‘The deadliest wave’

New book on America’s fentanyl crisis is frightening but mandatory reading

Left to right: A lethal dose of heroin, carfentanil and fentanyl, respectively.

Left to right: A lethal dose of heroin, carfentanil and fentanyl, respectively.

Photo courtesy of DEA

About this story:
Chris Faraone is the editor-in-chief of DigBoston and the editorial director of the Boston Institute for Nonprofit Journalism. This article was produced in collaboration with BINJ as part of its Film Intervening Getting High Team (F.I.G.H.T.) initiative. For more information and coverage of the epidemic visit binjonline.org.

First, a spoiler alert: Among the multiple apocalyptic revelations in Ben Westhoff’s new book, Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic, is sour news for all hard drug users, from casual weekend abusers to full-time cocaine cowboys. In light of developments presented by Westhoff in gruesome and unprecedented fashion, putting questionable substances up your nose, in your veins, or even on your tongue is highly discouraged from here on out.

“Any drug where it’s a powder or a pill, you just can’t trust it,” Westhoff said in an interview about his latest project. “There can be fentanyl in anything … [Home drug-testing kits] are getting very sophisticated, and there are websites you can consult, but in terms of going to a party and someone offering you some blow or something like that, it’s over.”

Indeed, locals may recall the fentanyl-related mass overdose back in January that killed one man and sent at least a dozen others to area hospitals for treatment. Weeks after the incident in a suburban Chico neighborhood, law enforcement officials attributed the death to acute poisoning from fentanyl, methamphetamine and cocaine. Those sickened reported believing they were snorting coke.

Many will not read Westhoff’s book or heed his warnings, and in tens of thousands of cases this year will steer directly off a cliff. According to the federal Centers for Disease Control and Prevention, “among the more than 70,200 drug overdose deaths estimated in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogues [other synthetic narcotics] with more than 28,400 overdose deaths.”

When Westhoff started this endeavor nearly four years ago, he couldn’t have imagined those statistics. Fentanyl showed up and kicked the hinges off a prior psychedelic focus that turns up in trace amounts throughout the book but that is overshadowed by the eponymous grim reaper.

Quoting a CDC report, Westhoff notes, “in 2013 the ‘third wave’ of the opioid epidemic began.” And “because of fentanyl, it is the most deadly one yet.” Focusing on urban Missouri in one especially harrowing chapter, he reports: “In 2012, St. Louis saw 92 opioid-related deaths, a number that rose to 123 in 2013 and up to 256 in 2017.”

“Fentanyl completely changed the game,” one character, a former jam band road dog who jumped from newfangled hallucinogens into the far more dangerous opioid scene, told Westhoff. Beyond the numbers, which are ugly but far from reliable in this nascent abusive honeymoon phase of the crisis, this is a story about people, and Fentanyl, Inc. features a roster of villains and victims who stray far from movie archetypes. From fast and furious nerdy bros brewing up alphabet soup in bunkers underneath the desert, to 20-something call center employees who peddle poison by phone from the back offices of semilegal chemistry labs in China, their stories follow a theme reflected in all of Westhoff’s vignettes: Everything you think you know about drugs has changed. Even the people packing, slinging, sniffing and filling their vaults thanks to this garbage don’t know the half. They care only about the math.

“A lot of drug dealing comes from people who have addictions of their own,” Westhoff said. “Painting the dark web or these people with a broad brush isn’t a good idea, because everyone has their own philosophies. A lot of people are in it for harm reduction; there’s a legitimate case to be made for getting a lot of these psychedelics and other potential medicines out to people they can potentially help. And then it gets a little harder when you get this guy who is selling nasal spray with fentanyl analogues and saying that he’s helping opioid addicts maintain their addictions in a more affordable way.”

Former President Barack Obama signs the 2012 Synthetic Drug Abuse Prevention Act.

Westhoff, a relatively early explorer into the unknowns of these notorious intoxicants, stresses the lack of common facts and figures in this post-medicine chest Wild West. “They used to say that touching fentanyl can make you overdose,” he said. Unsure of the verdict on the epidermal threat, the author nevertheless said some of his sources “were dealing [the extremely dangerous carfentanil] and breaking it up with their bare hands.”

“This stuff is so new that there isn’t much agreement—there’s not even agreement about how to pronounce the word fentanyl. Half the country says ‘fenta-nall’; the other half says ‘fenta-nil.’ But nobody knows.”

As for the countless analogues available online and maybe at your local McDonalds, Westhoff said, “It evolves too quickly for people to even come up with a clever name for [new drug incarnations]. … People don’t even realize what they’re taking—whether it’s heroin, or pills, or cocaine, or whatever.”

