The Real Danger of Fentanyl

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Mary Harris: Let’s start with the saga of Rainbow Fentanyl.

Speaker 2: Halloween is right around the corner. The DEA warning that deadly rainbow fentanyl could end up inside of a candy bag if your kid.

Mary Harris: I first heard about this stuff last month. It all started with a warning from the DEA over pastel colored opioids, and that turned into a warning that fentanyl could end up in your kid’s Halloween candy. This was a ridiculous idea. It looks like candy. And in fact, some of the drug traffickers have nicknamed it sweetarts Skittles. It has nothing to do with candy. To be honest, I mostly heard about rainbow Fentanyl because people in my social media feeds were dunking on how quickly it got spun up into a political weapon. Like this is Ronna McDaniel, the chairwoman of the Republican Party, appearing on Fox News in what is theoretically a segment about the November midterms Halloween.

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Speaker 3: Every mom in the country right now is worried What if this gets into my kids Halloween baskets?

Mary Harris: Talking about the rainbow? The rainbow.

Speaker 3: Fentanyl.

Mary Harris: What if my my teenager gets this? I’m talking to you about rainbow Fentanyl now, because to me, the way this story spread was instructive. It morphed in this way that a lot of stories about drugs do from a real fear about a drug that is dangerous to a manufactured one. And it seemed like some of the only people taking any of that fear seriously were on Fox News Brian Mann, who covers drug use and abuse over at NPR. He noticed this, too.

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Speaker 2: It’s sort of almost for a moment, felt like the old days of drug war. Just say no narrative. Be very afraid. Be very, very afraid. And of course, at the kernel of it, that’s because there is this scary thing happening out there. And the Republicans really did find a way to sort of, you know, insert that narrative into their talking points.

Mary Harris: Bryan says it seemed to him that Republicans backed Democrats into a corner on fentanyl and they haven’t let up.

Speaker 2: Here’s what I think. I’ve seen the the left and and the center. And even for a while, Republicans have really shifted their way of talking about addiction. There was a shift towards more harm reduction, more treatment, more of a public health response. Right. And and the Democrats and progressives are fairly committed to this idea. They’ve really leaned hard into the idea that the way forward, the main way forward is treatment and health care. And that’s left them pretty exposed. Right. That’s that’s a sort of soft on crime narrative that Republicans were able to pounce on.

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Mary Harris: Now that the election is over, do you think this narrative of fentanyl as a kind of bogeyman is going to go away? And do you think it should?

Speaker 2: Look, just factually Fentanyl is is really horrible. It is a boogeyman. And what’s more, here’s the thing that is really important for people to understand is it’s killing young people.

Mary Harris: So you’re saying this is not going to go away?

Speaker 2: It’s not going to go away. I mean, we just saw a new report that shows that in in some states around the country, fentanyl is the number one killer of pregnant women and women in the first year postpartum after delivering babies. When you kill teenagers or people between the ages of 20 and 40, the way that fentanyl is doing that has really profound effects on communities. It affects people who are supposed to be entering their working lives, starting families, building communities.

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Mary Harris: Today on the show, Fentanyl isn’t going anywhere. Why? Staying silent about it is not an option. I’m Mary Harris. You’re listening to what next? Stick around.

Mary Harris: When I called up Brian Mann to talk about Fentanyl, there was this story that loomed large in my mind. A few weeks back, the Wall Street Journal published an article describing the overdose deaths of three people in New York City back in March of 2021. These folks were well-educated, high achieving, and they were young 26, 38 and 40. They had all ordered cocaine off a DoorDash like service, and it had been laced with fentanyl. Brian says in the past he might look at a story like this one and think it could be fear mongering. Now, he doesn’t think about it like that because these days, three quarters of all drug involved deaths involve fentanyl.

