Opinion: Fentanyl is a poison in the US-China relationship

PETER BERGEN, CNN
November 15, 2023 

Editor’s Note: Peter Bergen is CNN’s national security analyst, a vice president at New America, a professor of practice at Arizona State University and the host of the Audible podcast “In the Room With Peter Bergen,” also on Apple and Spotify. The opinions expressed in this commentary are his own. View more opinion at CNN.

Fentanyl and other synthetic opioids kill tens of thousands of young Americans a year, and the compound is helping to poison the US relationship with China.

It was one of the issues on the table as the two leaders of the world’s most powerful economies, Chinese leader Xi Jinping and US President Joe Biden, met outside San Francisco on Wednesday.

Synthetic opioid overdoses, most of them caused by fentanyl, are a leading cause of death in the United States for 18 to 45-year-olds, according to the US Centers for Disease Control and Prevention (CDC).

The CDC estimates more than 100,000 people in the US died from drug overdoses in 2022 and most of these deaths were caused by fentanyl or other synthetic opioids.

The precursor chemicals used to make fentanyl primarily originate from China, though some also come from India. Those chemicals are then typically shipped to Mexico, where they are turned into fentanyl by Mexican drug cartels.

Last month, a delegation of US senators led by Senate Majority Leader Chuck Schumer met with Xi in China and demanded action on the Chinese supply of the chemicals that make fentanyl. On the trip, Schumer observed, “They are fueling the fentanyl crisis that is poisoning communities across the United States … Every one of us knows families who have lost young men and women to fentanyl.”

Chinese state media has said that fentanyl consumption is a US domestic problem.

Under pressure from the Trump administration, the Chinese government did designate fentanyl as a controlled substance in 2019, but that hasn’t stopped the precursor chemicals that are used to manufacture fentanyl from still making their way from China to Mexico.

CNN’s Phil Mattingly reports that a likely outcome of the Biden-Xi meeting Wednesday is an agreement by China to “crack down on the export of the source chemicals used to make fentanyl.”

If China can indeed get a handle on the flow of fentanyl precursor chemicals, that might help make a difference in preventing the deaths of tens of thousands of Americans succumbing each year to overdoses.

US President Joe Biden meeets Chinese President Xi Jinping in Woodside, California, on November 15. - Kevin Lamarque/Reuters

Pharmaceutical fentanyl is a very powerful painkiller that is legitimately used in surgery. The drug is 50 times more powerful than heroin, according to the CDC.

A minuscule dose as small as two milligrams of the drug “can be lethal depending on a person’s body size, tolerance, and past usage,” according to the DEA.

In May, for the podcast “In the Room with Peter Bergen,” I spoke to Biden’s Deputy Homeland Security Adviser Josh Geltzer, a former New America colleague of mine, who painted a sobering image of the scope of the problem, explaining that “the quantity of (fentanyl) pills and powder combined seized by US law enforcement at our border last year was enough to kill every single American, potentially with a few pills left over.”

I also spoke to Sam Quinones, a journalist who has written two excellent books about America’s drug problems.Quinones told me, “Fentanyl tends to make it almost impossible for you to be what’s known as a functioning drug addict. Your entire life is devoted to fentanyl.”

Quinones also said that based on his research, even fentanyl users who have developed a tolerance for the drug generally only survive for around two years once they get hooked, given the potency of the drug.

Fentanyl test strips are a low-cost method of helping prevent drug overdoses. - Michael Siluk/Universal Images Group/Getty Images

For drug dealers, fentanyl is particularly appealing compared to drugs like heroin, which require growing poppies to produce opium, which is then refined into heroin. With fentanyl, you don’t need to grow anything; it can all be made in a makeshift lab.

The rise of fentanyl originated with the opioid crisis in the United States. Opioid users sometimes turned to heroin and some, eventually, to fentanyl, which first became a serious problem in the US around a decade ago, according to the CDC.

A new trend has amplified the problem, which is the addition of Xylazine, a horse tranquilizer known as tranq, to the fentanyl supply. Tranq can cause severe wounds in users that may require the amputation of limbs. The DEA says that about a quarter of fentanyl powder that was seized in the US in 2022 contained tranq.

While, of course, reducing demand for drugs in the United States is also key to this problem, it’s worth noting that this is not just an American demand problem; it is also a supply issue. Mexican cartels will often mix fentanyl in “with cocaine, heroin, and methamphetamine, all to induce Americans to take fentanyl without knowing it and to get hooked on it,” according to DEA Administrator Anne Milgram.

As Geltzer observed to me, “For years, the kind of inherited wisdom on drug sales was that drug dealers wanted their clients hooked, but not dead. (But now) they seem to think that there are enough potential other buyers out there that if 60% of the fentanyl on the market is potentially lethal, so be it. And if they lose some users, they’ll sell to others.”