fentanyl

Fentanyl Epidemic – Part I, the big lie

by Dave

INTRODUCTION

Fentanyl is powerful and deadly. It is 100 times more powerful than morphine. Traffickers love it, because they can hide small quantities in vehicles crossing the US from Mexico. Addicts die mostly from overdoses. Per Wikipedia, “Fentanyl poses an exceptionally high overdose risk in humans since the amount required to cause toxicity is unpredictable.”

Wikipedia: Fentanyl

Wikipedia as usual, presents a very comprehensive and well researched article. It also documents the difficulties in controlling the flow into the US and actions taken by the Biden administration.

The Big Lie

Now, Trump’s big lie – “If we halt illegal migration across the border with Mexico , this will stop fentanyl from coming from Mexico.” It is a lie, because in general, the illegal immigrants are not bringing in fentanyl.

I say “in general” because if they find just one person illegally crossing the border with drugs in his knapsack, then for Trump supporters, this is proof positive that they are the cause of the problem. Unfortunately, the bar for believability has been set extremely low for Trump and company.

“About 85 percent of fentanyl seizures occur at official border crossings, where the potent, compact drug is typically smuggled by pedestrian couriers or hidden inside cars and trucks. Most of the rest is confiscated by U.S. agents at Border Patrol highway checkpoints, not in the backpacks of migrants entering the country.” Washington Post, November 26, 2024.

Link: Trump tied migrant entries and fentanyl to tariffs. Here are the facts.

Interception at the border is very difficult. Approximately 90 million vehicles and 4.3 million trucks cross through our Mexican border every year. It is not practical to shut down legal crossings. “Border officials have seized more fentanyl at ports of entry in the last two years than the past five years combined, and the President has added 40 drug detection machines across points of entry to disrupt the fentanyl smuggling into the Homeland. The bipartisan border agreement would fund the installation of 100 additional cutting-edge inspection machines to help detect fentanyl at our Southern border ports of entry.”

So, the bipartisan border agreement, with more inspection machines seem like a no-brainer. But Republicans killed this bill, because Trump did not want anything that Biden could claim that the Democrats did, to stem the flow of fentanyl. The problem with the bipartisan bill is that it didn’t have Trump’s name on it. But, Trump will bring it back, make his idea, and it will pass. Pure politics.

Trump’s lie about closing the border was told to millions, usually getting more absurd at each subsequent rally. Trump second lie- “It was Kamala, the border czar, who let everyone cross the border and with it, all our problems.” This was a lie also, as Kamala Harris was never responsible for border security. This was the responsibility of DHS Secretary. So, Trump successfully fused illegal entry and the fentanyl epidemic, where there was no real connection.

ENTRY THROUGH OF OFFICIAL PORTS

By land, sea and air, fentanyl arrives in the US. Even through the international mail. This is from a US Customs Border Protection (CBP) website. They show border agents at mail facilities. Dogs are frequently used. See full article: CBP fight against fentanyl

“In my 30 years as a customs official, the trafficking of synthetic illicit drugs like fentanyl is one of the toughest, most daunting challenges I have ever seen,” said CBP Senior Official Performing the Duties of the Commissioner Troy Miller. “We have the right capabilities from interdiction to intelligence capabilities. We’re in the right places at our land borders and between the ports in international airports, in both the passenger and air cargo environments and at our maritime borders, too. And we know what works. Intelligence-driven operations, relentless, targeting people, partnerships, and technology. CBP is well positioned to lead the federal government’s efforts in this fight.”

The CBP website offers hope in terms of successful large fentanyl busts, which means less for sale on the street. Yet, for me, the real measure of success would be a reduction in overdose rates in the US. Trump can spend billions on border security, and then claim he has been successful in stemming fentanyl deaths. But, the numbers from the CDC are likely to say something very different.

China and Mexico

The real problem with fighting the epidemic is the narrow perspective offered by Trump. It is not a Mexican or Chinese problem. It is our problem. In 2021, the U.S. had more opioid deaths than the rest of the world combined. See link below.

However, we need Mexico and China’s help. China took vigorous action in shutting down fentanyl production, but then a new industry arose, to make the essential ingredients (pre-cursors) of fentanyl and ship these to Mexico. China has passed laws to crack down on pre-cursors, but as the Council of Foreign Relations noted: “… [New laws enacted] this is unlikely to solve the core problem, as criminals will continue to discover new ways to make fentanyl using other chemical precursors that also have legitimate industrial uses.

