How fentanyl became the dangerous drug of the moment and what it means for our cities, for public health, and for the individuals and families devastated by it.
Heroin, crack, meth, opioids, and now fentanyl. The US appetite for drugs is insatiable. Add Mexico’s sophisticated illegal drug marketing and distribution skills, and the combination is deadly.
Our guest on this week’s WhoWhatWhy podcast, Sam Quinones, looked deep into the opiate crisis in his award-winning book Dreamland. Now, in his latest work, The Least of Us, he takes on fentanyl, the deadly drug of the moment, more addictive and profitable than previous opioids.
Quinones shows how, once again, drug traffickers have found that making synthetic drugs in a lab is far more efficient than having to grow anything. He describes fentanyl’s medical origins as an effective anesthetic, how and why it made its way to the streets, and how its explosive spread is a direct outgrowth of the opioid crisis.
He explains fentanyl’s appeal this way: In a nation perpetually on the brink of a nervous breakdown, fentanyl rewires the brain’s dopamine receptors, giving users a feeling of happiness unachievable without the drug.
Quinones details those responsible for fentanyl’s easy availability, and traces the connections between Mexican drug labs, Ohio treatment centers, federal prosecutors, and even the manufacturer of the widely prescribed painkiller OxyContin, Purdue Pharma.
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(As a service to our readers, we provide transcripts with our podcasts. We try to ensure that these transcripts do not include errors. However, due to a constraint of resources, we are not always able to proofread them as closely as we would like and hope that you will excuse any errors that slipped through.)
Jeff Schechtman: Welcome to the WhoWhatWhy Podcast. I’m your host, Jeff Schechtman. When the history of the early 21st century is written, there’s no question that illicit drugs will play a part in it, from the opioid epidemic to the daily reports of fentanyl deaths on America’s streets. Drugs are a lubricant for a nation perpetually on the brink of a nervous breakdown.
And as he did with the opioid epidemic, my guest, Sam Quinones, now turns his attention to fentanyl and what it means to our cities, for public policy, and for the individuals and families impacted by it. Sam is a journalist and author. His two acclaimed books of narrative nonfiction about Mexico and Mexican immigration garnered international attention. His book Dreamland won the 2015 National Book Critics Circle Award for general nonfiction, and it is my pleasure to welcome Sam Quinones here to talk about The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam, thanks so much for joining us.
Sam Quinones: Good to be talking with you again, Jeff. Thanks so much.
Jeff: First of all, talk a little bit about the history of fentanyl. This isn’t a new drug at all. This is something that’s been around for a very, very long time.
Sam: Since 1960, essentially. It’s a fantastic drug, really, in the medical context when it is appropriately and properly [used]. It’s a new synthetic opioid, meaning it’s not made from opium poppies; it’s made from other chemicals. It’s a revolutionized anesthesia, and with it, surgery and a variety of things were possible with fentanyl. It takes people into anesthesia and out of it very quickly. And it’s far less dangerous than the other forms that they were using in the 1950s.
It was invented by Paul Janssen. One of the great scientific minds, I think, of the 20th century, he invented numerous drugs, but fentanyl was one of them. It’s been part of surgery since the 1960s. Many people out there most likely hadn’t realized that they had been or weren’t aware of it somehow.
I had a heart attack four years ago, and they gave me fentanyl. So, in the medical context, it’s an enormously beneficial substance.
Jeff: And when did it start becoming something that people used on the streets, recreationally? Many people may remember that Michael Jackson overdosed on it.
Sam: I think that fentanyl became very gradually introduced to the drug underworld. There were these rogue chemists in the ’80s and ’90s. You’d see occasional little outbreaks of it, but they didn’t last long. They lasted about as long as it took to arrest the underground chemist who was making it.
2006 is the first time the Mexican drug world recognized fentanyl. A lab started in the city of Toluca, which is outside Mexico City, an industrial town run by a guy named Ricardo Valdez Torres who had been living in the United States for many, many years, since a kid. He was deported after being arrested and then tried and convicted of fentanyl manufacturing in San Diego.
