Unravelling China and India’s roles in the US fentanyl crisis
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Give the gift of scratches from the California Lottery. A little play can make your day. Please play responsibly. Must be 18 years or older to purchase, play, or claim. You're listening to a podcast from the South China Morning Post. Opioids. They're the leading cause of drug overdose deaths in America. Today is the day that I saw my son dead. Four years ago today, that is that day for me. Nearly a million people have died of drug overdose in the U.S. since 1999. You

Yet America is no closer to tackling the causes of the problem. Do you know how many families I know who had to declare bankruptcy because they put their loved ones through treatment? As addiction to prescribed painkillers takes over, millions have been turning to cheaper, black market alternatives like fentanyl.

But how did this synthetic drug that was initially created for medical purposes come to devastate so many communities across the U.S.? The answer lies on a different continent. "China, China, China." "It's all coming out of China." I'm Brian Wood, and this is Inside China. To learn more, I spoke with my colleague Khushboo Razdan. She's a correspondent based in Washington.

Khushboo, what is fentanyl? Why was it invented and how? Technically, fentanyl is a very powerful synthetic opioid. So what does that even mean? Opioids is a class of drugs which is not generally derived from traditional opium poppy plant. So we are talking about drugs that are basically made in labs.

And why are they made in labs? Because they're cheaper, they don't require the amount of resources, say for example land, that is required to grow the opium poppy plant. And also if you're making something in a secret lab, there are less chances of attracting law enforcement.

So opioids are basically approved only for treating severe pain, especially when you're going through a surgery or patients who are, you know, fighting cancer. But the whole idea and the motive behind the drug was...

Basically, they were trying to create something which was superior to morphine because morphine takes a lot of time to get into a person's brain and then wash out. But fentanyl was considered superior at that time because it goes into a person's brain really fast and then it wears off really fast. So if you are undergoing, say, an open heart surgery,

the patient can get the drug as a painkiller and it will wear off really fast. So the patient will be out of hospital or, you know, done with the pain and the surgery really fast. So that's why fentanyl was considered a breakthrough of the time.

What makes fentanyl more dangerous compared to other drugs on the market? So there are two reasons to it. First of all, it's extremely powerful. It's up to 50 times stronger than heroin, and it's almost 100 times stronger than morphine. Only two milligrams of fentanyl can be lethal, depending on a person's body size, tolerance, and past usage. It is a disturbing trend we've seen. Fentanyl deaths have skyrocketed.

- It is the leading cause of death for Americans ages 18 to 45. - So potent, you could die with a syringe still in your arm. - It's extremely effective as well. So it enters a person's brain much faster than other opioids. So it goes in really fast and it wears off really fast. So if, for example, you're taking

say a heroin dose, the high, the heroin high will stay with you for, say, a good part of the day. But if you take a fentanyl dose, it will wear off really fast, say about a few hours. So if I'm someone who's addicted to fentanyl, I would be kind of scrambling for more within a few hours. So...

That makes this drug extremely powerful and extremely addictive and more profitable for traffickers as well. And what are the short-term and long-term effects of fentanyl? The thing with fentanyl is it's like any other drug. The short-term effects could be, you know, nausea, confusion. You could feel drowsy.

But long-term problems are dependence and addiction. There could be changes to your brain. There could be organ damage. And the most lethal part of it is euphoria. So you are in such high state of euphoria that your body stops seeking oxygen. And that's when they call it respiratory depression.

So if you consume high levels of fentanyl, you may just stop breathing. And that's what makes it really, really dangerous. And now we are seeing fentanyl, which is coming into the U.S., coming in form of fake pills that look exactly like prescription drugs like Xenex, which may look extremely normal, but they are laced with fentanyl. And sometimes people who are using those pills are not even aware that these pills are laced with fentanyl.

I'd like to talk to you about the classification of NPS, novel psychoactive substances. Can you explain what that is? So NPS, it's like a cat and mouse game. So NPS is novel psychoactive substances. So in street terms, we call it legal highs. The manufacturers of these drugs, what they do is they try to stay ahead of the law. So before any drug is banned by a particular government,

They try to develop new drugs, new chemicals to replace those that are actually banned or they believe are going to be banned in the future. So they tweak the recipe a little, maybe a molecule here and a molecule there, but they keep the basic chemical structure of the fentanyl intact. So basically these

are trying to create a similar drug, which is almost the same in chemical structure. It's almost same in the effects of it. It gives you a high, you feel euphoric, but on paper, it looks different from the drug that has been banned. So it makes the efforts to ban fentanyl and fentanyl-related substances really hard because the government efforts to stop those drugs are basically outpaced by these manufacturers.