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Speaker 2: One of the things that I’m really reporting on now is that for the first time that I can find, we’re really in a space where if you take hard illicit drugs, whether it’s cocaine, whether it’s a party pill at a dance, whether it’s, you know, something where somebody says, hey, this came out of my mom’s medicine cabinet, it’s very real that that can kill you. We actually have entered the world. I don’t know if you remember your age, but back in my day, you know, sort of the Nancy Reagan just say no narrative. You know, just don’t do drugs. It’s deadly, deadly stuff. Well, you know, it turns out a lot of that was hype. Drugs were bad. Yes. They hurt communities and they hurt people, but they usually weren’t fatal. Right. Most people recovered from crack. Most people recovered even from meth. And now it’s different. And and this is a big challenge in part because so many people have lost credibility in talking to young people. It’s a big challenge now, coming to them and saying, listen, you need to wake the hell up.

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Speaker 2: And I have this conversation with my own son. He’s in his mid-twenties. He lives in New York City. He’s living a good young life. And in the past, you know, drug use has been part of that American experience, experimenting, kind of figuring stuff out and playing a little bit and playing a little risky at times. And I think that is a big part of the story. I talk to young people all the time who are still ordering cocaine from a dealer they think they can trust. You know, they’re taking a pill that looks exactly like it came from a pharmacy and they’re getting hurt really, really badly. And so, you know, that is, I think, at the core of the story.

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Mary Harris: Can you just give some basics on fentanyl, like what it is and where it came from? It’s a synthetic opioid, right?

Speaker 2: Yeah, that’s right. And it’s been around for a long time. I mean, you know, if you go to the hospital and you have a severe injury, there’s a really good chance that you will be given fentanyl because it’s very powerful. It’s very effective at easing pain. But over time, the Mexican drug cartels have realized that this is also a really cheap, easy to manufacture street drug. And so it’s been slowly trickling into the American drug supply over the last ten or 12 years. But really over the last five years, it’s gone everywhere.

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Mary Harris: Did it really start with the Mexican drug cartels? Because my understanding is it’s come from China as well, and it’s pretty easy to manufacture domestically.

Speaker 2: Yeah, it is. That’s right. And you’re absolutely right that China provides most of what are called the precursor chemicals, the raw ingredients that go into fentanyl. And for a long time, some of the actual fentanyl was coming from China and people were cooking fentanyl in the US just like they were cooking methamphetamines in the U.S. But really what we’ve seen over the last five years is, is that the cartels have cornered the market on this stuff and they’re getting their raw materials from China.

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Speaker 2: You know, drug enforcement in Mexico has largely broken down completely. There’s almost no interdiction effort. So there are labs around Mexico City and across Mexico where they’re producing massive quantities of fentanyl and also shaping it into, again, what look exactly like pharmaceutical grade opioid pills. And then they’re shipping these north. And in the last five years, it’s penetrated pretty much every drug market in in the United States, every street market, You know, again, wherever you go now, you find people who are who are using methamphetamines. They’re also using fentanyl.

Mary Harris: Is that because it’s cut into the drug or because they’re just mixing and matching?

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Speaker 2: It’s cut into the drugs by the cartels. It’s a cheap add on that they can add that really boosts the quality of the high. And it also gets people addicted really fast. It’s also just super, super cheap to make, right. Heroin is is costly to make. Cocaine is costly to make a fentanyl is just dirt cheap to make and it’s super easy to smuggle. So it’s a great cost center for the cartels and for street dealers. This is the dream drug. The cartels have finally found the perfect drug.

Mary Harris: Well, dream for them, but nightmare for people who take it. Potentially.

Speaker 2: It’s a devastating nightmare. It’s a horror, but it’s it’s super profitable. And, you know, for the attrition that they see among their customers, and by that I mean the death that we see among their customers. They’re getting enough additional people addicted and hooked that it’s it’s still a profit center. And really the heartbreaking thing that I’m seeing as I go around the country talking to people, including again, young people, is that more and more people who were using prescription opioids at one point and then using heroin at one point, they’re now actually seeking fentanyl. It’s so powerful that it gives them that high that they’re looking for that euphoric high that they no longer get from heroin or from OxyContin. And so I talk to people now all the time who are like, oh, yeah, I don’t I don’t even want heroin anymore. I want fentanyl because that’s what gets me there.

