More than 70,000 Americans died from drug overdoses last year, and a growing number of those deaths are attributed to the powerful synthetic opioid fentanyl. Journalist Ben Westhoff says the drug, while an important painkiller and anesthesia medicine in hospitals, is now killing more Americans annually as a street drug than any other in U.S. history.

"Fentanyl was originally formulated as a medical drug, something that was used in ... open heart surgery and in end-of-life care," Westhoff says. "It's an opioid that is 50 times stronger than heroin, 100 times stronger than morphine."

Westhoff's book Fentanyl, Inc. examines the manufacture, sale and use of fentanyl and other synthetic drugs. Over the course of his research, he visited two factories in China that make synthetic opioids and ship them to the U.S. or to Mexican drug cartels for distribution.

Westhoff notes that the synthetic opioids, which are sold over the "dark Web," are often cut into other drugs, including heroin, cocaine and even prescription pills.

"Basically, it's so cheap to produce and it's so powerful, that drug dealers began realizing it was a way to increase their profits," Westoff says.

He adds: "Since only 2 milligrams of fentanyl is enough to kill you, just the slightest miscalculation can make people overdose and die. ... If fentanyl starts taking over prescription pills and other drugs, the problem could get even worse."


Interview highlights

On how Belgian physician Paul Janssen invented fentanyl

In 1959, he was monkeying around with the chemical structure of morphine and he came upon fentanyl and it had some advantages: It acted faster, it was stronger, and so it quickly became an important medical drug. ... He started his own company and then, not too long afterward, it was sold to Johnson & Johnson, and Johnson & Johnson today makes the fentanyl patch from the drug that Paul Janssen invented. ... It is also a medical drug. [For] people who have cancer, people who have serious pain, it's used for pain management.

On how fentanyl is different from heroin

They're both extremely addictive and they both sort of satisfy the same cravings; but the problem with fentanyl is that it's just much more likely to make you overdose and die. ... It's getting to be that fentanyl can be in almost any drug. We're even seeing cases where ecstasy pills taken by ravers now sometimes have fentanyl. So it's getting to be that almost all drugs are unsafe. ...

Fentanyl, in places like St. Louis (where I'm from) is actually starting to catch on as a drug unto itself. And it is so much stronger that longtime addicted users who don't even get high on heroin anymore ... with fentanyl, they can actually feel that feeling again of being high.

On contacting a U.S. fentanyl dealer on the dark Web

He was [an] addicted opioid user himself. And he actually claimed to be doing some good in the world, if you can believe that. He was selling a nasal spray with a type of fentanyl and it was very cheap. And, despite the fact that he was selling this type of fentanyl over the dark Web, his contention was that he was helping addicted users like himself maintain their addiction affordably. ...

Even the slightest miscalculation can have fatal consequences. ... And he said he had anxiety issues and [that] starting to use these exotic opioids relieved his stress, and he has kind of a blue-collar job that doesn't pay the bills. He originally tried street dealing but that didn't make the money compared to the sort of worldwide potential customer base that he found on the dark Web. ...

I think it's fair to say that a lot of dark Web dealers really don't care who they're selling to. They don't care what it's being used for, the amounts. But at the same time, there are other dark Web dealers I talked to who specialize in psychedelics. They specialize in drugs they think should be legal medical drugs to help people with things like PTSD. ... So, it's a whole wide swath of different types of people on there.

On how fentanyl from the dark Web is shipped to users

It's surprisingly easy to send these drugs through the mail, and that's been another big bone of contention that President Trump has been tweeting a lot about recently. The amounts needed are so small that just a tiny amount, hundreds of doses, can fit in an envelope. And it's often mislabeled. ... It doesn't say what it really is on the customs declarations, and also it's often hidden inside other products. So this guy [I] was talking to ... said that he received his in, like, a cleaning product I think, something like an Ajax can, and from the outside it just looked exactly like a cleaning product and you would have had to open it up to see what was inside. ... He showed me the little nasal spray mister that he sends and it does looks like something you would buy at CVS or Walgreens; it has a little label and it looks totally innocuous.

On the Chinese government's attitude toward fentanyl

China has big problems with drugs like heroin and meth and ketamine but they don't have a fentanyl problem like we do in the U.S. And so a lot of people think this is why they haven't sufficiently cracked down on this huge industry that they have. ...

The big problem in China is that a lot of these drugs which are banned in the U.S. are still legal in China. And so the companies can make them with the full support of the government and have them basically smuggled into the U.S. ... The biggest and most disturbing revelation from my book was that not only is China not doing enough to contain this industry, they're actually encouraging this industry through a series of tax breaks, subsidies and other grants.

On how the rave scene is piloting ways to detect fentanyl-laced drugs

When I got started in this story, I started hearing about all this adulterated ecstasy, and since then there have been some really sophisticated test kits that can check to see: Is this drug what you think it is, or is it something else? And this was developed out of the rave scene, and now fentanyl test strips are providing this same sort of service for drugs that may be adulterated with fentanyl. So if you have a longtime user of heroin, and they're able to check their heroin to see if there's fentanyl, if they discover it, studies have shown that they're less likely to use it or to use as much or to use as quickly — and therefore overdose rates are likely to drop.

There are also city governments, even certain states, that are providing funding for public health organizations to dispense these kits. At the same time, in some states, including Pennsylvania, fentanyl test strips are actually illegal, and so that's really hindering and making things worse.

Sam Briger and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for Shots.

Copyright 2019 Fresh Air. To see more, visit">Fresh Air.