The story of how the United States became addicted to fentanyl is a classic story of supply and demand creation. It began in the mid-1990s, when pharmaceutical companies like Purdue aggressively upended the rules of medical marketing and flooded doctors\’ offices and medicine cabinets with revolutionary pills called Oxycontin. Not only did the pharmaceutical companies claim that the pills would end all pain once and for all, they also claimed that they were not addictive.
When that supply was curbed due to a crackdown on the use and prescribing of opioids to treat chronic pain, large numbers of addicts took to the streets in search of heroin, which was cheaper and also more dangerous. . In the middle of the last decade, when the opioid epidemic had become an unprecedented health crisis, history took another unexpected turn: a powerful drug that few outside the operating room had ever heard of until then entered on stage. Fentanyl outperformed all other drugs. In 2022, fentanyl caused about three-quarters of overdose deaths, and according to US authorities, 2023 is expected to set a new record, with nearly 110,000 deaths. In other words, more than 2,000 a week.
Sam Quinones, investigative journalist and writer, is the great chronicler of what narcotic agencies call the worst drug crisis in the history of the United States. He looked into the opioid crisis in Dreamland, a National Book Award-winning bestseller that focused on the ravages of painkillers across vast expanses of the Midwest. That book led to another, the last of us, which portrays the United States in the days of fentanyl and methamphetamines.
Methamphetamine, recounts in the last of us, set the stage for fentanyl. Thanks to it, Mexican drug traffickers have embraced the synthetic drug. Until then they had always been the delivery men for the Colombians. Meth allowed them to make their own drugs, not rely on criminals from other countries. Initially, Mexican drug traffickers imported fentanyl from China. When Beijing announced the ban in 2019, Chinese chemical companies began selling them the precursors needed to make the powerful painkiller. The Mexicans figured out how to make it in Mexico. And then, all of a sudden, it was going through much larger quantities across the border. At first, powdered. Later disguised as counterfeit pills, Quinones explains in a telephone interview. From Mexico it comes many kilos at a time, almost always. So now it\’s everywhere in the United States
The father of fentanyl is a Belgian chemist named Paul Janssen. His invention, more effective and less expensive than morphine, began to be used in heart surgery and revolutionized medicine. In 1985, Janssen opened the first Western laboratory in China to produce fentanyl.
But far from the supervision of an anesthetist, it is a highly deadly substance. The first blow came in 2006, when fentanyl hit the streets of Chicago, where it was known by the nickname of lethal injection. The drug entered the United States after a chemist named Ricardo Valdez-Torres nicknamed The Brain convinced Mexican drug trafficker Joaqun El Chapo Guzmn Loera\’s men to produce fentanyl instead of ephedrine. Valdez-Torres only had time to send 10 kilos to the United States before being arrested in Mexico. He told police he sent the drug with the warning that it had to be diluted up to 50 times before it could be sold. But perhaps those instructions never reached their intended recipients. Or maybe convincing an addict that what he was dealing with was too strong was too difficult. The traffickers take over and then of course they don\’t care. They don\’t know how to use it. They don\’t know how to mix it, says Quiones. The police dismantled the lab and that time the drug was nipped in the bud.
Create addicts
The second blow came around 2014 and, this time, nothing could get in the way of the drug. Drug dealers began cutting other substances, such as cocaine or methamphetamine, with the much cheaper fentanyl, so that thousands of people—those who didn\’t die from an accidental overdose—ended up addicted to something they didn\’t even know they were taking. Not only were they trying to increase their profits, but the traffickers were also interested in creating addicts, says the journalist.
This was one of the reasons that drugs helped break down racial barriers. Quinones explains that the first wave of the opioid crisis, caused by prescription pills, affected a predominantly white population (up to 90%). With fentanyl, it was different: It spread as an invasive species through the corners of cities across the country, taking heroin and other substances by storm and hitting African-American and Hispanic communities equally hard.
The Last of Us tells the story of the first black person to die of a fentanyl overdose. His name was Mikey Tanner and he was from Akron, Ohio. Tanner battled a cocaine addiction for 10 years, but it only lasted a couple of months after fentanyl hit the scene.
The Last of Us is full of terrible stories about the people behind the statistics, the faces that together paint a picture of a deeply sick society beset by pain and isolation. It also interweaves the rise of fentanyl with the story of the decline of the United States in the 20th century, focusing on cities like Muncie, Indiana, which was the auto gear capital of the world until it all fell apart, or Kenton ( Ohio), a Rust Belt town where high school sports stars ended up addicted to heroin after taking pain pills.
The Covid-19 pandemic was the last straw. In 2020, overdose deaths increased by 20% to 91,799 cases. In 2021, there were 106,699 overdose deaths, according to the National Institute of Drug Abuse, an increase of 16 percent. And in 2022, the Drug Enforcement Agency (DEA) seized 50.6 million fentanyl pills and 10,500 pounds of fentanyl powder, the equivalent of more than 379 million potentially lethal doses, more than enough to wipe out the entire US population. And the one thing they tell you in drug recovery, most importantly, is don\’t isolate, and of course, during COVID everyone is isolated and what\’s more, a lot of jobs have been lost, Quinones recalls. And they were doing meetings with Alcoholics Anonymous and Narcotics Anonymous on Zoom, which is really not a substitute.
The alarming figures woke the US to an issue that has since morphed into another political battleground between the US and Mexico. He\’s also playing a key role in national politics, with Republicans using the scourge of fentanyl overdoses to criticize the Joe Biden administration\’s border policies and rising crime in big cities, which traditionally vote Democrat. San Francisco has become a symbol of the crisis: since 2020, twice as many people have died in the city from overdoses (about 2,000) than from the pandemic. Quinones, who was a reporter for the Los Angeles Times, is surprised by the attacks of the Republican Party, because the truth is that all this happened under the presidency of Donald Trump. Locally, I think people are trying to figure it out, unable to figure it out. But this is really a national problem.
In The Last of UsQuinones asks two key questions: Why would anyone want to take something they know could kill them? And what would make a drug dealer give their customers something with a high probability of killing them?
To the first, the journalist, who has interviewed prominent neuroscientists, replies: This is the nature of addiction; reprogram our brains so that their mission is not to ensure our survival but to pursue drugs.
To the second he replies: It was more potent than any street drug before. Anyone selling drugs that didn\’t include the powerful boost of fentanyl wasn\’t going to have customers for long. The drug dealers didn\’t dare mix it. () Fentanyl soon became a market expansion tool.
In the interview, Quinones highlighted another unexpected effect: It\’s truly marking the end of the era of recreational drug use in the United States, which has been something we\’ve had as part of our culture. You can\’t trust any cocaine line. You can\’t trace any pills. You can\’t trust any dose of meth not to have fentanyl. And it could kill you.
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