Council of Foreign Relations article What Is China’s Role in Combating the Illegal Fentanyl Trade?

WAYS TO FIGHT THE EPIDEMIC

  • Follow the Fentanyl Profits

One of the Council’s recommendations is interesting – follow the money. The Chinese criminals have to hide their profits, so they become involved in money laundering, and the US could collaborate with the Chinese in helping them crack down on the illicit profits from pre-cursor sales.

In order to follow the money, you have to follow bitcoin transactions. In this case, the drug smugglers and other cybercriminals, including hackers for profit, have something very much in common, the need to hide the chain of transactions, from deposit to withdrawal, which can be done with a “crypto mixer” software. A recent case was decided in favor of a company which profits through the use of a cryto mixer, which is a win for cyber criminals and drug traffickers to hide profits. I will discuss this further in Part II.

  • Reducing Demand and Overdose Rates in the US

Addiction causes demand for opioids. The US Drug Enforcement Agency message was excellent, “One pill can kill.”

See DEA link: One Pill Can Kill

This is by far, the best approach, to stop addiction before it begins. There is help for addicts, which includes counseling and drug recovery programs.

An overdose does not always result in death. Naloxone acts as an antidote to fentanyl. So, one approach is to increase awareness of family members of addicts of what can be done in case of an overdose to prevent death.

It is not like a pill that saves you.” It can be used as injection or spray form. Police officers and first responders are being trained to be able to administer it. There is no harm in injecting naloxone in someone who is not overdosing on opioids.

An excellent recent advance (FDA approved March 2023) is the one dose naloxone spray. Family members without training can administer an effective dose of naloxone. The spray is marketed under the trade name of Narcan. It is an over-the-counter medication, and costs around $50 for two sprays.

So, there is a problem of mixed messages in harm reduction. On one hand, the fentanyl does destroy lives, and the addict’s only real choice is come clean. The narcan spray may lead some to believe they can continue to tempt death to continue their addiction. Living with fentanyl is a terribly wrong decision. I am hoping that any addict who was saved once by Narcan, will choose to seek help and come clean.

NIH website: Naloxone Drug Facts

AP Press: FDA approves over-the-counter Narcan. Here’s what it means

As stated in the NIH posting, the Narcan lasts for only 30-60 minutes and a second dose may be necessary.

Drug users taking other illegal drugs, like cocaine and meth, can accidently overdose because these drugs are often mixed with fentanyl. So, in the interest of “harm reduction”, there are test strips available to identify the presence of fentanyl.

CDC Website: What You Can Do to Test for Fentanyl

WHERE ARE WE?

Below is a graph from CDC, showing overdoses per year from all drugs, based on provisional data. The last 12 months show a steady decline in deaths.

PBS Link: NPR Exclusive: U.S. overdose deaths plummet, saving thousands of lives

CDC Vital Health Statistics Site, Provisional Drug Overdose Death Counts

In another chart, the CDC shows a very similar decline in overdose deaths for synthetic opioids and methadone, from June 2023 to June 2024. Overdose deaths in this group dropped from 77,000 to 64,000, a drop of 13,000 deaths.

PBS cites a number of factors in their article for fewer deaths, including availability of treatment centers, and programs to help addicts come clean.

SUMMARY

I began this blog focused on the big lie promoted by Trump, that it was illegal immigrants bringing in fentanyl. The truth is fentanyl comes through legal ports of entry from Mexico. China has cooperated with the US in cracking down on the export of precursor chemicals to Mexico, but much more progress is needed.

I will leave for Part II, more information on how international smugglers use bitcoin and cyber mixers to hide their huge profits. Cyber privacy issues clash with the FBI need to break up money laundering operations in many areas including drug enforcement.

The trend today is fewer overdose deaths. There are many government agencies involved in finding ways to sustain this declining trend, from international agreements with China and Mexico, to vehicle inspections at entry points to the US, detection through the postal service, and disrupting the distribution chain within the US.