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Mary Harris: Fentanyl has been around since the 1960s. My understanding is that it entered the recreational drug scene mostly because of a supply and demand problem. People who had gotten addicted to opioids all of a sudden found themselves seeking off market opioids. And that created a lot of demand and there just wasn’t enough supply. And all of a sudden, fentanyl was there to replace, say, a heroin. And then my understanding is that. The general public. Begin to kind of understand the impact of fentanyl. Around 2016. So what happened in 2016.

Speaker 2: 2016 was the year that that the death toll just began to surge. We saw about 20,000 additional overdose deaths that year. And that was really, you know, kind of the first big alarm that this wasn’t any longer kind of a treatable long term illness, that this was more of a terminal illness for many, many people.

Mary Harris: Did folks know right away that it was fentanyl that was to blame or was it a little bit more of a detective situation where folks had to look into it and see what was going on?

Speaker 2: Yeah, totally the latter. And let me just say that one of the things that’s horrible about this public health crisis is that the information that we have about drug overdoses and fatal drug overdoses is incredibly poor. And so you just put your finger on something that has contributed to the death toll in the U.S. is that we’re always behind in understanding what’s going wrong.

Mary Harris: So once there was an understanding that fentanyl was surging onto the recreational drug market. Was there a coordinated response?

Speaker 2: I think the short answer is that there was not a coordinated response. I think that, you know, what we’ve seen over time is a lot of confusion and disarray within the major government agencies that deal with drug addiction, within the public health community, within the medical field. We saw, for example, during the Trump administration, a diplomatic crisis that almost completely wrecked the ability to target fentanyl producers in Mexico. That whole law enforcement piece just unraveled and broke down.

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Mary Harris: What happened?

Speaker 2: What happened in the in the final year of of the Trump administration was that the Drug Enforcement Administration and other federal agencies arrested a top Mexican official in Los Angeles. And, you know, Mexico was already leery of this whole drug war model. They were already sort of not thinking it was working very well for Mexico. It was creating a lot more violence in Mexico. But that arrest essentially shattered the final vestiges of the ability of U.S. law enforcement to really operate in Mexico and to mount these big complex raids on laboratories and pill mills and other places in Mexico.

Speaker 2: And another piece that’s unraveled is that a few months ago, you’ll remember that Nancy Pelosi, the House speaker, visited Taiwan and infuriated the Chinese. And so there again, there was a diplomatic breakdown where the Chinese, who were never terribly helpful at stopping these precursor chemicals from going to Mexico, they again backed away from any kind of real partnership with the U.S. and they said, we’re just not going to work with you if you’re going to disrespect us in this way.

Speaker 2: And so those two big diplomatic crises have left the U.S. with almost no tools to really stop the flow of of fentanyl until it really reaches the US-Mexico border. That’s the first really strong chance we have to stop fentanyl. And we are making more busts than ever before, seizing more fentanyl than ever before. But all the experts I talked to say that’s a drop in the bucket. Basically, the cartels are able to pump as much of this into the US as they want.

Mary Harris: But Brian Mann doesn’t just point to Nancy Pelosi and Donald Trump when he thinks about who to blame for what’s happening with fentanyl.

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Speaker 2: Another place where there’s been a profound failure is just in the health care community. I mean, again, this is a you know, addiction is is an illness. And it’s now because of fentanyl. It’s a fatal illness. But if you go to an emergency room in most parts of the U.S. after having an overdose for fentanyl, they’ll they’ll prop you back up, they’ll put you together again, and they’ll send you out the door. Contrast that with what happens if you come in with, say, a heart ailment or something that looks like cancer in your lungs or some other serious health problem, they will channel you into a whole series of medical responses that will help you survive.

Speaker 2: But if you go to that same family doctor and say, I’m really struggling with an opioid addiction, or my son or daughter is struggling with an opioid addiction, nine times out of ten, that doctor will not know what to do. They will not want to work with you. They will distance themselves from helping you. And so there’s this political breakdown. There’s this diplomatic breakdown, there’s this law enforcement breakdown. But we’re also at this point where, you know, a lot of people who want help, it’s damned hard to get it.