He gets out, gets deported back to Mexico, and a similar drug cartel contacts him, and offers to fund a lab as he would make. They really wanted him to make ephedrine, which is a precursor in one of the ways you make methamphetamine. He wanted to make fentanyl. He thought he had this great thing, and then he was going to make $1 million. And that they didn’t quite understand it yet. He had to educate them.
In fact, that’s what happened. He began to make this stuff, and what happened was tragic. He tested his fentanyl on mice and found that it would not kill the mice if it was diluted 50:1. The guys — who took the fentanyl from him, who bought it from him, and then shipped it north into the United States, first into Chicago — I think would tell people this, but nobody on the street believed it is the way of the reports I’m getting, that nobody thought you could possibly cut a drug so that one kilo would make 50 kilos. That means the drug was almost useless. So it was a non-drug. No one would buy it. And so, nobody did that.
What ends up happening is that, for the first time, you see mass death because of fentanyl, because of this one lab in Toluca, Mexico, where the guy was producing that. And that lasted about eight or nine months before they finally got busted. But along that time, it kills thousands of people in Chicago, St. Louis, Philadelphia, Cleveland, I believe, Camden. It stretches its way across over those months. And then when the lab was busted in April 2006, eventually that fentanyl, is just sold out, peters out, and those deaths just vanished. It’s a perfect example of supply reduction equaling harm reduction.
That was the first time — it’s a historic moment, really — the Mexican trafficking world began to realize that there was a replacement for heroin. This was a heroin replacement thing. You didn’t need land. You didn’t need farmers, seasons, irrigation, any of that. You just needed a lab, certain chemicals, and a few folks who knew what they were doing. And you could produce it year-round if you had the chemicals to do so. And it was their realization that gradually grew into the problem that we’re seeing today.
Jeff: How much of that movement forward and attractiveness of this came about because of what was going on with heroin, the fact that it was getting more scarce, more difficult to produce, etc.?
Sam: I think the Mexican trafficking world had already learned that if you can make chemicals in a lab, it’s far, far superior from a business standpoint than growing them, and they’d learned that with methamphetamines first. They really had already, by then, dominated the methamphetamine world. We’ll talk about that later if you like, but they had already known this idea.
The Mexican trafficking world grew up on land. They were rancheros or farmers. The whole idea was you grow marijuana, you grow opium poppies, that thing. Well, as time went on, they began to realize that there were these substitutes, and for heroin, fentanyl was a substitute.
It made perfect economic sense that you would not have to have land that you had to protect, that was outside, growing under the sun that helicopters could come over. It was a large, large supply chain associated with growing a drug. There were packers and harvesters and transporters and was bulky and all this stuff. With fentanyl, they began to realize, “Jeez, we can reduce that supply change dramatically.”
I think what also began to happen was, yes, at a certain point, our heroin demand [increased]. All of this grows from the opioid epidemic. All of this grows from this massive prescribing of opioid painkillers, and significant numbers of those folks who used them started to get addicted. Many of them switched to heroin.
At a certain point, they’re really using a lot of the heroin that Mexico can produce. There’s this natural idea to say, “What else can we do?” And that’s when this whole case out of Toluca, Mexico becomes very relevant. Everyone goes, “Well, there is this other stuff; I think we should just switch to that.”
The economic sense behind fentanyl is perfect. It’s so much better from a business standpoint as a drug trafficker to make your own dope. It costs less, the profit is geometrically higher. That’s what you see.
Now you don’t see much demand for opium poppies. The opium poppy farmers in Mexico are really in, what you might call a depression; the prices drop, nobody’s buying it. That’s because in the United States, most people, now, if they’re using an opioid, it’s going to be fentanyl. And a lot of folks now are just simply addicted to fentanyl.
Jeff: And of course, you’ve alluded to this, one of the things about it is that it was so incredibly cheap even in terms of its street price.
