Synthetic Fentanyl Drives Record Overdose Deaths In U.S. : Consider This from NPR During President Trump's first year in office, 42,000 Americans died of drug overdoses linked to heroin, fentanyl and prescription opioids. After a minor decrease in 2018, deaths rose to a record 50,042 in 2019. That number will likely be even worse for 2020.

NPR's Brian Mann reports on the surge of synthetic fentanyl, especially in the western U.S.

And NPR's Emily Feng unveils a web of Chinese sellers exporting individual chemical components to produce fentanyl.

In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.

Email us at considerthis@npr.org.
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America's Other Epidemic: The Opioid Crisis Is Worse Than 4 Years Ago

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America's Other Epidemic: The Opioid Crisis Is Worse Than 4 Years Ago

America's Other Epidemic: The Opioid Crisis Is Worse Than 4 Years Ago

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AUDIE CORNISH, BYLINE: Hi, it's Audie Cornish. And we here at CONSIDER THIS want to know what you think of the show. A short, anonymous survey is open now. Go to npr.org/considerthissurvey to share your thoughts. That's npr.org/considerthissurvey. And thanks.

AILSA CHANG, HOST:

In 2016, during America's last presidential election season...

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PRESIDENT DONALD TRUMP: Thank you very much.

CHANG: ...Opioid overdoses were surging...

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TRUMP: We love New Hampshire.

CHANG: ...Especially in battleground states like Ohio, Pennsylvania and New Hampshire.

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TRUMP: So as I said when I won the New Hampshire primary - I promised the people of New Hampshire that we would stop drugs from pouring into your community. And I guarantee you, we will. You will be so proud of your president. You will be so proud of your community.

CHANG: That was a month before Donald Trump won the 2016 election.

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TRUMP: You will be so proud.

CHANG: And almost a full year later, as president, Trump declared the opioid crisis a national public health emergency.

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TRUMP: No part of our society - not young or old, rich or poor, urban or rural - has been spared this plague of drug addiction.

CHANG: That year, 42,000 Americans died of overdoses linked to heroin, fentanyl and prescription opioids.

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TRUMP: We will defeat this opioid epidemic. It will be defeated.

CHANG: The following year, there was a slight dip in overdoses. But since then...

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BRETT GIROIR: All the progress that we made has now been reversed. And this is even before the pandemic.

CHANG: At a panel discussion in late July, Admiral Brett Giroir, a senior adviser on opioid policy in the Department of Health and Human Services, laid out a pretty sobering picture. More than 50,000 Americans died of opioid overdoses last year, which was a record. And that number could rise again this year.

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GIROIR: All the factors we know that are associated - stress, isolation, loss of job, loss of employment, insurance, economic stress - basically everything is pointed in the wrong direction.

CHANG: CONSIDER THIS - the Trump administration promised to end America's opioid epidemic. But four years later, that epidemic has never been worse, in part because the people who make and sell deadly drugs overseas have stayed one step ahead.

From NPR, I'm Ailsa Chang. It's Wednesday, November 18.

It's CONSIDER THIS FROM NPR. Now, let's talk about what the Trump administration did do to fight the opioid epidemic.

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TRUMP: Today, we are here to update the American people on the historic action we have taken and to sign landmark legislation.

CHANG: President Trump signed legislation that poured more federal funds into drug treatment. And during trade talks with China last year, he pushed the Chinese government to adopt tighter regulations on fentanyl, the dangerous synthetic opioid. China designated it as a controlled substance just last spring.

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BEAU KILMER: The federal government has taken some important steps to increase access to evidence-based treatment for opioid use disorder and made some progress at pressuring China to better regulate some of its synthetic opioids.

CHANG: Beau Kilmer, who heads the RAND Corporation's Drug Policy Research Center, says there were missteps behind the scenes. For instance, last December, Congress's Government Accountability Office issued a report blasting the administration. They said it failed to come up with a coherent national drug control plan two years in a row, as required by law. The administration also sidelined the Office of National Drug Control Policy, which has handled America's drug response since the 1980s. Instead, what the Trump administration did was hand leadership of the opioid effort to political appointees, like former New Jersey Governor Chris Christie and White House adviser Kellyanne Conway.

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KILMER: This made it difficult for people to understand, well, you know, who's leading and coordinating the efforts on opioids?