Mary Harris: After the break. Even though fentanyl is coming across the Mexican border building, a wall will not stop it. Brian explains why.

Mary Harris: Can we talk about the politics of fentanyl a little bit more? And I want to do that because you’ve been pretty clear that a lot of the fentanyl is coming from Mexico is coming across the border. But I wonder if even given that you think the way Republicans have linked Fentanyl to the border is fair.

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Speaker 2: A lot of what Republicans have said about the border. Based on our reporting, is just factually wrong. And the main connection where it is factually wrong is that they’ve linked it to undocumented migrants. Right? That this is a problem where they say that people streaming across the border seeking refugee status or coming to the U.S. to work, that they’re the prime vector for fentanyl.

Mary Harris: Now, the DEA.

Speaker 3: Is warning that a massive influx of migrants will lead to a surge in mass fentanyl overdose events. The fentanyl crisis is a public health issue, and a majority of it is coming across the southern border. So how is fentanyl affecting your community?

Speaker 4: Fentanyl is at everyone’s doorstep because of that porous border and because of what the cartels and how much supply they are moving across the border, the southern border. And of course, it’s infiltrating every single community in the United States.

Speaker 2: And it really does look unequivocally true that most of the fentanyl coming in is coming through ports of entry. It’s being smuggled in, in, you know, in trucks, in, you know, cargo shipments, things like that.

Mary Harris: It’s a business. It’s coming in like, I don’t know everything else that comes in through the U.S. border to go to Wal-Mart.

Speaker 2: That’s exactly right. And there’s a supply chain that the cartels have created that’s pretty reliable and pretty dependable. I will tell you, just one, you know, funny story is that during the pandemic, when a lot of that supply chain was really disrupted, one of the problems that the cartels had was that they were generating so much money in the U.S. from selling fentanyl and other drugs that they were having a hard time actually shipping the cash, according to the DEA and other law enforcement. I talked to the pandemic, was shutting down a lot of their typical routes. It was hard. They had supply chain problems just like everybody else. And cash was the biggest problem. You know, fentanyl is so you can ship it in such micro amounts. You know, one person on their body can carry enough fentanyl that you can cut it later in the U.S. to to supply a whole city. Right. So getting it into the country is really, really easy, you know, getting the cash out. That was a little bit harder.

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Speaker 2: But I think that so I think that’s one of the most inaccurate things that Republicans are saying. I think the next thing that is really challenging about the Republican narrative is just, you know, what would the answers be? At one point, there’s been a lot of good reporting that near the end of his time in office, then President Trump was talking about firing missiles into the into Mexico to to bomb some of these drug labs, to hit some of these fentanyl labs and blow them up. Well, you know, that’s crazy. That’s not going to happen. But that gives you a sense for just how few options there are on the table.

Speaker 2: And so that’s really the thing that is is really at the heart of the Republican narrative that I can’t sort out like, okay, so if you think the Biden administration is getting this wrong, what would you do instead? The answer that I generally here is we would build a wall. But again, most of these drugs are coming in through legal ports of entry already. So what would a wall do? And I can’t get answers to that question.

Mary Harris: I mean, the Republican talking points do remind me of the crack epidemic a little bit in that talking about fentanyl as an issue having to do with migrants in particular in Mexico. It is racialize, is what is a public health issue.

Speaker 2: I think race always comes into drug policy questions in the U.S. It’s an inevitable part of the conversation. And I also think just, you know, many of the public health experts who I talked to, the addiction treatment experts who I talked to, they say that if you aggressively re criminalize addiction and re stigmatize addiction, you are going to cause a lot more deaths. And I think that is one of the concerns you asked earlier in our conversation whether this Republican narrative is going to survive beyond the midterms.

