A History Of Fentanyl

Fentanyl is one of the biggest killers in the opioid epidemic. NPR's Leila Fadel talks to Ben Westhoff, author of the new book Fentanyl, Inc., which tracks the rise of the synthetic drug.

LEILA FADEL, HOST:

Americans are dying of opioid overdoses at an alarming rate. And fentanyl, a drug created in labs in the 1960s, is among the biggest killers. To understand how fentanyl took its place atop America's opioid crisis, journalist Ben Westhoff travelled the world. His new book, "Fentanyl, Inc.," traces the crisis through the scientists who created fentanyl, the rogue chemists who replicated it and its users. Ben Westhoff joins us now. Welcome.

BEN WESTHOFF: Thank you for having me.

FADEL: So why don't you start by telling me what set you on this journey, what you were searching for when you started travelling across the U.S., the world and ended up with this book?

WESTHOFF: I was writing about music in Los Angeles when I noticed that someone was dying at raves almost every time there was a rave and I was wondering what was adulterating the ecstasy that these kids were dying from. And I learned there was this whole new crop of synthetic drugs that were being made out of labs in China that nobody knew much of anything about.

FADEL: So how and why was fentanyl created?

WESTHOFF: Fentanyl began as an important pharmaceutical drug used in epidurals and all sorts of stuff for people who were in hospitals. And since then, it has come out of the pharmaceutical realm and gone into the illicit realm used by drug dealers.

FADEL: So how does that happen, where it goes from something that scientists are creating to help people in hospitals and ends up killing people at raves?

WESTHOFF: In the old days when scientists studied something and wrote about their findings in a paper, these papers were mostly in university libraries. But in the Internet age, all of these papers started being published on the Internet. And so rogue chemists could find out about them that way, and they could dig into the research and copy the synthesis techniques themselves.

FADEL: You know, as I was reading your book, it felt like trying to control this and deal with it was a game of whack-a-mole. Countries would ban one drug, and scientists or rogue chemists would create new ones, more dangerous ones, and then the list would grow of different types of drugs. Can you talk about this cycle?

WESTHOFF: Yeah. If you take fentanyl, for example, once fentanyl was banned decades ago, chemists simply changed the molecular structure just a tiny bit and were able to create something that was now legal but still had basically the same effects as fentanyl. And there have been dozens of these, which are called analogs, since then. And places like the U.S. have pretty much blanket banned all the types of fentanyl. But until recently in China, they could only ban these drugs one by one. And so whenever China banned a new one, the chemists would simply tweak the formula just slightly and now sell the new product.

FADEL: Now, you traveled to China for your book. Tell me about those trips, and what were you looking for?

WESTHOFF: I pretended to be a customer, and I wanted to see how these operations ran because there was really no information known about these Chinese fentanyl labs. And so I started just by Googling buy drugs in China, and all these different company websites came up. And I said I was a customer, and would they be willing to show me their lab if I came to China? And a surprising number of them said yes. And what I saw was really shocking. There are these huge piles of drugs being synthesized, huge piles on the counters of these lab tables, and just the whole scope of the operation was much bigger than I would have thought.

FADEL: I'm curious. You said you hid your identity as a reporter. Why did you make that decision? You know, usually we say who we are, that kind of thing. I'm just wondering.

WESTHOFF: I tried that approach at first, but, really, nobody wanted to talk to me. And so I realized that the only way I could get into these places was to go undercover.

FADEL: You know, there's been some landmark decisions this past week with pharmaceutical companies being blamed for fueling the opioid crisis here. You wrote a lot about pharmaceutical companies and their role in the opioid epidemic. I'm just wondering what you think of this past week's news.

WESTHOFF: Well, I kind of compare it to the big tobacco settlements from the '90s. And I think it's good that there will be funding for all these new prevention programs, for these treatment programs that we so desperately need. But at the same time, a lot of - it really is just a drop in the bucket for a lot of these companies who made billions and billions and billions of dollars. So I have mixed feelings about them.

FADEL: You know, the book laid out a lot of drug policies that aren't working, a multibillion-dollar war on drugs that isn't working, outright banning of substances that seems to lead to new and more dangerous substances being introduced into the market. And I just wonder, what does work? What will work?

WESTHOFF: I think we need to practice something called harm reduction, which basically is admitting that people are going to always use drugs. And once you admit that, you can start making sure people use them more safely.

FADEL: Ben Westhoff, author of the new book "Fentanyl, Inc.," thank you so much.

WESTHOFF: Thank you very much.

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