Sam: Right. Yes. I interviewed a kid who was making counterfeit pills, and he did the math for me, his own math. He bought a quarter kilo of fentanyl from China, and with a pill press and some other binder chemicals, he would turn that fentanyl into counterfeit pills that looked like generic oxycodone 30-milligram pills. He would buy that fentanyl for $5,000. He could turn that into $2 million because it’s so potent; very, very little of this drug is needed to get people high.
In fact, a little bit more than what’s needed will kill someone. That’s the main problem with the illicit use of fentanyl. It’s very, very difficult to mix it properly. So, therefore, that’s why we are seeing these record deaths over the last several years. Really, it’s connected to the substitution of fentanyl for heroin.
Jeff: Because it can be made in these labs and done so secretly, it has been very, very difficult for the DEA [Drug Enforcement Administration] or any law enforcement, either here, in Mexico, or anywhere else, to really find out where it’s coming from.
Sam: Well, I think now what’s happened is it’s mostly coming from Mexico. Now, specifically where? I think that’s the problem. There are lots and lots of producers of this stuff because the knowledge about it has spread. Plus, in Mexico, there are two very prominent shipping ports on the Pacific coast, straight down from Arizona, a couple of days drive, you’ll get to one.
And the traffickers now have enough control to be able to get access to enormous quantities of the chemicals that they require to make fentanyl, and so they can make it. The thing about synthetic drugs is if you have those chemicals, you can make them year-round. It’s not like marijuana where you have to grow it every four months, where you need the sun, etc., etc. No, you can make this in a lab all year round if, — crucially — you have access to shipping ports. And that’s what they now have.
In the era of synthetic drugs, which is what I say in the book we are now firmly in, land doesn’t matter as much, certainly not as much as it used to. What matters is access to shipping ports because, from shipping ports, you get access to the entire world chemical market; that means chemicals made in Chile, China, India, the Czech Republic. You name it; you can get them all. And they have control of law enforcement enough so that they can do this. They have control of those ports, and hence you see the production out of Mexico just of synthetic drugs, primarily fentanyl and methamphetamine. It is just astounding — staggering — the number of drugs coming out of there now.
Jeff: To what extent are we seeing this epidemic of use in other parts of the world or is this a particularly American problem?
Sam: I would say fentanyl makes sense for traffickers — the world over. So you have seen outbreaks of fentanyl or fentanyl analogs, or fentanyl cousins that are similar to fentanyl, sometimes far more potent even, believe it or not, than fentanyl. You see this in other parts of the world, and it’s entirely possible that as time goes on, really, there won’t be much production of strict heroin because it’s just going to crowd it out. You can’t outcompete it; fentanyl will.
You’ve seen these things in Sweden, reports in Estonia, different places, Russia, I believe. But I don’t think any country has quite the problem we have had in this country for two reasons. One is, we through our opioid epidemic of painkillers, created a brand new market of opioid-addicted customers that did not exist in 1995. By 2005 and 2015, that population is enormous. So clearly, there’s a market; plus, we happen to reside right next to the country that has one of the most sophisticated drug underworlds on the planet, and that’s Mexico. And those guys are constantly innovating. It’s a highly innovative industry — it seems to me at times.
And so you have those two combinations, our own creation of an opioid-addicted consumer base connected to the problem of what’s going on down in Mexico, a lot of which is, it’s important to really notice, that the impunity with which the traffickers down there produce these drugs is really dependent on deep corruption within Mexico, and unprepared police force, unfunded, etc., and withered moral as well. But also because traffickers in Mexico can get all the guns that they need to enforce their will from the United States.
It’s been a long, long history of drug trafficking south into Mexico, with which they can enforce that impunity. So all of that is why we have this issue, perhaps far more acutely than any other country on the planet.
Jeff: How is this related to or an evolution of the meth crisis that we saw in this country in the ’80s?
Sam: In the 1980s and ’90s is when the Mexican trafficking world discovered methamphetamine. And with that, the idea that you could manufacture drugs instead of growing them. That was the first time they did. Now what’s happened, though, is that this has morphed. It’s connected to this whole problem we’ve just been talking about because they made industrialized meth, in fact. And they made it with one chemical known as ephedrine, which you find in antihistamine, Sudafed pills, etc., that stuff.