I have posted previously on the excellent FBI busts of gangs involved in distribution and sale of fentanyl. Much of the credit goes to dedicated FBI agents under Director Christopher Wray and the Department of Justice, for convicting these criminals.

I strongly support efforts by the Drug Enforcement Agency, to raise awareness to the dangers of fentanyl, with the simple message “One Pill can Kill” which is very true. The last 12 months resulted in 64,000 deaths attributed to synthetic opioids.

I consider a practical step forward is increase availability Narcan spray that prevent death by overdose. Test strips help prevent accidental overdoses.

Stay tuned,

Dave

Fentanyl Epidemic – Part II

by Dave

I provided some basic information on fentanyl. It is coming mainly from Mexico. Precursors to make fentanyl are coming from China. It is an extremely powerful and deadly drug. A dose of 2 mg is enough to kill a person. This posting covers overdose statistics, recent setbacks and difficulties, and recent positive steps forward.

OVERDOSE STATISTICS

I began with the big lie from President-Elect Donald Trump, that illegal immigrant are bringing fentanyl to the US. They are not.

“We’re losing 300,000 people a year to fentanyl that comes through our border. We had it down to the lowest number and now it’s worse than it’s ever been.” Donald Trump. The death rate is not 300,000, Trump did not have the lowest number, and overdose rates are coming down as shown below.

The opioid overdose death rate, really took off beginning in 2020, in the last year of the Trump administration, rising from about 37,589 to 58,908 deaths (Jan 2020 to Jan 2021) or an astounding 57% increase on a 12 month basis.

From June 2023 to July 2024, fentanyl overdoses were on the decline, dropping from 77,800 (June 2023) to 61,623 (June 2024). The latest statistics represent a 21% drop. As the CDC has noted, it is provisional data, as cause of death is complicated when multiple drugs or health conditions are involved. The CDC link is provided at the end of this post.

This decline in deaths is likely due in large part to the availability of a new drug in spray form, Naloxone, to rescue people who have overdosed on fentanyl. It is called an antagonist drug, because it reverses the effect of fentanyl.

The Drug Enforcement Agency produces a report each year, entitled the National Drug Threat Assessment Report (NDTA) and the 2024 report is an excellent source of information. It comes to the point right away on the very first sentence: “Fentanyl is the deadliest drug threat the United States has very faced, killing nearly 38,000 Americans in the first six months of 2023 alone.”

I have provided a lot of statistics, but for those who have lost loved one early in life, whether 1,000 or 100,000 people die of drug overdoses, it is still far too high. Plus, drug addiction destroys lives, even if life does not end with a fatal overdose.

I begin with recent setbacks or new difficulties in dealing with the epidemic. The bad news is difficulties related to supply of fentanyl. Then, I turn to the good news, which makes me hopeful for the future.

RECENT SETBACKS AND DIFFICULTIES:

  • Mexican Organized Crime Cartels Involvement

It is a story of both bad news and good news. The Sinaloa Cartel and the Cartel Jalisco Nueva Generación (CJNG) are the main criminal organizations in Mexico and control clandestine production and distribution of fentanyl. According to DEA Threat Assessment Report, they are involved in arms trafficking, money laundering, migrant smuggling, sex trafficking, bribery, extortion and other crimes. Their criminal operations are world wide.

These Cartels are extremely dangerous for several reasons. They are becoming rich from meth and fentanyl sales in the US (largest customer) and abroad. They are tech savvy, using encrypted messaging to communicate to their supply and distribution centers. They use cyber cash to make it difficult to track transactions. And they are clever in marketing, making the pills look like legitimate prescription drugs.

Under the heading of positive steps, there are a number of indictments and arrests of Cartel leaders. So, law enforcement both in Mexico and the US are actively breaking up the cartels, seizing pills and shutting down operations. In fact, on December 4, Mexico made a very large seizure of fentanyl pills two properties in Sinaloa were worth $394m (£309m) and weighing more than a ton.

  • Potential Tariff trade wars and social media attacks by Trump

We need cooperation from both China and Mexico, in the fight against illegal opioid drugs. Although Trump is not yet president, the tensions between Mexico and the US are increasing due to Trump’s postings on social media.