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Speaker 2: And I think this is one of the things I hear from a lot of people. They’re really worried that long after the votes are counted for 2022, we’re going to be seeing basically crack style laws around fentanyl, where carrying micro amounts of fentanyl will get you mandatory minimum sentences, will fill prisons up with people for carrying small amounts of of this very powerful drug. Very little evidence that that will help save lives or stop addiction or stop people from using fentanyl. A lot of evidence from past history that it will mostly target people of color. It will mostly target poor white Americans and have a really disproportionate impact on those parts of the community.

Mary Harris: In my conversation with. And we kept circling around this one point. Again and again that while stopping overdoses is important, resurfacing nasty drug war tropes won’t do that. So I asked for some practical advice, especially for people like me raising young kids.

Speaker 2: In doing my reporting, one of the things I really try to do, because I’m well aware that I’m one of the many gloomy, gloomy reporters out there talking about really depressing stuff. And there’s a tune out factor. People are just like, you know, I just can’t do anymore. Right? So. So what I really try to do is I try to talk about things that might really help and what are the policy solutions that do seem to be moving the needle a little bit. One of them is communicating with young people in a really honest, factual way. Even now, even today, most people who experience addiction do recover. They do get better and they go back to having a healthy, productive life. And there has been a decline in addiction and heavy drug use among younger people, which is really hopeful. Unfortunately, they’re still dying at much higher rates because the drugs are so dangerous.

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Speaker 2: But there is also a lot of evidence that there are other answers to this public health crisis. And let me just name a couple of them. You know, there are now medical treatments for addiction for for opioids in particular, but other things, you know, that are really effective, you know, Narcan and Naloxone that reverse overdoses so they don’t become fatal. There’s more efforts to get that drug out onto the streets, out into communities. And there are other drugs that can really help people avoid relapses into addiction.

Speaker 2: Another thing that often doesn’t get talked about enough is that the Affordable Care Act, Obamacare, which has been controversial for a lot of reasons, is actually the prime mover of addiction treatment in the country. And it’s been very effective. It’s probably saved more lives than any other single policy initiative in the country simply by funding much more addiction treatment.

Speaker 2: So the good news here is that there are treatments, there are strategies that that really can affect this deadly curve. I compare this to COVID. You know, we knew some things that could really save lives during COVID. A lot of those strategies got lost in the noise. They got lost in the culture war debate. But when we carved through, we really could say, you know, get vaccinated, wear your mask, do some social distancing. There are some similar, very affordable, simple strategies that can really help here. If we can keep talking about those and if we can get people to pay attention to those, that’s not going to be easy.

Speaker 2: It is definitely a thing that is sometimes, you know, has me, you know, kind of screaming, frankly, that, you know, there are tools and there are strategies that could save a lot of these young people. Probably the best strategy is not to re them and to drive them underground and to force them into hiding, to continue their drug use in secret.

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Speaker 2: Probably the solution is to help them get health care. And it’s pretty boring, right? It’s pretty boring to say when when that 25 year old goes to an emergency room. Goddammit, you got to get them on track to get care and get help and to move through a really good professional medical care system that respects them and treats them with dignity. It’s not going to work every time, Right?

Speaker 2: This is a dangerous disease, but it’s a lot better than saying, hey, you better go back underground and and you better go hide again and use illicitly because we got nothing, you know, that we that we can do to help. In fact, that’s not true. We do have tools that can help and hopefully, hopefully more and more of these people will get access to that.

Mary Harris: Brian Mann. I’m super grateful for you coming on the show. Thanks for giving me all this context. I really appreciate it.

Speaker 2: Thanks for having me. Appreciate the conversation.

Mary Harris: Brian Mann covers addiction for NPR. And that’s our show. If you like what we’re doing here, what next? A good way to support us is to go on over to Slate.com, slash what next Plus and join us when you join Slate Plus, you get great benefits like ad free podcasts, including this one. So scoot on over. Do it like right now. What next is produced by Elena Schwartz, Carmel Delshad and Madeline Ducharme. We are getting a ton of support right now from Anna Phillips, Jared Downing and Victoria Dominguez. We are led by Alicia montgomery and Joanne Levine. And I’m Mary Harris. I’ll be back in the speed tomorrow. Catch you then.