Editor’s Note:
The US has frequently shifted blame for the fentanyl crisis onto China in recent years. US President-elect Donald Trump recently claimed that as drugs are pouring into the US, China will face an increase of 10 percent above any existing tariffs on its goods. However, the problem of fentanyl in the US is the result of its own drug manufacturing industry. “Fentanyl is an issue for the US,” said a Chinese Ministry of Foreign Affairs spokesperson, regarding the US’ comment on counternarcotics. In the spirit of humanity, China has given support to the US’ response to this issue, the spokesperson said.
The US is one of the countries with the most severe drug problem in the world. Although a recent report from the Centers for Disease Control and Prevention indicates that the number of drug overdose deaths in the US showed an unprecedented decline, there were still over 100,000 cases of drug overdose deaths from April 2023 to April 2024. This marks the third consecutive year that more than 100,000 people have died from drug abuse, promoting the US government to target fentanyl. What has led to the fentanyl crisis in the US? Why is it said that the fentanyl crisis is a case of the US being caught in its own web? The Global Times will publish two installments to explore the causes and consequences of the fentanyl crisis in the US, as well as revealing the various stakeholders involved. This is the first installment.
Homeless individuals inject a mixture of heroin and fentanyl on a street in Pennsylvania, the US. Photo: VCG
In the US, fentanyl is often disguised as prescription medication, but “as little as two milligrams, the amount that can fit on the tip of a pencil, can be lethal,” according to the an article of US Centers for Disease Control and Prevention (CDC).
Unlike cocaine and heroin, fentanyl is a purely synthetic opioid that was originally developed for pain relief and can be considered a “chemical relative” of morphine. However, it possesses an astonishing addictive potential – 50 times stronger than heroin, read the US CDC article.
The origins of the fentanyl crisis in the US are closely linked to the widespread abuse of opioids. In the report from the Stanford-Lancet Commission on the North American Opioid Crisis, Howard Koh, former US Assistant Secretary for Health of the US Department of Health and Human Services, pointed out that the opioid epidemic in the US began in the 1990s, when opioids such as OxyContin were aggressively marketed by Purdue Pharma and approved by the US Food and Drug Administration, leading to the first wave of deaths associated with the use of legally prescribed opioids.
Subsequent evidence revealed that Purdue Pharma misrepresented the addictive potential of OxyContin in its reports, falsely claiming that its addiction risk was lower than that of other opioids in order to secure its approval, Koh said in the report.
Securing regulatory approval through deceit is just the tip of the iceberg. After the drugs were approved, manufacturers of opioids, such as Purdue Pharma, continued to influence drug regulation policy in the US by making donations to politicians. Additionally, many officials fresh from government regulatory agencies, such as the US Drug Enforcement Administration, entered the pharmaceutical industry through a “revolving door” mechanism, further exacerbating the collusion between government and business, according to Koh.
‘Zombie-like people’ on streets
The US is one of the countries most affected by drug problems worldwide. About 12 percent of global drug users come from the country, three times the proportion of the US population to that of the world, according to a report titled “Drug Abuse in the United States” released by the Chinese Foreign Ministry in February 2023.
According to estimates from the US National Center for Health Statistics, a division of the US CDC, there were 107,543 drug overdose deaths across the country in 2023, with 74,702 of them attributed to fentanyl. In 1999, fentanyl overdoses resulted in 730 deaths. Over the course of more than 20 years, this figure has increased more than a hundredfold.
Although the total number of fentanyl users is far less than that of marijuana, its lethality is unmatched. The number of deaths due to fentanyl overdoses is twice that of methamphetamine (crystal meth), nearly three times that of cocaine, and several times greater than that of heroin.
In a Reuters report, it pointed out that in the US, “the switch to fentanyl has been devastating,” and fentanyl is “cheap, easy-to-produce.”
Dai Runzhi, a US-based Chinese media professional, told the Global Times that in the US, it is not uncommon to see homeless “zombie-like” individuals in New York City frozen in place and their bodies contorted either forward or backward in unusual postures. He said this is a common characteristic of fentanyl users, a physical manifestation often referred to as the “fentanyl fold.”
It’s a degree of loss of consciousness and a degree of lost muscular control, Los Angeles-based media outlet ABC7 quoted Daniel Ciccarone, a professor of addiction medicine, as saying.
Ni Feng, director of the Institute of American Studies of the Chinese Academy of Social Sciences, told the Global Times, that the drug issue has long existed in the US, and was especially prominent in the 1960s when drug use was widespread among the youth during the counterculture movement. By the 1970s, the country had begun to reflect on this issue, leading to a decline in drug use. However, today, the number of deaths caused by fentanyl has drastically increased.
