What's fentanyl, the opioid at the centre of Biden-Xi talks, which led to 70,000 deaths in US?

On Wednesday, US president Joe Biden announced that China would take action to stop the influx of fentanyl, a synthetic opioid that killed over 70,000 people in the previous year. On the sidelines of the Asia-Pacific Economic Cooperation conference in San Francisco, Biden had a “candid and in-depth” conversation with Chinese President Xi Jinping about resuming high-level military communication, initiating an intergovernmental conversation on artificial intelligence, and talking about Taiwan. The venue of the Biden-Xi meeting is an important one as there have been 619 opioid-related deaths, most related to fentanyl, in San Francisco itself this year so far. This is in comparison to 647 such deaths across the whole of 2022, according to the city’s Office of the Chief Medical Examiner. Across America, tens of thousands die annually from an overdose of synthetic opioids. What is fentanyl? According to the US Centers for Disease Control and Prevention (CDC), fentanyl is a synthetic opioid. It is 100 times more potent than morphine and 50 times more so than heroin. It was initially approved by the US Food and Drug Administration (FDA) as an analgesic (pain relief) in 1998 and was developed by pharma companies to treat the pain of cancer patients, as per the Drug Enforcement Administration (DEA). In its prescription form, fentanyl is known by such names as Actiq®, Duragesic®, and Sublimaze®.4,5. Like morphine, it can be used to treat patients with severe pain, especially after surgery. It can also be prescribed to patients suffering from chronic pain who have developed a tolerance to other opioids. It can be given as an injection, a skin patch, or as pills in a prescription setting. [caption id=“attachment_13394132” align=“alignnone” width=“640”] Travis Hayes, 65, holds up a bag of what he says is the synthetic drug fentanyl at the Tenderloin section of San Francisco, California, US. Reuters[/caption] There are two forms of fentanyl that can be purchased illegally: liquid and powder. In its latter form, it can be used as eye drops, nasal sprays, or even as drips within tiny candles. It is offered as pills as well. Fentanyl causes euphoria, pain alleviation, sedation, confusion, drowsiness, nausea, vomiting, pupillary constriction, and respiratory depression, just like other opioid analgesics. According to CDC, fentanyl and pharmaceuticals laced with it are “extremely dangerous,” and many people may not even be aware that their medications are laced with it. Some of the signs of its overdose are constricted pupils, weak or slow breathing, choking or gurgling sounds, a limp body and discoloured or cold or clammy skin. Why it’s a big problem in America The medication has been widely available in the US market in recent years due to its ease of production at a low cost in the lab. The version connected to overdose deaths is illegally produced. Other names for it on the street are Great Bear, He-Man, Poison, Dance Fever, Goodfellas, China White, China Girl, and Tango & Cash. According to the DEA, a portion of it is extensively sold as fake prescription medications like Xanax, OxyContin, and Percocet. Fentanyl was the “major reason” behind more than 107,000 overdose deaths in the US between July 2021 and June 2022, according to official data. [caption id=“attachment_13394152” align=“alignnone” width=“640”] A rally, organized by Lost Voices of Fentanyl, advocates for additional border security while highlighting overdose victims, outside of the White House in Washington, US. Reuters[/caption] Based on data from CDC, the number of drug overdose deaths nationwide containing fentanyl more than tripled between 2016 and 2021. The government agency reported there was a 109 per cent increase in the average monthly rate of overdose among adolescents between 2019 and 2021. Additionally, overdoses involving fentanyl produced illegally rose by 182 per cent. How China is involved China has long been a major supplier of fentanyl that is trafficked into the United States. Chinese state media has repeatedly said addiction and demand for the drug are US domestic problems. According to Reuters, last month, the United States imposed sanctions on 28 people and entities involved with the international proliferation of illicit drugs, including a large China-based network. “We know that this global fentanyl supply chain, which ends with the deaths of Americans, often starts with chemical companies in China,” said US Attorney General Merrick Garland. Advocates have also accused pharmaceutical companies and related businesses of fueling the crisis through downplaying the risks of opioids and lack of regulation. Landmark settlements since 2021 have set compensation at a total of more than $50 billion nationwide. The production and sale of fentanyl and many of its variants were banned by the Xi Jinping-led government in May 2019 in response to international criticism. This significantly decreased the nation’s illicit fentanyl trade. However, according to an NPR investigation and research from the non-profit Centre for Advanced Defence Studies (C4ADS), over a year later, Beijing’s vendors utilised online networks to openly sell fentanyl analogues and the precursor chemicals used to make the drug, shipping them directly to customers in the US and Europe as well as to Mexican cartels. Chinese vendors frequently operate undercover thanks to an intricate web of corporate entities registered in remote Chinese cities. In these locations, law enforcement control is often less stringent than in larger Chinese cities, and these vendors even use sophisticated shipping techniques to get around screening procedures. It is possible to ship thousands of doses in tiny, discrete packaging. “Many Chinese networks involved in the production and advertising of fentanyl quickly adapted to increased legal constraints by modifying their techniques to exploit loopholes in chemical restrictions and disguise their activities,” a 2020 report by NPR quoted Michael Lohmuller, a C4ADS analyst and report co-author as saying. What’s the outcome of Biden and Xi’s “blunt” talks Joe Biden said Beijing had agreed to stem the export of items related to the drug’s production. [caption id=“attachment_13394322” align=“alignnone” width=“640”] Chinese President Xi Jinping waves as he walks with U.S. President Joe Biden at Filoli estate on the sidelines of the Asia-Pacific Economic Cooperation (APEC) summit, in Woodside, California. Reuters[/caption] “It is going to save lives,” he told reporters, and said he appreciated China’s “commitment” in the issue. Under the new agreement, China will go after companies that make precursors – items needed to produce the opioid – a senior American official said. However, in a caveat underlining the distrust between the two sides, a senior US official told reporters that the US will “trust but verify” China’s actions against the drug. Joint efforts to “combat global illicit drug manufacturing and trafficking (including fentanyl) and establishment of a working group for ongoing communication and law enforcement coordination on counter-narcotics issues” were noted in a White House statement following the meeting. According to the White House, Biden also emphasised the need to combat the growing threat posed by illegal synthetic drugs like fentanyl and to stop the flow of precursor chemicals and tablets into the US that support cartels. With inputs from Reuters