This process, very easy to make, very clean, really not too difficult to do, turned them, and they realized, “Jeez, why grow a plant?” And that’s when the idea first took hold. “We’re in the wrong business. We need to be making drugs, not growing them or buying them from the Colombians whom we hate.”
So they began to do that, but then everything changed. The ephedrine meth was party meth. You began to see people using it, and they would want to party and stay up all night or be up for two or three days. After a while, you began to see those famous mugshot posters where you see people over six or eight years gradually decline pocked, all that very famous.
All of that in 2008 changed, though. Mexico made ephedrine illegal, except for a few pharmaceutical companies to possess it. And the Mexican trafficking world switched to another form of making meth that is far more messy, stinky, requires more chemicals, but it has one benefit to them that the ephedrine method doesn’t. And that is, you can make the precursors to this form of meth with a variety of toxic industrial, legal, very common chemicals.
And that means that you can get supplies if you control world chemical markets and the ports; you can get supplies of this stuff to be making it by the ton, all year round. And that is really what’s happened.
So the meth business that they were in changed in 2008. By the time 2010, ’11, ’12 rolled around, it was pretty much this entire new method of making meth. And what you found is, you began to see methamphetamine marching across the country, destroying local manufacturers — these small-town guys who would make an ounce or two here and there. Now, none of that happens. It’s all Mexican meth, and it’s all coast-to-coast.
The problem with this meth, though — Fentanyl will kill you, but this meth, perhaps because it’s made with such toxic chemicals, it’s not clear why, but what is definitely clear is that this meth is creating vast, very quick, rapid onset of symptoms of mental illness, schizophrenia, paranoia, hallucinations, delusions, a lot of things like that. And with that, of course, comes homelessness. As they have switched to making meth this new way, and as that method has really been learned and caught on, and now everybody knows how to do it down there, you are seeing widespread psychiatric problems in people on the street even more than before, and all connected to meth.
And then connected to that as well, is the expansion of our homeless problem, all over the country, but especially notable at times in areas that never really had any homeless problem to speak of before that. So that is the other side of this synthetic drug era that we’re now in. Fentanyl will kill, the meth will drive you to mental illness and homelessness.
Jeff: How is the crackdown or the attempted crackdown on opioid use, which you’ve written extensively about in Dreamland, how has that impacted the increased use of these other synthetic drugs?
Sam: What has happened is, people who have been using the opioid painkillers — some of them prescribed by doctors, others simply bought on the black market, some people never needing them in the first place, but just because the supply was so vast, they ended up using them at a party, say — started to develop the habit after that.
What begins to happen is that doctors get very worried. The CDC and various authorities start saying, “Wait, we got to be careful about this.” And in fact, they needed to be careful. The problem is, of course, you’ve got people out there who are dependent on these pills in one form or another, and they don’t have many other options.
Now, some people don’t have access to treatment. Other folks are in legitimate pain, patients who are then scurrying around to find something to deal with the very real and terrifying pain, the life mangling pain that they feel. A lot of these folks then begin to look on the street for whatever painkiller they can find.
What then begins to happen, I would say as well, is that the Mexican drug world changes again or morphs again. And what you’ve seen now in the last few years, since roughly 2017, is an expansion of the counterfeit pill that looks like an oxycodone generic 30-milligram pill or a Xanax or a Percocet branded opioid. It now contains nothing really but fentanyl.
Fentanyl has allowed the trafficking world to do a couple of things. One is to provide all those people — who were really using pills and now don’t have maybe the access they once had to those pills — with pills that really are fentanyl, very dangerous pills, very deadly it can be, very often. But also the fentanyl has allowed the trafficking world, for the first time, access to our American culture, Americans’ love affair with pills. It goes back to at least Valium in the 1960s. And the trafficking world has never been able to take advantage of that until fentanyl came along.