“As the drug is cheap and can be easily obtained in the US, Fentanyl has led to the downfall of many. For many drug addicts, fentanyl has become their main drug of choice,” Ni said.
At the same time, the dangers of fentanyl have drawn widespread condemnation across the US.
In 2019, Alexandra Capelouto, a college sophomore, reached out to Brandon McDowell, a peer who was a drug dealer, to purchase oxycodone, a prescription painkiller. Instead, McDowell sold her counterfeit pills laced with fentanyl. Hours later, Alexandra was dead in her Temecula, California, home, according to an Associated Press report.
In 2022, McDowell was sentenced to nine years in prison for illegal possession and distribution of fentanyl. Alexandra’s father, Matt Capelouto, has since been advocating for the stricter regulation of fentanyl and harsher penalties for drug dealers. In September, a California court ordered McDowell to pay $5.8 million in damages to the Capelouto family. Their lawyer, Baruch Cohen, noted this as the first case he had seen where a drug dealer was successfully held civilly liable for a death caused by fentanyl.
Several Americans shared similar experiences. An American resident who preferred to be called Keenan told the Global Times that a relative of his colleague nearly died after purchasing counterfeit prescription drugs laced with fentanyl. “Luckily, they were rushed to the emergency room in time,” he said.
“The US needs to adopt a zero-tolerance policy toward drug dealers, like China’s approach. These individuals knowingly distribute poison and profit from countless deaths and broken families. Imposing the death penalty on drug dealers may not solve the fentanyl crisis entirely, but it’s a step in the right direction. We need better prevention, education, and treatment programs,” Muhammad, an American citizen, told the Global Times.
Chris Didier holds a picture of his son, Zach Didier, who died in 2020 of fentanyl poisoning, at the US Capitol in Washington DC, on January 31, 2024. Photo: VCG
Inadequate oversight
In a written interview with the Global Times, Anna Lembke, author of the book Drug Dealers, MD, said that the opioid pharmaceutical industry played a significant role in creating and perpetuating the current opioid epidemic, by overstating opioid benefits and understating opioid harms, especially the addictive potential of opioids prescribed by a doctor, “thereby giving doctors and the public ‘a false sense of security’ around prescribing and using opioids.”
Andrew Kolodny, medical director of the Opioid Policy Research at Brandeis University, wrote in a report in the AMA Journal of Ethics that over the last few decades, the false claims disseminated by drug manufacturers about the risks and benefits of opioids reveal the negligence of the USFDA, the agency responsible for regulating pharmaceutical companies.
In 2017, the Commission on Combating Drug Addiction and the Opioid Crisis found that part of the opioid epidemic stemmed from “inadequate FDA oversight.” The US National Academy of Sciences has also called for a comprehensive overhaul of the FDA’s opioid policies. However, despite these calls, the FDA’s policies on approving and labeling opioids remain largely unchanged, according to the report.
A 2016 investigation by the Associated Press and the Center for Public Integrity found that the opioid industry and its allies provided financial support to approximately 7,100 candidates for state-level positions. Additionally, pharmaceutical companies and their allies maintain a lobbying force of over a thousand individuals, covering the capitals of all 50 states. Between 2006 and 2015, painkiller manufacturers, including Purdue Pharma, and related organizations spent over $880 million on lobbying and political contributions, according to NBC News.
Dr Art Van Zee, a rural doctor in Virginia, told the Guardian that the US has yet to learn from what he describes as a “uniquely American catastrophe.”
He emphasized the need to break the influence of corporate money on drug policies, regulation, and political accountability. The real problem, he argued, lies in the structural system that allows the pharmaceutical industry to wield such significant influence over medical professionals, regulatory agencies, and Congress.
David Herzberg, a historian of addictive pharmaceuticals, wrote on The Conversation in July 2022 that that the opioid epidemic starkly illustrates a broader issue in the American consumer market: Corporations consistently prioritize profit over consumer safety.
He explained that pharmaceutical companies draft or influence professional guidelines that encourage prescribing their products, sponsor professional organizations, and pay medical experts to disseminate their messages. They also fund and steer patient advocacy groups to support their products and lobby for legislation, regulations, or any measures that increase demand for their drugs.
“Until those broader problems are resolved, the unhappy history of addictive prescription drugs will keep repeating itself,” he wrote.
Trapped in a web