In his quest to source answers to new wide-open questions, Westhoff “consulted politicians, police, DEA agents, and international drug policymakers, who would like to put these traffickers away forever,” as well as “counselors, doctors, activists and policy wonks, some of whom believe these drugs should be legal.” He even “corresponded with two infamous, now-imprisoned LSD kingpins who worked together out of an abandoned missile silo in Kansas.”

“The demise of their operation in 2000,” he writes, “may have inadvertently fueled the rise of a new hallucinogen whose effects are far worse than LSD.”

You may be wondering, Is this one of those stories about the real Walter White? You could say that, but there are thousands of them, wearing different hats on multiple continents, dealing on the web and in your backyard.

Fentanyl, Inc. is like Breaking Bad, sure … meets Night of the Living Dead meets New Jack City, Gummo, Kids and Gremlins. With a cast from a lot of the places on President Donald Trump’s shithole list. As one candid former U.S. State Department special agent explains: “Fentanyl can be produced anywhere a laboratory can be set up, such as a warehouse in an industrial park, a home in a residential area or a clandestine lab in the mountains.”

For Westhoff, the first taste of disaster came nearly a decade ago, in Los Angeles. He writes:

In 2010, fifteen-year-old Sasha Rodriguez fatally overdosed at Electric Daisy Carnival at the LA Coliseum, reportedly from ecstasy. Local politicians revolted, and the event was forced to relocate to Las Vegas. A Plymouth State University student named Brittany Flannigan overdosed and died in late August 2013 after attending a Boston EDM concert featuring the popular DJ Zedd, and just days later a University of Virginia student named Mary “Shelley” Goldsmith passed away as well. Both were nineteen, and reports said they had taken “Molly.”

Purchasing a pill press for home use from a legitimate Chinese website can be tricky, as many sellers will not ship the machine to the U.S. This product, which decribes its use for pressing “candy” tablets, offers free shipping to the U.S.

“I had a friend who died from multiple fentanyl patches a while back, before I even knew what fentanyl was,” Westhoff said. “My way in was through the rave scene in LA when I was the LA Weekly music editor. I had gone to raves a lot back in the day, and ecstasy was pure MDMA, and people weren’t dying … But at these raves, someone—if not multiple people—were dying at every one. I wanted to investigate that, and I found out about all of these ecstasy substitutes and learned that there were all these new drugs coming out of China. But then all that stuff was really just the tip of the iceberg, because by 2016 fentanyl was much worse than all of the others by far. So it’s a completely different project than I envisioned.”

Westhoff includes ample relevant history—from when “one could buy opium from the Sears, Roebuck catalog”; to a Boston dealer who unknowingly tipped off the DEA in 1992 about the nation’s first known leading source of black market fentanyl; and back to the industrial revolution and addiction in the United Kingdom, and how that nation attempted “to balance its trade deficit by using its British East India Company to ply opium in tremendous quantities to the Chinese, causing a pair of wars.” The latter is especially critical background, as fentanyl and other new drugs have not caught on there, spurring many to think that’s why China has been so lax about laws and exports.

“In May, [China] blanket-banned all fentanyl analogues, which has been proven to be effective,” Westhoff said. “When China actually bans stuff it has an effect. At the same time, there’s all these loopholes. China is shipping the fentanyl precursors by the boatload to Mexico, and they’re getting [government] incentives for it. … It’s a huge sprawling bureaucracy—there’s not this one person who has a plan and is manipulating everything. It’s just capitalism gone awry. On the other hand, how could they not know what they’re doing?” In the words of one of Westhoff’s Chinese sources, a less-than-clandestine manufacturer: “We are afraid that a reporter come to our lab, to our country, to find out why we synthesize these chemicals, or why we sell these chemicals to your country. To let your people’s health down. To harm your country’s people.”

There is plenty of blame to go around. Some fingers can be pointed at figures like former presidents of the United States, including but by no means limited to Barack Obama, whose 2012 Synthetic Drug Abuse Prevention Act outlawed multiple kinds of synthetic cannabinoids, but which Wired magazine cracked, “was obsolete before the ink of his signature dried” thanks to the speed of innovation in the drug culture.

More generally speaking, the culprit is every rank-and-file Greatest Generation prohibitionist who ignorantly warned us that our drugs could be laced with something deadly long before that was a thing that really happened.

