The United States has been hit by another wave of the drug epidemic—this is the fourth. Thousands of people are overdosing on fentanyl, a synthetic opioid that is 50 times more potent than heroin and 100 times more potent than morphine. In terms of the number of deaths, fentanyl poisoning has already overtaken road accidents, and in 2022, an American died because of it every seven minutes.
How the United States became addicted to the dangerous drug and why teenagers and young children are increasingly becoming its victims?
Last treatment
The opioid epidemic in the United States is now in its third decade. Millions of Americans became addicted to drugs because doctors prescribed opioid painkillers after severe fractures and injuries. Frequent use of the drugs was highly addictive: patients suffered from hellish pain and could not function normally until they took another Vicodin, OxyContin or Percocet pill.
In 2012, the trend in prescribing opioids to patients reached its peak: according to the American Centers for Disease Control and Prevention (CDC) in the United States, there were 81.3 prescriptions for opioid medications per 100 people written by doctors.
When these drugs were no longer prescribed to patients, those who had already developed an addiction began to look for the coveted pills on the black market and often switched to other opiates, including synthetic ones.
The share of one of them, fentanyl, began to rise rapidly in the 2010s—and along with it, the number of fatal overdoses. On April 21, 2016, rock and roll icon Prince died of accidental fentanyl poisoning.
Scourge of America
In 2021, the number of drug overdose deaths in the United States exceeded 100,000 for the first time. Synthetic opioids, including fentanyl, accounted for the lion’s share—75 percent . Poisoning with this substance has become the most common cause of death among Americans aged 18 to 45 years.
The unprecedented number of such cases has also led to a decline in life expectancy in the United States for the first time since World War II. In December 2022, this figure fell to a 20-year low of 76.4 years. And the proportion of deaths among young Americans aged 15 to 24 years was twice as high as that of their peers from France, Germany, Japan and other developed countries.
“The fact that life expectancy is declining in a developed, rich country like ours just doesn’t seem right. If you look at other affluent countries in the world, they don’t see anything like this,” said Robert Anderson, head of CDC statistics.
Opioid laboratories
Fentanyl itself is not a banned substance: in the United States, the drug is prescribed to patients suffering from severe chronic pain or undergoing major surgery. An unprecedented number of deaths are caused by fentanyl, which is produced illegally and imported into the United States in the form of powder, nasal spray and, increasingly, in the form of tablets – to resemble the legal drug, the US Drug Enforcement Administration notes.
This synthetic opioid is produced in clandestine laboratories in India, Mexico and China – with the latter considered by US authorities to be the main source of the dangerous substance. On the sidelines of the Group of Twenty (G20) summit in 2018, Chinese leader Xi Jinping entered into an agreement with the United States in which he promised to take control of the production and trafficking of fentanyl: the following year he banned the production and sale of fentanyl in China.
However, Chinese laboratories found a loophole and switched to supplying the latest fentanyl analogues that were not banned, as well as exporting drug precursors, which drug cartels in the USA, Mexico and Canada have already used produce an opioid.
Gray area
According to an NPR investigation, Chinese suppliers often disguise themselves as a complex network of legal entities registered in remote cities in the Chinese hinterland. In these places, law enforcement control is often weaker than in large cities such as Beijing and Shanghai. Bypassing rigorous inspection, they package thousands of doses in small packages, often hidden in other goods.
Moreover, as experts note, the trade in fentanyl is mainly carried out by small chemical and pharmaceutical companies, and not by large organized crime groups.
Operating in a gray area, Chinese suppliers even advertise their fentanyl precursors on Facebook. One of them, with whom NPR spoke, has a dozen positive reviews from “customers” on his page. In June 2023, the US Department of Justice opened a criminal case against four Chinese companies involved in the supply of chemicals for the production of the drug. During arrests and searches, American police seized more than 200 kilos of fentanyl precursors: this amount is enough to produce 25 million dangerous doses, the department emphasized.
The problem quite expectedly acquired a political dimension. A number of American politicians blame the Chinese authorities for their reluctance to stop supplying components for a dangerous substance, or even for deliberately inciting a drug epidemic in the United States.
According to US experts, Beijing has lost interest in cooperation with Washington in this area amid a general deterioration in bilateral relations. Additionally, China could use its anti-drug efforts—or lack thereof—as leverage against the United States.