The private conversation between President Sheinbaum and Trump was considered by both to be productive. On the positive side – they discussed at illegal migration across the Mexico border is down in part because of actions by Mexico. Presently, Mexico does not allow caravans of migrants to travel to the border. This is an achievement that Biden was able to negotiate with Mexico. Watch as Trump will claim credit.

But the more public comments by Trump on social media, were the source of tensions. I am not sure what tariffs will be imposed by Trump, but Mexico is ready to impose tariffs of equal value on the US. It is inflationary as consumers pay the tariffs in terms of higher prices on imported goods.

It also seems Trump is ready to wage another trade war with China. This will not be helpful in getting their cooperation to stop the manufacture and export of fentanyl precursors, essential to the pill production in clandestine labs in Mexico.

  • More difficult to “follow the money” thanks to cyber cash technology

The Council of Foreign Relations recommend following the money as a way to pursue the criminal operations of producing fentanyl precursors in China. Cyber cash is often used to hide illegal transactions. The crypto mixer software makes hiding transactions much easier.

The Tornado Cash case, decided November 26, 2024, by the Fifth Court of Appeals, stated the US Treasury could not sanction (or shut down) companies involved with the crypto mixers. The court’s reasoning was company cyber mixer was an open source software and could not be sanctioned over something they did not actually own.

See link: Appeals court tosses sanctions on Tornado Cash crypto mixer

As stated in the opinion, the justices noted the following “However, mixers are also “go-to tool[s] for cybercriminals” seeking to launder stolen cryptocurrency. Nearly a quarter of funds sent to mixers in 2022 were tied to money laundering efforts. Most relevant to this case, North Korea, through one of its cybercriminal organizations known as the Lazarus Group, has hacked and stolen just shy of one billion dollars’ worth of cryptocurrency. And all of that dirty money needed to be laundered before it could be cashed out for traditional (and far more liquid) fiat currencies.”

I found this incredible. One billion dollars stolen, and the laws actually protect the thieves. The appeal process is not over, so there is more to come. It is a difficult problem as cyber currency industry generates huge profits. Coinbase, probably the largest dealer of cyber currency was up 6% on the decision. If upheld, it does not bode well for a “follow the money” strategy, either in the US or other countries.

The Mexican cartels (Sinaloa and Jalisco Cartels) are tech savvy, and will exploit the difficulties in tracking international transactions. They will use cyber currency to hide a host of crimes, including arms trafficking, money laundering, migrant smuggling, sex trafficking, bribery, extortion and other crimes. Their criminal operations are world wide.

Finally, issues of cybersecurity are complex and can become political. It seems the incoming Trump administration may be reluctant to monitor cyber transactions, based on an effort to reduce federal regulations and privacy issues.

  • Difficulties in banning precursor compounds from China

Fentanyl and methamphetamines are a synthetic compounds requiring essential ingredients (precursors). The clandestine labs in Mexico and the US can change the process, to use other precursors, not yet considered illegal, to continue their operations.

The good news is the US is taking the lead, through the UN Commission on Narcotic Drugs by adding to the list of illegal precursors. In March 2023, at a meeting of the commission, it was agreed that 2 fentanyl precursors and 16 methamphetamine precursors would be added to the list.

  • Fentanyl Marketing -New pill formulations and appearances

There are no legal fentanyl pills. Fentanyl is administered in hospitals with a transdermal patch.

The DEA 2024 Drug Threat Assessment summarizes recent attempts by organized drug cartels in Mexico to make synthetic opioids more appealing to users (“illegal drug marketing”) through changes in appearance. The multi-colored fentanyl pills (rainbow pills) are produced to appeal to ecstasy users, although they are not market for that purpose. The efforts to make fentanyl and methamphetamines look like legal drugs, is detailed in the DEA threat assessment.

Nitazene is a synthetic opioid compound that has been add to fentanyl. This results in an even more powerful drug, making drug poisonings more likely. Pills with the fentanyl-nitazene mix may be made in Mexico or the US, but the source of nitazene is likely China according to DEA threat assessment.

Xylazine is another compound found in fentanyl. It is a sedative, not an opioid, and is sold legally to veterinarians to sedate large animals. It complicates the lifesaving administration of naloxone spray (Narcan), design to rescue fentanyl users from overdose death. Xylazine is also found in heroin.