So NPS explains why there are so many derivatives or analogs of fentanyl out there. How much of these NPS are allegedly produced in China? According to U.S. government, between 2013 and 2019, China was the primary source of manufactured illicit fentanyl and fentanyl-related substances that were illegally entering the U.S. directly via international mail. So things...

It's really changed in 2019 when the Trump administration kind of forced Beijing to impose a class-wide control on all fentanyl-related substances. So the trade, the pattern of this illegal fentanyl trade completely changed.

After 2019, since China imposed a class-wide ban, all these manufacturing facilities moved to Mexico. And now fentanyl is produced in these secret factories. You know, there is mass production of fentanyl by Mexican cartels. And then these pills are smuggled into the U.S.,

How does fentanyl get smuggled into the U.S.? So the thing with fentanyl is it's extremely easy to hide because it's not like a big brick of heroin that you're trying to get in or a big brick of cocaine. These are small baggies of fentanyl powder that are coming in or pills that look exactly like prescription pills. So it's easier for traffickers to get them into the U.S. illegally through U.S. citizens.

In 2021, over 86% of the convicted fentanyl drug traffickers were actually U.S. citizens and not illegal immigrants. A lot of Republican lawmakers believe that the illegal immigrants that are coming from Mexico are smuggling these drugs into the U.S. But if the immigration authorities are to be believed, most of the illicit fentanyl is actually coming by U.S. citizens themselves.

through mostly official port entries in California, Arizona, and Texas. So San Diego in California, El Paso in Texas, and Nogales in Arizona. And when it manages to get into the U.S., then it kind of fans out and gets into the distribution ladder, and it then spreads across the U.S. through different gangs. This distribution ladder is very, very regional. There are different groups that are working together

Once it crosses the border, it's out of the Mexican cartel hands. It goes to these regional leaders and regional gangs that spread it across the U.S.

If the pathways to getting into the U.S. have shifted from China to Mexico, why does the U.S. continue to blame China? First, the U.S. says that there are various Chinese individuals, Chinese brokers, and even sometimes large family-based networks and companies that produce and sell these precursor chemicals to Mexico. And it's not just these chemicals. They also believe that Chinese individuals and companies are also

providing them the recipe to make these fentanyl. So that is one thing. The other thing is that they believe that the Chinese government is not doing enough to stop these precursors from getting out of China and being used illegally. What the U.S. government wants from China is something called know your customer. So they want China to make sure that they also check the

the client to which the Chinese exporter is selling this fentanyl to make sure that the person who's importing the drug in Mexico is not using it to make illicit fentanyl. And that's where China says that we cannot do it. We cannot make sure of that.

And then there is a problem of NPS. Like every day, manufacturers are being creative and getting these new drugs which are not banned. So that is one problem. The second problem is about financing. So the U.S. government and mostly Republican lawmakers basically say that Chinese transnational groups are using Chinese institutions,

financial institutions to launder money, which provides basically the financial resources for keeping these secret factories in Mexico going.

Okay, so in terms of these accusations, how has China responded? Over the years, China has portrayed itself as a painful victim of opium history. They talk about opium wars, how the British forced China to keep buying and getting addicted to opium in the mid-19th century. And then when the Qing dynasty said no, they launched opium wars and then it culminated into unequal treaties.

So China says we're very empathetic towards, you know, what's happening in the U.S. and we are sad about it, but we are doing all we can. I would like you to know that China sympathizes deeply with American people, especially the young who are suffering from fentanyl. So as far back as 2021,

the Chinese ambassador to US said that, you know, you can use steel for making cars, and you can also use steel for making guns. So for that, you cannot just ban steel. So the Chinese side basically says that these chemical precursors are also used in medicine, which is very crucial to some of the patients who deal with chronic pain, severe pain. So we cannot just

ban all pharmaceutical companies or all chemical companies from exporting these. And we have put in place good export and import licensing and international verification system, but we cannot make sure that the chemical that is going out of our country is not used for any legal purpose because we cannot verify that completely.

The Chinese side also says that it's up to Mexico to make sure that these chemicals that are leaving China are not used for manufacturing illicit fentanyl. It's the job of the Mexican government to make sure that these chemicals are used for what the importer says they are used for. The U.S. and China haven't been on the best terms over the last couple of years. There was House Speaker Nancy Pelosi's visit to Taiwan in 2022, which led Beijing to suspend communication and cooperation with the U.S.,

But then last November, Chinese President Xi Jinping met with U.S. President Joe Biden in San Francisco. What's happened since then? Have the two countries resumed their joint efforts to tackle the fentanyl crisis? A high-level U.S. delegation visited Beijing and launched this working group, which was announced in November after both the presidents met in San Francisco. This was the first formal cooperation between two sides in more than two years.