Other formerly contrived tropes about the horrors of drugs have also become real, like the one in which dealers walk around offering complimentary samples to teens. As one young woman from the Rust Belt told the author about a strip that doubles as a trap in her town: “They’ll come up to anybody who’s parking, getting gas, even getting cigarettes. They’ll drive up to you and ask if you mess around. They give it to you for free.”

“There’s one condition, however,” Westhoff writes. “You must have a working cellphone and give them your number.”

Of course, all of the yellow bricks lead back to governments, complicit politicians, all those gratuitous check boxes. Those pining for the days when it seemingly couldn’t get worse than regionally concentrated crack, meth and heroin scourges may take aim at lazy and misguided attempts to throw a wrench in the cycle of supply and addiction, like with the Combat Methamphetamine Epidemic Act of 2005. After that law limited the amount of drug store staples like Sudafed that you could buy and subsequently harvest to manufacture methamphetamine in your barn, Mexican cartels stepped in to fill the gaps, and we all know how that’s turned out.

To learn more about the source of so much mayhem, Westhoff “infiltrated a pair of Chinese drug operations, one a sophisticated laboratory operation distilling outsize quantities of the world’s most dangerous chemicals in industrial-size glassware, and the other an office of young, cheery salespeople, who sat in rows of cubicles and sold fentanyl ingredients to American dealers and Mexican cartels.”

A potentially lethal dose of fentanyl.

Photo courtesy of DEA

After demasking wizards in China and possibly learning more than any other American civilian has to date about the mechanics of that country’s fentanyl trade, Westhoff came to understand that the problem is bigger than the F-word and its awful analogues.

There are countless oddball drugs available on the black market. Take U-47700, for example; “originally created in the mid-1970s as a morphine alternative, it never received FDA approval.” Nevertheless, for one of Westhoff’s sources and who knows how many others, U-47700 “was like an ‘antidepressant,’” making them feel “whole, confident, and happy, very little stress.” Also of note is that fake weed can kill you. “Even today,” writes Westhoff, “synthetic cannabinoids remain the fastest growing class of drugs. … Some are twice as potent as marijuana; some are one hundred times as potent or more. And there is little formal testing, almost nobody knows how safe each blend is, not even the scientists who invented them.”

The good news keeps on coming. “Even more disturbingly,” the author reports, fentanyl began “being pressed into pills that look exactly like name-brand prescription tablets. Raids across the United States have turned up operations in houses and apartments that turn fentanyl powder into tablets using specialized presses. Both the drugs and the machines are bought from China. These operations can make thousands of pills per hour. They stamp pills with the OxyContin or Percocet logo, and they’re indistinguishable. … The dosages of these fake pills vary greatly. One might have ten times as much fentanyl as the next. Investigators believe such counterfeit pills were responsible for the death of music star Prince; about one hundred white pills found on his property looked exactly like Vicodin but actually contained fentanyl.”

From Paisley Park to the park behind your apartment, no place seems to be immune. “When you think of the opioid epidemic, you think of a lot of white middle class people,” Westhoff said. “That certainly has been a big part of it, but there’s always been a huge African-American population using heroin, and now that fentanyl is in the mix it’s causing massive casualties in places like LA and Chicago. This is not a death sentence for just one demographic. Just when the prescription pill deaths were finally falling, and just when the heroin deaths were finally falling, the deaths from fentanyl are going way up. And prescription pills are still abused at a very high rate, so if fentanyl really starts getting cut into pills, then this thing can balloon even worse than it already is.

“It just seems like with each drug epidemic, things keep getting worse.”

Toward the end of Fentanyl, Inc., Westhoff points to some solutions. “The crack epidemic, the meth epidemic—keep in mind people were blaming the user back then, so thankfully we’re moving beyond that.” He also supports harm reduction strategies like supervised injection facilities, which he argues “is really just a no-brainer.”

“We know from the failure of the War on Drugs that focusing on the supply side is not going to work,” Westhoff said. “Killing a drug kingpin from Colombia or capturing El Chapo doesn’t do anything—the drug supply is just getting worse. The drugs will find a way to get here, drug users will find a way to get their drugs, and all we can do is focus on the demand side.”

The shifting goal posts make the problem nearly impossible to smother. Still, the author hopes his contribution plays a role in navigating us out of this state of emergency.

“The inventor of fentanyl, Paul Janssen, there’s literally nothing written about him, and so I wanted to tell his story and that of the other people who brought these drugs to life,” Westhoff said. “No one did it on purpose really—these are all drugs taken from scientific literature.

“I tried to have it not just be about statistics, but about bigger trends. Even when this information is out of date, I think people are going to want to look back on how this fentanyl crisis got off the ground.”