POSITIVE STEPS

  • Recent arrests of Sinaloa Cartel Leaders and seizures of fentanyl

To break up a cartel, the leadership must be arrested. After the arrest of Joaquín “El Chapo” Guzmán and his son Ovidio Guzmán López in 2016 and 2023 respectively, the cartel was headed by old-school leader Ismael “El Mayo” Zambada, as well as Guzmán’s other sons.

July 26, 2024 was a great day for our country when El Mayo and Joaquim Guzman (El Chapo’s son) were arrested in El Paso, Texas. The arrests come a month after the DOJ indicted two dozen people, accusing Chinese “underground bankers” of helping Mexico’s Sinaloa cartel launder over $50m in drug proceeds. The investigation revealed a partnership between Sinaloa cartel associates and a Chinese criminal syndicate to launder drug money, exploiting Chinese nationals’ demand for US dollars.

Then, there was more to celebrate, this time in Mexico, on December 3, 2024, Mexico made the largest seizure of fentanyl ever. Per the BBC link: “Earlier, Mexico’s top security official, Omar García Harfuch, had announced on X, formerly known as Twitter, that the fentanyl pills seized at two properties in Sinaloa were worth $394m (£309m) and weighed more than a tonne.”

BBC Link: Disappearances double in Sinaloa amid Mexican cartel rift

The BBC link includes infighting within Sinaloa cartel for control and details on the massive seizure of fentanyl.

On Dec 4, 2024, the US offered a 15 million dollar reward for the arrest of Nemesio Ruben Oseguera Cervantes, better known as El Mench, who is the leader of the Jalisco cartel. The US investigation has resulted in several indictments against their leader, as well as arrests and conviction of other members of the cartel.

Every year since 2019, the amount of fentanyl seized at US borders has increased. From January to September 2024, 16,565 pounds have been seized.

I am encouraged by Mexico’s President, Claudia Sheinbaum, who took office on October 1, 2024, who vow to break up the cartels. I believe she will partner with the US in going after the drug cartels.

  • More Money: US Budget FY 2024 calls for a $2.3 billion dollar increase as for the National Drug Control Program agencies.

The FY 2024 budget request for 46.1 billion dollars for National Drug Control agencies includes increased funding for efforts to reduce the supply of illicit drugs like fentanyl and stop drug trafficking. It also includes and increase in funding to support the expansion of prevention, treatment, harm reduction and recovery support services.

  • Increase awareness and availability of narcan spray to reduce overdose fatalities

The link below is from the University of Rhode Island, College of Pharmacy, which is helping addicts to stay alive, and hopefully seek treatment. The Community First Responder Program (CFRP) distributes the single dose Narcan nasal spray which, if used soon after an overdose, can save someone’s life. Narcan was reviewed in my previous post.

URI Link: LIFESAVERS A NEW WAY TO ADDRESS THE OPIOID OVERDOSE CRISIS

The 7% decrease in overdose deaths last year is the first decline in Rhode Island in four years. It’s very nice news. I would strongly recommend reading this article from URI. CFRP Director, Anita Jacobson, has a clear vision of the purpose of her organization.

“People usually think of police or fire and rescue departments as first responders,” Jacobson says. “We’re trying to build a community of first responders—people who have basic knowledge, training, and resources to help others who need it. If people are educated about this and know how to recognize an overdose and recognize someone caught in the cycle of substance-use disorder, we can save lives.”

Summary

There have been some very positive steps taken, at the federal, state and local levels, to reduce fentanyl use. The message “One pill can kill” is honest and direct. hope there is more awareness of the huge risk in taking fentanyl.

The DEA successfully seizes thousands of pounds of fentanyl each year, but more needs to be done. Curtailing the supply of fentanyl into the US requires international cooperation. Mexico’s President has vowed to destroy the cartel. Since they operated within the US, close cooperation and information sharing with Mexico is essential.

Stay tuned,

Dave

Links:

CDC Link: Provisional Drug Overdose Death Counts

Note that there are down arrows to provide graphs by select groups of drugs. Also, data for June 2023, is for June 2023 and the prior 11 months of data. In this manner, typical variations related to reporting delays and revisions can be smoothed out.

DEA Link: 2024 National Drug Threat Assessment, DEA link

State Department Press Release: Fentanyl Precursor Scheduling at the UN Commission on Narcotic