage can lead to overdose and death. Hundreds of doses can fit into an envelope, which explains how Chinese manufacturers ship their product into the U.S. with ease. Over 400 million international packages arrive to the country each day, and there is no technology or amount of detection dogs that can scan every unopened package.
While Fentanyl, Inc. paints an undeniably bleak picture, it is also nuanced. Westhoff discusses harm-reduction strategies like supervised injection facilities or the work of nonprofit organizations like Energy Control and DanceSafe that provide testing kits at music events. The end result of this searing look that takes us from music festivals in the woods to Chinese pharmaceutical companies is an exhaustive and eye-opening investigation.
— Gonzalo is a writer born in Texas, raised in Chile, and currently living in Shepherdstown. His books have been published in Spain and Chile, and his fiction has appeared in Boulevard, Goliad, and The Texas Review, among others.
Review by Gonzalo Baeza