Fentanyl, Inc.. Ben Westhoff
the potential popularity of fentanyl. Experts ranging from health-care professionals to top scientists knew how powerful and addictive fentanyl was, and yet very few of them expected it to seize hold in the general population. The underestimation of fentanyl’s potential extended to the DEA, even as recently as 2015. That year the agency’s National Drug Threat Assessment Summary, which focuses on drug abuse trends, read: “Fentanyl will remain a threat while the current clandestine production continues; however, it is unlikely to assume a significant portion of the opioid market. Fentanyl’s short-lasting high, coupled with its high mortality rate, renders it unappealing to many opioid users who prefer the longer-lasting high that heroin offers and who wish to avoid the increased danger from fentanyl.”
One year later, fentanyl had shot past heroin and was killing more Americans annually than any other drug in American history. And the fentanyl analogues, which are being developed and marketed at a rapid clip, threaten to make the problem worse. Seventeen analogues were reported to the UN Office on Drugs and Crime between 2012 and 2016, some of which were developed from information found in scientific papers published thirty or forty years ago. These fentanyls—including ocfentanil, furanylfentanyl, acetylfentanyl, and butyrfentanyl—had never been made into marketable drugs. They could have existed only on paper, but at a time when old research is more accessible than ever before, these chemicals have roared to life.
We are now living in pharmacology professor Gary Henderson’s dystopian future, which he described in his 1988 paper “Designer Drugs: Past History and Future Prospects.” Just as Henderson predicted, the production of illicit fentanyl has become an international business. Like most NPS, the majority of illicit fentanyl is made in Chinese drug laboratories. It’s then sold over the Dark Web to individual dealers or shipped to Mexican drug cartels, who press it into counterfeit pills, cut it into heroin, coke, or meth, or package it up as powder and bring it into the United States.
What Henderson didn’t predict is that many fentanyl users don’t even realize they are taking it. Thinking they are buying another drug, they instead receive a product cut with fentanyl. They don’t know they have put a potentially lethal drug into their system until it’s too late. Today, in many places, little heroin can be found that hasn’t been cut with fentanyl. “There are very few people that just make pure heroin nowadays, because of the quality of ‘El Diabolito,’ ” a Sinaloa trafficker told Fusion, referencing fentanyl.
That dealers would kill off their own clients may seem counterintuitive.
“It brings more business,” said Detective Ricardo Franklin, of the St. Louis County Police Department’s Bureau of Drug Enforcement. “Sure, it kills more people, but from a user standpoint, they’re not thinking about the death. When they hear someone OD’d, they think it must be an amazing high. A friend who will tell a friend who will tell a friend, and in the end it’s promotion.”
“If addicts find something that killed somebody, they flock to it,” said Jack Sanders, a former fentanyl dealer from St. Louis. “They want the strongest product possible. Most people, they want to be drooling. The dealers don’t look at it as if we’re losing customers. They look at it as if we’re gaining more customers.”
Today, Janssen Pharmaceutical of Johnson & Johnson makes only one fentanyl product—the fentanyl patch. Marketed as Duragesic, it helps relieve chronic pain, including in cancer patients. Patented in the United States in 1986, Duragesic was approved by the FDA for advanced pain treatment in 1990, with medical fentanyl no longer required to be diluted with droperidol. By 2004 it was a certified blockbuster, clearing $2 billion in worldwide sales. But like Purdue Pharma, the makers of OxyContin, Janssen Pharmaceutical engaged in deceptive marketing, suggesting Duragesic had less abuse potential than other opioids. In 2000 the FDA said that this and other claims Janssen made about the patch were “false or misleading,” and four years later the FDA instructed the company to “immediately cease” such claims, including the claim that the patch was less abused than other opioids.
Sales dipped after Duragesic’s patent expired in 2006, and Janssen stopped marketing it two years later, according to a company spokesperson, but the patch is still used in medicine, and different companies sell other fentanyl medical products, including a lollipop. The patch in particular continues to be trafficked on the black market. Not long ago on the Dark Web emporium Wall St. Market, for example, Duragesic patches were being offered for one hundred dollars each, from a vendor called BigPoppa7777.
Even as it devastates communities in North America and around the world, fentanyl remains a critical pharmaceutical product. Overall, fentanyl was prescribed by doctors 6.5 million times in 2015, according to the DEA, a number that dropped to about 6 million in 2016, and about 5 million in 2017. Still producing many medicines, the Janssen division within Johnson & Johnson continues to prosper, today boasting more than forty thousand employees in labs and offices around the world.
Paul Janssen didn’t live long enough to see the mass destruction fentanyl has wrought. Upon his death in 2003, at age seventy-seven, he was widely celebrated as a lifesaving innovator. Obituary tributes noted Janssen’s passion for the country of China. Janssen was the first Western company to set up a pharmaceutical factory there, and in 1993 Paul Janssen became the first non-Chinese person to receive a pharmaceutical honorary doctorate in China. Janssen’s factory was in Shaanxi province, near the excavation site of the famous army of terra-cotta soldiers, sometimes called the Xi’an Warriors, buried more than two thousand years ago with China’s first emperor, Qin Shi Huang, to protect him in the afterlife. When the statues were threatened by mold, Janssen analyzed the damage and provided antifungal sprays developed by his company to save them, even setting up an on-site lab. The soldiers remain one of the most popular tourist attractions in China.
The opioid epidemic sweeping through the United States, Canada, and Estonia undoubtedly would have horrified Paul Janssen, as would the fact that Chinese laboratories today produce most of the world’s illicit fentanyl. According to Andrew Wheatley, spokesperson for the Janssen Pharmaceutical Companies of Johnson & Johnson, Duragesic patches sold in the United States are manufactured in the United States, and those sold outside the United States are manufactured in Belgium, and none of the controlled-substance active pharmaceutical ingredients in either Janssen or Johnson & Johnson products are manufactured in China.
Janssen and other pharmaceutical companies like Purdue are now facing lawsuits from states and other entities around the United States for their contributions to the opioid epidemic, but Paul Janssen continues to be remembered as an unparalleled medical drug innovator. Since 2005, Johnson & Johnson has been giving out a biomedical research award named for him. But the proliferation of illicit fentanyl may alter his legacy. His focus throughout his professional life—up until the day he died, while attending a scientific conference in Rome—was the science and business of creating chemicals to help ease suffering. To his core, Janssen believed in medical science’s ability to benefit humanity. When fentanyl was first synthesized in 1959, nobody could have predicted that it would eventually create so much suffering. Nobody could have known it would become as common as cheap liquor in America’s inner cities and much more deadly, or that anyone with an Internet connection could have it sent to his or her door.
One consequence of the Federal Analogue Act of 1986 , which regulated drugs that hadn’t yet been created, was its effect on science and medicine. Some believed the law derailed development of potentially beneficial treatments and medical drugs by making it difficult for researchers to study new chemicals on human subjects. “The placement of medical research approval within law enforcement, the DEA, is unthinkably stupid and inappropriate, and cannot be tolerated,” wrote Sasha Shulgin in 1993. “We, as the research community . . . have quietly acceded to a non-scientific authority that can oversee and, to an increasing degree, influence the direction of our inquiry.”
Shulgin was easy to dismiss, by some. He wasn’t a medical doctor but rather a psychedelics chemist, who manipulated the structures of chemicals to try to create new drugs. He had a record of pushing the bounds