And from the U.S. side, basically, the narrative was that the meeting was positive and it was in the right direction. But there is a lot of work that needs to be done. Beijing has also said that it was a positive meeting and they're looking forward to working with the U.S. side in dealing with this problem. So, so far, it appears that everything is going in the right direction, but it remains to be seen how larger the impact is.

Kushboo mentioned how China is the primary source of manufactured illicit fentanyl that's illegally entering the U.S. But what does this look like on the ground, inside China? And how is India connected to all of this? My name is Ben Westhoff and I'm an investigative journalist.

How did you get interested in this topic, fentanyl trafficking, in the first place? I had a friend who died from fentanyl back in 2010, back before I'd ever even heard of it. And he was using the fentanyl patches that were, I think, stolen from a pharmacy. So when he died from that, it sort of sent me down the rabbit hole to learn about this drug that really didn't even come onto the scene until a few years later. And

Eventually, I learned that all the illicit fentanyl was now being produced in China. And I started investigating that and wanted to learn about the sort of business aspect, the geopolitics aspect, and the kind of like drug trafficking aspect of it. So why is the production of fentanyl such a big industry in China? China has the world's biggest chemical industry, the legal industry.

and, you know, illegal. And so there's just the best infrastructure in China, the most trained chemists, the most companies that are operating, you know, both giant companies and companies kind of on the margins. And so it's like the same reason the U.S. buys everything else from China. You know, China does it the most cheaply and efficiently. Okay, so are there any other big players involved in the trafficking of illicit fentanyl other than China, U.S., and Mexico?

Well, India is sort of getting into the game, too. And there's been these meetings with Biden and Xi and discussions about how to tamp down on the precursor trafficking out of China. And India is already picking up some of the slack. So you can see that precursors are for sale on Indian websites and they're starting to deal with the Mexican cartels as well.

Are there any regulations focused on controlling trafficking from India yet? Or is that something so new that the U.S. hasn't even caught on? Yeah, India has been even more reluctant to put the kind of controls in place that the U.S. would like, even less so than China. So tell us about your investigation. What was it like and what did you discover? I was the first journalist to go undercover inside India.

Chinese fentanyl operations. And so in 2018, I went undercover inside a Shanghai lab where they were making types of fentanyl and also other synthetic drugs like synthetic cannabinoids like K2 and spice. And I also infiltrated a huge company selling precursors in Wuhan,

called Yuan Chong. And it was an elaborate operation and I pretended to be a trafficker and made up this whole story and met with these chemists and convinced them basically to take me into the lab. And I had a whole fictional backstory. I called myself Johnny Webster. What is this? Your new lab.

When I saw this lab, we drove out to the outskirts of Shanghai and it kind of reminded me of like the Breaking Bad type of lab or even just a college chemistry lab. It was small and there weren't that many people, but they were producing these huge volumes of chemicals. Quite a lot of planning went into this. I would say so.

You know, I was shocked to see hundreds of salespeople operating at desktop computers and cubicles. They were on social media. They were, you know, it's just like a Western office except they were selling these ingredients for the world's most dangerous drugs.

I met the CEO. He claimed that, you know, these were just chemical intermediaries. They weren't actually drugs to get people high. But really, the only reason anyone would buy these chemicals is to make it into fentanyl. This is just out of my curiosity. Have you ever felt scared in the aftermath of this? It's a big deal what you found out. No, I haven't been too worried that, you know, here in the U.S., it's so far away. I mean, I have gone to great lengths to...

make sure our address is not on the internet. And, you know, I had a great time in China. I love going to China. But the U.S. State Department has said basically I could well be on a list, and so I should not go back there. Otherwise, I might be put in prison or something. We actually asked China's Ministry of Foreign Affairs about whether Ben is on any kind of list, but they didn't respond.

So Ben, China and the U.S. have been working together to curb the smuggling of fentanyl. Do you think the situation has improved or is it getting worse? Well, the good news is that younger people are declining their usage of illicit pills and powders and things like that. But the bad news is that the death toll is still as high as ever. In fact, it's still going up. And

I think more and more of the drug supply keeps getting tainted. And there still isn't a widespread education campaign to teach people about how so many different drugs are tainted now. And not to mention, there's this big homeless problem in the US right now. And the drug problem and the unhoused problem are sort of one and the same. And so that's where it's really hitting people the hardest.

Yeah, just don't take any drugs from the black market that are in pill or in powder form without checking them first. There are good drug checking tests available, but it's dangerous out there. That was Ben Westhoff. To learn more about the fentanyl crisis, you can go to SEMP.com to watch the video explainer. I'm Brian Wood. Thanks for listening.

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