Revenge for the Opium Wars?

 

 

 

 

China may have been defeated in the Opium Wars of the past, but maybe they’re getting revenge on the West now.

Back in the 1840’s, China declared its own war on drugs, confiscating opium brought to its shores by British traders. Chinese authorities were worried about the growing problem of opioid use and dependence in their citizens, fueled by foreign traders from the West, peddling their opioid products. The British East India Company sought to sell opium from India to the citizens of China, in violation of Chinese laws.

In 1839, the Chinese authorities confiscated a shipload of opium from England. When China refused to pay the full street value of the drugs, British forces attacked China in an inglorious manner. They bombarded coastal towns into oblivion, deeply shaming Chinese people and creating a lot of bad feelings towards the West. The war settled with a treaty dictating that China give Hong Kong to the British and that they establish five ports to be available to Western traders. It also dictated the Chinese pay millions of dollars to the British for reparations.

The second Opium War, around 1856, broke out when the Chinese leader at Canton, which was one of the designated ports open to foreigners, arrested British sailors and put them in chains for importing opium to China. This reignited conflict between the British and French against China. The treaty at the end of this war legalized the importation of opium, along with other concessions that China had to make to Western powers.

Today, we are into the third wave of the opioid epidemic in the U.S. The first wave of overdose deaths was mostly due to prescription pain pills. As providers were better educated about the dangers of profligate prescribing of opioid pain medications, pills grew relatively harder to buy and heroin became more available. It was also cheaper, with higher purity than before. Heroin thus fueled the second wave of our opioid situation.

Since it’s cheaper to make fentanyl in a lab than it is to harvest and process opium into heroin, drug cartels became more interested in making and selling fentanyl.  Fentanyl is also much more potent than heroin, so it takes less product to provide a drug effect per person, making it easier to transport for sale. Therefore, fentanyl is replacing heroin and causing our third wave of overdose deaths from opioids in the U.S. And most of the fentanyl precursors are being sent from China to Western labs, in Mexico and other places, to be made into fentanyl, packaged for sale, and transported to the U.S. and Canada.

I just read an interesting book, “Fentanyl, Inc.,” written by Ben Westhoff, which describing how most of fentanyl’s precursor chemicals now come from China. These precursors are sent to the West to be made into fentanyl and its analogues, often via Mexico, fueling this third wave of our opioid epidemic. The author mentioned the ironic link to the past Opium Wars, which was intriguing. [1]

The book presents an interesting idea. Maybe the West’s karmic chickens are coming home to roost. I don’t think the book ever suggests China is intentionally targeting the U.S. It’s business; Chinese chemical manufacturers see an opportunity to make money and are taking advantage of it.

Unlike in the U.S., it’s not illegal to make and sell some fentanyl precursors in China. These precursor chemicals don’t cause intoxication but are the necessary ingredients to make fentanyl and potent analogues. Many businessmen in China sell a great deal of precursor to the West to be made into fentanyl. Much of these precursors are sold to buyers in Mexico, where they are turned into fentanyl or even more potent analogues of fentanyl.

As early as 2006, fentanyl from Mexico, made from Chinese precursor products, was responsible for around a thousand deaths in Chicago and Philadelphia. Soon after that episode, the two main precursor chemicals, abbreviated NPP and 4-ANPP, were placed on the DEA list as Schedule 1 and Schedule 2 respectively. This means these products can’t legally be made in the U.S., or in the case of 4-ANPP, only with extensive regulation and oversight.

In China, as in other countries, the precursor chemicals weren’t controlled at all until 2017, when the International Narcotics Control Board asked China to sign a treaty agreeing to closer control of their manufacture and sales. However, after the treaty agreement was finally implemented in China in late 2017, the largest manufacturer switched to making other, unscheduled, fentanyl precursors not covered by the treaty. These other chemicals can be made into fentanyl, though it takes more chemical reaction steps to do so.

To make matters worse, the Chinese government gives tax breaks to companies that make these fentanyl precursors. According to the author of the book, it’s unclear whether China is aware that these policies encourage export sales of fentanyl precursors, as well as precursors to other drugs like synthetic cannabinoids, stimulants, and hallucinogens.

The author of “Fentanyl, Inc.,” is an award-winning investigative reporter. He seems to be brave, foolish, and persuasive in equal amounts, because he writes about how he went to China and got a tour of a fentanyl precursor manufacturing lab. That’s plenty bold.

He describes these Chinese business owners as ordinary men and women who act and dress conservatively, vastly different from the stereotypical image of the drug bosses of Mexican and Colombian drug cartels. He asked his Chinese contacts if they know they are providing chemicals which cause suffering and death to people in the West who become addicted. Overall the answer was yes, they feel a little bad, but they must work and make a living too.

Despite the title, “Fentanyl, Inc.” contains many chapters about non-opioid NPSs, the abbreviation for “novel psychiatric substances.” NPSs can be synthetic opioids, new psychedelics, synthetic cathinones and cannabinoids. The book provides a quick education about the extent of the newer wave of synthetic drugs, which often provide a more intense highs with more intense side effects too.

I read through the book, hopeful that the author would talk about evidence-based treatment for opioid use disorder: medications such as buprenorphine, methadone, and naltrexone.

Finally, near the back, I found two pages in the Epilogue about treatment. The author says a little about buprenorphine’s potential benefits, and to a lesser degree, methadone’s. The paragraph about methadone came with a warning that methadone dependence was a “problem in itself,” and that it’s frequently sold as a street drug and has caused thousands of drug overdoses per year.

Sigh.

This book was so extensively researched that I hoped for better from this author. In truth, methadone has been studied more intensely than any other drug on earth and is effective at saving the lives of people with opioid use disorder. It can be dangerous when used inappropriately. However, methadone overdose deaths peaked around 2007 and were due to prescriptions from pain clinics where there was little oversight, not from opioid treatment programs. OTPs are highly regulated and while diversion still occurs, it’s relatively rare.  Overdose deaths rates from methadone have continued to drop since 2007, when pain clinics were asked not to use methadone.

To be fair to the author, this book isn’t about treatment of opioid use disorders, so perhaps I shouldn’t have expected the author to research treatments. It was about how these novel psychoactive substances are replacing the more “classic” drugs and how they are being manufactured and marketed, largely over the internet.

It’s overall an interesting read, with intriguing ideas linking the past to the present.

  1. “Fentanyl, Inc.: How Rogue Chemists are Creating the Deadliest Wave of the Opioid Epidemic,” by Ben Westhoff, 2019, Atlantic Monthly Press, New York

2 responses to this post.

  1. Posted by Daniel M Strickland on January 13, 2020 at 4:11 pm

    What terrible seeds we sow!

    Reply

  2. Posted by Tony on January 15, 2020 at 12:57 am

    Very interesting…I will be buying the book, it sounds like a really good look into how this problem has been ongoing for years and years

    Reply

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