The story begins with a road trip. Two teenage addicts, Bailey Henke and Kain Schwandt, are driving west across the snow-covered plains of North Dakota on a desperate quest to get sober. They’re hooked on the deadliest drug in America, fentanyl, and as we discover in Ben Westhoff’s timely and agonizing new book, “Fentanyl, Inc.” (Atlantic Monthly Press, 356 pp., ★★★ out of four stars), sobriety would prove elusive. Henke’s relapse and subsequent overdose would trigger one of the largest drug busts in history.
The sting, known as Operation Denial, is still in progress. It targets international kingpins and everyday scammers who have made millions selling fentanyl, a synthetic opioid that’s roughly 100 times more powerful than morphine. Many of the dealers are now in jail (the guy who sold the fatal dose to Henke received a life sentence), but the manufacturer at the top of the pyramid, Jian Zhang, remains free. He continues to produce fentanyl and other lethal substances in a laboratory in Shanghai because Chinese officials have refused to turn him over. “China,” the author tells us, “believes America needs to control its drug problem.” This is our issue, not theirs.
Westhoff was drawn to this story while working as the music editor at LA Weekly, where he began investigating why so many kids were dying at raves (fentanyl was partly to blame). His book is the product of a four-year deep-dive into the world of designer drugs, and it’s an impressive work of investigative journalism. He interviewed 160 people and visited laboratories all over the world; he even infiltrated a pair of Chinese drug operations.
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The research leads to a bleak conclusion: Fentanyl is worse than crack in the 1980s, meth in the early aughts, and more damaging than heroin and oxycodone in the 2010s. And the problem is only getting worse.
The dramatic rise in fentanyl deaths has caught many by surprise. I have prescribed the drug to my patients for more than a decade, finding it to be a reliable pain reliever for those with intractable discomfort from cancer. It can be taken as a lozenge, nasal spray, patch or even a lollipop, and it consistently alleviates suffering, allowing patients to die with dignity. But in the past few years, fentanyl has made its way into the illicit drug market, used and abused in ways that were never intended, largely via the Dark Web. (That’s how Blake Henke and countless others got ahold of it.)
I will think twice before I prescribe fentanyl again.
This story begins with a road trip but ends with a roadblock. Federal officials and local law enforcement agencies have been stymied at every turn by a confluence of forces that allow fentanyl to seep into communities across the country, killing thousands of Americans every year. By focusing on the manufacturers, Westhoff comes to an uncomfortable conclusion: Once fentanyl is eventually contained, another dangerous drug will simply pop up in its place. Rogue chemists are already working on the next deadly detour.
Matt McCarthy is an internist and author of “Superbugs: The Race to Stop an Epidemic.”