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Could the Trump-Xi G20 deal help get a handle on the US opioid crisis?

Drew Angerer, AFP | Fentanyl is considered one of the main causes of overdoses in the US.

Although it was a secondary point in the Sino-American trade agreement negotiated at last week’s G20 summit, China has vowed to crack down on the production of fentanyl – a potentially decisive step in the fight against the US opioid crisis.

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“A very, very big deal.” US treasury secretary Steve Mnuchin was not talking about the 90-day trade ceasefire or Chinese promises to import more American cars. Rather, he was talking about Beijing’s promise to curb the manufacture and export of fentanyl, a powerful painkiller that plays a central role in the US opioid crisis, and of which China is a major exporter.

Beijing has “always tended to deny that this substance is a problem”, said a February 2017 US Senate report. Understandably, China has no desire to advertise its role in the opioid crisis, which caused 72,287 deaths in the US in 2017, according to US Drug Enforcement Administration (DEA) figures.

From American OxyContin to Chinese fentanyl

Although substantially documented by American authorities, the link between China and the explosion of synthetic drug use in the US remains little known amongst the general public. The opioid crisis is driven by the over-consumption of painkillers that are just as potent and addictive as hard drugs. In the 1990s, it was an American drug, OxyContin, which first led to widespread addiction to painkillers in the US.

Then in the mid-2000s, fentanyl slowly but surely took over. The production of this powerful painkiller is not illegal in the US, thanks to its effectiveness in dealing with severe pain, especially that of patients with advanced cancer.

But increasingly fentanyl – which is “50 times more potent than heroin and 100 times more potent than cocaine”, according to the US National Institute on Drug Abuse – came to be used as a recreational drug. In response to this challenge, the US announced a crackdown on the illicit production of fentanyl, closing down several clandestine factories both on home soil and in Mexico. By 2006, Washington thought it had come to grips with the problem, Bryce Pardo, a narcotics specialist at the RAND Corporation think-tank, recalled at a congressional hearing in September 2018.

The problem was that this campaign failed to take into account China’s emerging role in the crisis. From the beginning of 2010, Chinese exports of fentanyl – both legal and illegal – started to increase exponentially. The substance soon became enemy number one in the fight against the opioid epidemic. In 2017, nearly 40 percent of overdoses in the US were due to synthetic drugs, the vast majority of which were fentanyl or derivatives. That’s while, increasingly, the painkiller has been mixed with other drugs such as heroin or cocaine to accentuate the effects.

Figures from customs seizures now suggest that around 60 percent of the fentanyl sold in the US comes from China – although that statistic doesn’t take into account shipments through Mexican cartels, which, according to the DEA, traffic significant amounts of fentanyl for Chinese manufacturers.

Lucrative industry

The 2017 US Senate report attributes this proliferation in the Chinese manufacture and export of the drug to two factors: the growth of the country’s pharmaceutical and chemical sectors and the fact that fentanyl is very little used there as a narcotic. The Chinese authorities have long taken a hands-off stance on the production of this substance, allowing more and more pharmaceutical companies to reap the rewards of a lucrative business. Only very small quantities of fentanyl need to be sold for it to be highly profitable.

Consequently, the trade truce agreed between US President Donald Trump and his Chinese counterpart Xi Jinping “could significantly help” in combatting the opioid crisis, Rebecca Haffajee, a specialist in health policy at the University of Michigan, told Time magazine.

Yet Trump is not the first US president to press Beijing to bring its fentanyl industry under control. In 2015, his predecessor Barack Obama persuaded China to put it on its list of controlled substances. Thus, exports of this drug to the US for non-medical purposes are already banned by Chinese law.

Indeed, the 2015 agreement did little to deal with the fentanyl trade. According to Pardo, this is due to “competition” between different Chinese agencies responsible for controlling the country’s pharmaceutical sector, which “makes them inefficient”. Moreover, manufacturers have developed fentanyl-like substances and given them other names, so that they are off the list of controlled substances. Beijing has updated its legislation several times, but it remains a game of cat and mouse.

Ergo, there is the risk that the December 2 agreement will just create new lists of controlled fentanyl derivatives – leaving doubt as to whether it will make much of an impact, as the death toll in the US opioid crisis continues to mount.

This article was adapted from the original in French

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