Fentanyl was created in the 1960s to treat pain in cancer patients and others.
Yet over the past decade, an illicit form has shown up in the U.S. drug supply as Mexican cartels convert precursor chemicals, often from China, into synthetic opioids and mix them with other drugs.
Fentanyl made in clandestine labs has proved highly deadly and is increasingly found in drugs other than heroin, including cocaine and fake prescription pills.
Still, it raises the question: Why would suppliers be willing to kill some of their customers?
It all comes down to money.
Synthetic opioids such as fentanyl are “cheaper to produce, don’t rely upon the climate, can’t be spotted, and are easier to smuggle,” said Regina LaBelle, who was acting director of the White House Office of National Drug Control Policy during President Biden’s first year in office. “All in all, then, it’s a better product for drug trafficking cartels, and they may assume that the market will eventually adjust to this new product.”
Drug agents detected a spate of fentanyl-related overdose deaths in the Midwest around 2005 and 2006, prompting a major crackdown on a lab in Toluca, Mexico. Yet a major seed had been planted in the traffickers’ minds, said Derek Maltz, who used to run the Drug Enforcement Administration’s special operations division.
“The Mexicans realized that by getting involved with the synthetic drugs, it was going to be a much more profitable endeavor, and it was going to be easier for them to get it out on the streets. They didn’t have to worry about, like, having all these people employed, having the [right] weather, growing the poppies, you know — converting, getting the opium,” Mr. Maltz said. “They started getting these ideas about fentanyl because they saw the addicted population in America, and they’re looking at it from a business standpoint.”
He said the problem resurfaced in the form of synthetic cannabinoids marked as Spice and K2, fueled in large part by Chinese chemicals before heroin traffickers started using Chinese-manufactured fentanyl.
The results have been devastating. Roughly 70,000 of the 107,000 overdose deaths in the U.S. in 2021 were tied at least in part to fentanyl, according to death certificate data from the most recent year available.
Lawmakers and others often characterize fentanyl as a form of poison infiltrating communities, though experts say the drug taps into the same brain receptors as other opioids, resulting in robust markets of users looking for a quick high despite the risks.
“Fentanyl is not poison. Fentanyl is desired by people who like to use opioids, just as heroin is,” said Jonathan P. Caulkins, a professor of operations research and public policy at Carnegie Mellon University. “They operate similarly.”
He said so many more people die from fentanyl because it is hard for suppliers to control the dose and concentration of the drug. They accidentally create “hot bags” or “hot pills” that are more likely to cause overdoses.
It’s also powerful. The U.S. government says fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin.
“It takes very little to produce a high with fentanyl, making it a cheaper option,” according to a National Institutes of Health fact sheet. “This is especially risky when people taking drugs don’t realize they might contain fentanyl as a cheap but dangerous additive. They might be taking stronger opioids than their bodies are used to and can be more likely to overdose.”
Although it is unusual for sellers to kill their own customers, experts say it does happen. Cigarettes were highly profitable in the 20th century despite evidence that they would kill a substantial share of people who used them regularly, said Keith Humphreys, a Stanford University professor who tracks the opioid crisis.
“You can kill lots of customers and still make money with more addictive products because they are better [than] other products at attracting and holding customers, allowing wealth to be extracted from them up until their death,” he said.
Mr. Humphreys pointed to the hypothetical example of a dealer who sells cocaine mixed with fentanyl versus cocaine alone. Someone with a cocaine problem might buy the drug several times a week, he said, but someone with a fentanyl problem is likely to purchase it more than once a day.
Even if a dealer is increasing the odds that a customer will be dead within five years, “you will still make more money as a dealer of fentanyl-laced cocaine over those five years than you would selling them unadulterated cocaine for the rest of their life,” Mr. Humphreys said.
Lost customers can be replaced by other users, and built-up tolerance forces surviving fentanyl users to buy more.
Some experts say dealers will intentionally put a lethal amount of fentanyl into their drug supply because the deaths advertise the potency of the dealer’s wares. Fentanyl is also easier to smuggle than other drugs, given that a small bag of it can drive the same profits as a large brick of another drug.
Beijing permanently restricted fentanyl-related substances in 2019 under pressure from the Trump administration, although Chinese labs are now sending precursor ingredients to Mexican cartels that make fentanyl. The cartels often press fentanyl into fake pills.
On the street, traffickers can sell their products for 100 times or more than what it cost to make the drug.
“It costs the cartels as little as 10 cents to produce a fentanyl-laced fake prescription pill that is sold in the United States for $10 to $30 per pill,” Jon C. DeLena, the DEA’s associate administrator for business operations, told Congress this month. “The business model used by the Sinaloa and Jalisco cartels is to grow at all costs, no matter how many people die in the process. The cartels are engaging in deliberate, calculated treachery to deceive Americans and drive addiction to achieve higher profits.”
The counterfeit pills are particularly concerning to lawmakers and anti-drug advocates who point to their popularity among young people. In some cases, American teens are buying drugs online through social media.
“Pills are easier to use, and newer users typically don’t initially inject drugs,” Ms. LaBelle said. “But they won’t be reluctant to consume a pill.”
Mr. Maltz is worried that the problem will become worse and more complex.
He said Chinese labs are responsible for shipments of xylazine, a non-opioid animal sedative known as “tranq” that is being added to drugs in the U.S. to extend the euphoria from an opioid high. It also causes nasty skin abscesses and lesions, sometimes resulting in amputations.
“We’re seeing significant quantities of xylazine coming out of these Chinese labs,” Mr. Maltz said. “So in my opinion, as the Mexican cartels are doing the hands-on dirty work with the pills now in America, China’s now starting up another phase of their ongoing attack on America.”