Fentanyl comes along, and all of a sudden, you can put a few grains of the stuff in every pill, and you can show it as if it were an opioid as if it were a hydrocodone or oxycodone pill. The problem is, of course, you have to make sure it’s well mixed and very, very often that’s not the case. A lot of those are mixed “properly”, but there are frequently cases where they’re not.
So it is once again you see these transformations that happen every few years, very quickly responding to market conditions, and the counterfeit pills are one of those responses to that issue you just mentioned.
Jeff: Given all of this, is there any reason to think that there’s anything that policy or law enforcement can do to get any rein in on this?
Sam: Well, I do believe this is calling on us to do a few things. One is to develop a far deeper connection with Mexico. I have to say I lived in Mexico for ten years as a journalist, and we have never developed the relationship with Mexico that really it requires, given the nature of the problems that exist between the two countries. It’s such an important country for us. And we still don’t know what to think about it really.
Ask yourself how many congress members know to name the six Mexican border states with the United States. Very few, probably. We need to develop so that, with that relationship, we can then move towards actual collaboration — us doing something about our guns, them doing something about the brazen way in which this stuff is promoted.
I often ask people, “What do you think the price of an AK-47 that’s smuggled south from the United States into Mexico is?” In my opinion, the price is meth made with impunity, and now at the lowest price it’s ever been, and turning people crazy. To me, that’s the price we’re paying for that.
And Mexico still is, I would say, blithely not worried about its corruption. I think a lot of Mexicans are, but I think there is this attitude in the government that it doesn’t really matter or something. It’s not been addressed forthrightly, and I believe that needs to happen.
I also think that we need to start expanding a variety of ways of dealing with this that we haven’t done so far: expanding treatment options and, absolutely, developing more prevention efforts at the local level.
I think we need to rethink how jail is done. Jail has never been a solution. It’s always been part of the problem. You’re always going to have jail when you have drugs involved, and if all were legal even if the biggest threat to send people to jail is alcohol because it’s cheap and available everywhere.
We need to rethink how jail is done, how jail can be a place for recovery to begin, instead of a place where just people veg out, watch Judge Judy all day long, sleep all day long, doing nothing productive. Now you’re seeing that happen in a lot of counties. They are experimenting with new ways of dealing with jail. To me, that’s a huge step forward. It’s a necessary step forward. It’s not the solution. There is no one solution, but I think also it just gets back, frankly, to an idea that we have done so much to shred and destroy community in this country in a million different ways. We could go on for quite a long time about that topic.
And I think part of the reason I call the book The Least of Us is because this is calling on us as Americans to return to the small, local initiatives, that small stuff in neighborhood unification strengthening: having a barbecue, being outside, and getting to know your neighbors, being around each other, coming out of the house.
So often, I think if we just do that, it will break down a lot of the awkwardness and a lot of the suspicion and a lot of the fear and, “Oh, I don’t think I can politically — so what am I going to talk to him about?” etc., etc., all that stuff. To me, I believe that’s why I called the book The Least of Us. We have to get back to a concern about the folks who are most vulnerable. That grocery store clerk, who may or may not have health insurance but still had to show up in the middle of COVID-19, for example. That addict eating from the trash, but also get back to these small, small things.
And so that’s why half of my book, The Least of Us, is really about finding the least noticed, non-sexy, non-publicized stories of Americans involved in community repair that I could find. I wanted to make it small because, for too often, we’ve been looking for the big splashy answer that’s going to solve all. And that’s how we got into this. We wanted [an answer] for the mystery of human pain. We wanted one magical answer, and that turned out to be opioid painkillers, which do a wonderful job in some cases but frequently lead to unintended consequences with which we are now in the middle of living.
Jeff: Sam Quinones, his book is The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam, I thank you so much for spending time with us today.
Sam: My pleasure, Jeff, anytime. Thank you so much.
Jeff: Thank you. And thank you for listening and joining us here on the WhoWhatWhy Podcast. I hope you’ll join us next week for another radio WhoWhatWhy Podcast. I’m Jeff Schechtman. If you like this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to WhoWhatWhy.org/donate.