Associated crisis
Critics of US President Joe Biden have also linked the fentanyl epidemic to the migrant crisis at the US southern border, which has returned with renewed vigor since pandemic restrictions were lifted. In 2022, more than 2.3 million migrants tried to enter US territory illegally, and in less than 2023 – already 2.2 million.
The exceptional strength of the drug – tens of times more powerful than morphine and heroin – makes it very compact. Even two milligrams of fentanyl can be fatal, and a backpack or hip pouch could easily hold a kilo of the substance—that is, half a million doses. Republicans blame migrants for the drug epidemic, along with whom, in their opinion, dangerous drugs poured into the country.
Meanwhile, according to the Cato Institute for Research, most fentanyl is smuggled across the southern border by US citizens, and in 90 percent of cases, the substance was seized while being imported through a checkpoint, and not during an attempt to illegally cross the border in the desert. But at least an indirect influence of the migration crisis cannot be ruled out.
Border guards are too exhausted by the endless flow of refugees and simply overlook some of the American smugglers, who are not examined so thoroughly due to lack of time and resources.
Fourth wave
Now the United States has already been hit by the fourth wave of the drug epidemic – the shipment of fentanyl in combination with another narcotic substance. Typically, the dangerous drug is mixed with a “stimulant” such as cocaine or methamphetamine. If such a “cocktail” accounted for only half a percent of fatal fentanyl overdoses in 2010, then in 2021 it is already about a third—34 thousand deaths.
Experts believe the reason lies in the fact that fentanyl can now be found in almost any street drug. Drug dealers deliberately add cheap synthetic opioids to other substances to “enhance the product” and make more money, but do not inform customers about the dangerous impurity.
Fatalities are often the result of a drug dilution error that causes fentanyl concentrations to exceed life-threatening levels. Thus, 42 percent of the drugs seized by the authorities in the form of tablets contained at least two milligrams of fentanyl – a critical dosage for life. In some cases, this figure reached five milligrams.
“This is truly the first time in the history of our country that there has been a drug on the streets that even a small dose can kill you instantly,” said Charlie Smith , chief prosecutor of Frederick County, Maryland.
Dangerous high
Of particular concern to US authorities is that teenagers are increasingly becoming victims of the drug: the number of deaths from fentanyl overdoses in this age group almost tripled from 2019 to 2021. In just these three years, 1,800 teenagers died from fentanyl poisoning, and in California, overdose of this synthetic opioid caused one in five deaths among minors.
Moreover, as a rule, the dead children were from prosperous families and did not suffer from drug addiction, but simply bought through social networks what they considered “harmless” Adderall, Valium, Percocet or MDMA for the next party. However, instead of them, teenagers are increasingly being sold counterfeit fentanyl, often with a dosage incompatible with life.
Across the country, local officials are passing legislation named after the teen victims to raise awareness among middle and high school students about the dangers of fentanyl. And in July, congressmen from the opposing Democratic and Republican parties achieved the adoption of a joint bill providing for the allocation of $146 million for these purposes.
School management in a number of regions began regularly sending messages to students asking them to hand over all tablets purchased on the street or on social networks, promising not to ask any questions or hand them over to the authorities.
In search of the culprits
Very young children are increasingly becoming victims, often through the fault of their own parents who use fentanyl and leave the drug unattended in the middle of the room. The dead children, some of whom were under two years old, accidentally inhaled or took dangerous powder into their mouths or eyes – even the minimum dosage of this powerful drug turned out to be incompatible with life for them.
In recent months, American law enforcement agencies have begun to massively charge such parents with “murder by drugs.” And in those states where this crime is not provided for by local law, such as California, drunk driving is used for criminal prosecution.
The actions of prosecutors split American society. Some agree with the harsh approach and even the use of inappropriate articles to bring charges against unfortunate parents: in their opinion, like drunk drivers who get behind the wheel, drug-addicted women and men are aware of the danger of fentanyl, which they leave in a place accessible to their children. Opponents of the draconian measures insist that parents themselves are victims of the drug epidemic, and they need to be helped, not punished.
It is necessary to find out which of them is right at numerous court hearings that are taking place throughout the country.
“I’ve been a prosecutor for 25 years and I can’t think of any other drug that has caused so much destruction and death,” said Dayma Calhoun, Deputy District Attorney for Riverside County, California.
