What It Means For The U.S. That China Will Label Fentanyl As 'A Controlled Substance'

NPR's Ailsa Chang talks with STAT News reporter Lev Facher about China agreeing to label fentanyl as a controlled substance and what that means for the U.S. opioid epidemic.

AILSA CHANG, HOST:

One concrete promise that did come out of the talks this weekend has to do with the drug fentanyl. China is a leading supplier of the drug, playing a major role in the opioid crisis here in the U.S. After this weekend's meeting, China has agreed to label fentanyl a controlled substance. The White House calls this a, quote, "wonderful humanitarian gesture." For more on what all of this entails, we're joined in the studio now by Lev Facher of STAT, a health and medicine news website. Welcome.

LEV FACHER: Thank you.

CHANG: So just remind us about what fentanyl is and the role it's played in this entire opioid crisis in the U.S.

FACHER: Fentanyl is an opioid that's manufactured as a pain medication used in settings where you need something really strong, essentially. So often in cancer care, someone will be prescribed fentanyl in a hospital setting, sometimes to take home. The problem that's developed in the last many years is that it's incredibly cheap to produce in China. There hasn't been enforcement that prevents Chinese exporters from sending fentanyl here to the U.S. The drug ends up getting cut into heroin or other recreational drugs. And drug users here in the United States, sometimes they don't even know there's fentanyl in what they're using. It's much, much more powerful than heroin, and if you don't know what it is you're using, it's difficult to gauge what the dose is that won't kill you.

CHANG: So what happens when a drug is designated a controlled substance in China? I mean, what's the significance? What does it allow authorities there to do?

FACHER: Essentially, my understanding is that it allows the Chinese government much harsher criminal penalties for people convicted of distributing fentanyl, of producing it. This has certainly been a focus for the Trump administration, which is now almost two years old. But in 2016, President Obama's administration pressed China on this issue. We saw bills in the last Congress, one of which would have eliminated foreign aid to any country that doesn't cooperate with the United States on curtailing fentanyl exports. So this has been a focus for at least two years, if not longer.

CHANG: OK. Why hasn't fentanyl already been designated as a controlled substance in China?

FACHER: That's the question, right?

CHANG: Yeah.

FACHER: And this is something that, as I said, that the U.S. government has pushed for quite a while, has taken steps to reduce fentanyl production domestically. And they've already cooperated with some American law enforcement efforts. But how is this happening in 2018 and not in 2013 when this crisis was starting to gain more notoriety?

CHANG: I mean, is there some incentive for the Chinese government to keep the fentanyl market loosely regulated?

FACHER: You know, just in terms of the cost of production there, a figure I see often is that it costs about $6,000 to buy a kilo of fentanyl. And then once it's pressed into tablets, once it's mixed into heroin, that same kilo can sell for $1.6 million. So you see the really fantastic (inaudible).

CHANG: Sure. I mean, given that the market's been so loose in China, why hasn't opioid abuse or, specifically, fentanyl abuse been a problem in China?

FACHER: I think you can sell it for more here than you can sell it there.

CHANG: How significant do you think this decision is by China to label fentanyl a controlled substance, finally?

FACHER: It'll depend on severity of Chinese law enforcement and whether that itself proves a real disincentive for fentanyl export. But, yeah. You don't want to induce demand for fentanyl use in the United States by having this massive supply. And you'd hope that, if nothing else, it makes the U.S. drug supply safer. And I know that's an interesting concept when you're talking about something as dangerous as heroin, but the reality is you're much more likely to overdose from heroin that has fentanyl in it than from heroin alone. And if you can at least get American drug users a product that is less likely to cause an overdose that quickly and that unpredictably, you're probably going to have done something to reduce overdose deaths.

CHANG: Lev Facher is a reporter at STAT. Thanks very much for coming in today.

FACHER: Thanks for having me.

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