CHANG: And what's made that effort even more challenging is that Americans are no longer just addicted to prescription medications or heroin. Fentanyl is more and more widely available, and it's often mixed with other drugs, like meth and cocaine.

When Jake got out of jail seven months ago, he expected to go back to heroin. But the street market in Phoenix had totally changed.

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JAKE: I just started, you know, smoking pills 'cause that was the thing that was around here. It was so easy to get pills.

CHANG: Pills meaning fentanyl.

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JAKE: As soon as I wake up, I have to have a pill. And the high is not very long. So, I mean, 20 minutes after I smoke a pill, I want to smoke another one, you know?

CHANG: You see, several times a day, Jake crushes a fentanyl pill on a piece of foil, then cooks the powder with a flame, inhaling the fumes. NPR is only using Jake's first name because he fears being arrested for speaking openly about his drug use. He's in his late 20s, lives on the streets and in motels in Phoenix, where it's not hard to find his next dose.

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JAKE: It's extremely easy. Like, I could walk through the motel and have at least, you know, three or four people tell me they got pills for sale.

CHANG: Jake spoke to NPR reporter Brian Mann, who's been looking into the surge of street fentanyl, especially in the Western U.S.

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BRIAN MANN: Researchers say what Jake's experiencing is part of a devastating new development in America's opioid epidemic. Chelsea Shover is an epidemiologist at Stanford University.

CHELSEA SHOVER: After 2018, the vast majority of synthetic opioid overdoses occurred east of the Mississippi River.

MANN: Fentanyl didn't catch on in the West, in part because people addicted to opioids in those states tend to use a different kind of heroin, one that doesn't mix easily with fentanyl powder. But while studying overdose deaths, Shover found what she describes as a fentanyl breakthrough in the West. Starting last year, fentanyl began killing far more people in cities like LA, San Francisco, Seattle and Phoenix. She says fentanyl is in everything now.

SHOVER: You think you're using heroin, or you think you're using ecstasy or Xanax or what looks like an OxyContin pill, but it's actually fentanyl.

MANN: The spike in fentanyl deaths in the West contributed to a record number of fatal overdoses last year. Roughly 72,000 Americans died.

MATT DONAHUE: It's just getting worse, and it's just killing too many people.

MANN: Matt Donahue heads the U.S. Drug Enforcement Administration's overseas operations. It's his job to fight smugglers bringing fentanyl into the U.S. He thinks there's one major reason fentanyl is surging in the West. Last year, under pressure from the Trump administration, the Chinese government cracked down on direct shipments of fentanyl to the U.S., so Chinese companies adapted. They started doing business with middlemen, with drug traffickers in Mexico.

DONAHUE: Sending the precursor chemicals directly to cartels in Mexico to produce the fentanyl, along with fentanyl in pills.

MANN: Once they got into the fentanyl trade, Donahue says, Mexican cartels used their existing drug routes and street markets in Western cities to push the new product. Their motives are simple. Fentanyl is deadly, but it's also cheap, easy to make and highly addictive, making it far more profitable than heroin or cocaine.

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UNIDENTIFIED REPORTER: Phoenix police announcing a major bust, seizing nearly 170,000 fentanyl pills from someone's car.

MANN: The DEA and local police have responded, making a series of massive fentanyl seizures in Phoenix this year. But Sergio Armendariz, a street outreach worker for a program called the Phoenix Rescue Mission, says that hasn't done much to dent supply. He worries the city's homeless camps offer a vulnerable and still mostly untapped market.

SERGIO ARMENDARIZ: Everyone's talking about the fentanyl on the street. When I come up to camps, you see the foils.

MANN: His group and others are scrambling to adopt the public health response already widespread in Eastern cities. That means educating people with addiction that fentanyl is different, more toxic, while handing out Narcan kits that can revive people suffering overdoses. Despite the dangers, Armendariz says some people addicted to opioids are turning to fentanyl as their new drug of choice.

ARMENDARIZ: Knowing that it's very powerful, that that's a driving force for people who are just looking for that extreme high.

MANN: That's Jake's story. He says he understands the danger, but the pull of fentanyl is just too strong.

JAKE: It's just the high I really think about.

MANN: He already overdosed once on fentanyl last summer but was revived. I ask if he thinks he'll survive this new, deadlier addiction.

JAKE: I think that I'm careful enough to, you know? But I've had plenty of friends that have died that thought the same thing, you know? So I don't know.

MANN: So now Western states, too, face an escalating fentanyl crisis. Researchers and law enforcement tell NPR if street fentanyl continues to spread without more treatment and a better, more coordinated public health response, the U.S. will see another record number of overdose deaths this year.

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CHANG: That is NPR's Brian Mann.

So a lot of the fentanyl that winds up on American streets is made with ingredients from China. But China actually banned the drug more than a year ago. So how is it getting here?

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MICHAEL LOHMULLER: We observed that the bulk of fentanyl-related sales activity appear to be occurring on the clear Web on e-commerce websites such as Alibaba.

CHANG: NPR partnered with Michael Lohmuller at the Center for Advanced Defense Studies and found that many Chinese sellers who used to move fentanyl have changed their business model. Now they're selling individual chemicals that can be used to make the drug, and they're doing so more or less openly online. Lohmuller found many of the businesses were registered with public names and addresses.

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LOHMULLER: So they'll maintain independent websites, and they also appear to be using social media, particularly Facebook. It's all occurring very much out in the open.

CHANG: Michael Lohmuller collaborated with NPR's Beijing correspondent Emily Feng to learn more about this new drug network. Emily spoke with NPR's Steve Inskeep.

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STEVE INSKEEP: Was it easy for you to begin finding the exact locations, even, of people who were selling ingredients of fentanyl?

EMILY FENG: Well, because Michael had found all of these vendors with addresses, I then went to see whether these people really existed in the places they said they were. And we found that many of them, in fact, were operating in clear daylight. Many of them had offices to do sales in the middle of quite large cities, in apartment buildings, in shopping malls and cubicled office buildings. And it speaks to how difficult it is to stop fentanyl. I mean, these are compounds that are cheap to make. You can ship thousands of doses at a time, undetected sometimes. And because of the Internet, these people can directly reach clients in the U.S. and Mexico and Europe from an apartment building in industrial China.

INSKEEP: Would you describe your visit to one of these places?

FENG: One of the main vendors that I visited calls himself Benjamin Chen online. And he was one of the more active vendors that C4ADS and NPR were able to identify. I was able to find him in remote Ningxia region, which is in China's northwest. And during the day, he worked as a salesperson selling legitimate products used in the steelmaking process out there. But in addition to his regular job, he was also selling fentanyl precursors - so the type of chemical ingredients used to make fentanyl, as well as other synthetic drugs.

When I met Chen at his employer's office, he was very nervous. He ushered me into a conference room so his colleagues couldn't hear our conversation. And when I confronted him as a person who was secretly dealing deadly synthetic drugs on the Internet, he denied everything. You know, he said he himself was not involved in any of this. However, headshots of him linked to fentanyl precursor advertisements do match the man that I met. The phone number provided on these advertisements matches the one that Chen answered and that I texted him on, as did the address that he listed for some of his websites.

INSKEEP: So a bottom-line question then - has the flow of fentanyl from China to the United States been significantly interrupted in any way by China's law enforcement?

FENG: Well, we reached out to China for comment. We reached out to the National Narcotics Control Commission, which is in charge of enforcing this ban. They said that they had not seen any illegal sales of fentanyl-class chemicals online within Chinese borders since the ban. But due to the openness and cross-border nature of the Internet, any country would have a difficult time completely eradicating illegal information.

The U.S. Drug Enforcement Administration does say that mail shipments of fentanyl from China to the U.S. have dropped dramatically since the ban. But the DEA also says that more and more of these fentanyl ingredients are being shipped from China to Mexico, where the ingredients are made into finished fentanyl and then sold again into the U.S. So the flow has not stopped, but the manner by which it's reaching the U.S. has changed.

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CHANG: A lot of the reporting you heard in today's episode came from NPR's Emily Feng and Brian Mann. You can find links to more of their work in our episode notes.

It's CONSIDER THIS FROM NPR. I'm Ailsa Chang.

CORNISH: Once again, just a reminder that we want to hear what you think about CONSIDER THIS. A short, anonymous survey about CONSIDER THIS is open for a limited time at npr.org/considerthissurvey. This is going to help us all so much and will give you a chance to help shape the future of the show. That's npr.org/considerthissurvey. And thanks.

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