Dissecting the source of America’s opioid epidemic

On Monday, Sept. 17, the U.S. Senate unified to pass a comprehensive package of 70 initiatives addressing the nation’s lethal opioid epidemic, which was followed by the House of Representatives voting to approve legislation Friday agreed to in conference by both legislative chambers.

Senators voted 99–1 to pass the Opioid Crisis Response Act, which is expected to be the only major legislation passed before the November mid-term elections.  Only Sen. Mike Lee (R-Utah) dissented.

In the House, the SUPPORT for Patients and Communities Act passed by a count of 393–8.

Proposals outlined in the bills would cost billions of dollars, providing grants, loan-paybacks and renewing programs across multiple treatment agencies. In addition, the proposed law would allow doctors to prescribe more medication to wean addicts off opioids.

Beyond caring for those in recovery, the legislation aims to prevent the deadly synthetic drug, fentanyl, from being shipped through the U.S. Postal Service.

SUPPORT also abolishes the antiquated Institutions for Mental Diseases exclusion rule, or “IMD exclusion,” which prohibits federal Medicaid reimbursements for inpatient treatment centers with more than 16 beds. The “exclusion” was part of a 1960s effort to deinstitutionalize mental health treatment and transition care into community-based facilities.

Unfortunately, community-based facilities are underfunded and starved for resources.

The bill requires Medicaid reimbursements for treatment centers with 16 or more beds caring for mental health patients with an opioid addiction. CBO estimates a cost of $1 billion over the next 10 years.

Furthermore, the STOP Act, included in the reconciled bill, will crack down on the shipment of synthetic opioids into the U.S.  While private shippers like FedEx and UPS are required to gather data in advance on incoming international shipments, the Postal Service is not mandated to do so, making USPS a choice delivery system for drug traffickers operating in the U.S. market.

Why do we suddenly care?

Statistically, addiction to opioids is declining, yet heroin overdose deaths are rising. Heroin is being cut with fentanyl, a potent, cheap, synthetic opioid. Fentanyl is similar to morphine, but anywhere from 50–100 times stronger. The CDC estimates that of the 72,000 opioid-related deaths in 2017, about 30,000 were caused by synthetic opioids.

Currently, shipping opioids to America is an effortless task; only commercial carriers are required to scan and receive electronic data on packages. U.S. law enforcement believes fentanyl is coming primarily from China, a claim refuted by Beijing.

Yu Haibin, a senior official with China’s National Narcotics Control Commission, said American officials have provided China with “dozens” of leads since 2017, which pales in comparison to the millions of opioid abuse cases in the U.S.

Beijing officials announced Wednesday China would list an additional 32 New Psychoactive Substances as controlled substances, making it illegal to manufacture, sell or possess them without authorization — a small change to their otherwise unregulated pharmaceutical industry.

The White Drug War

Blacks are no more likely than whites to use illegal drugs. However, African-Americans are up to 10 times more likely to be incarcerated for drug-related offenses.

Historically, the U.S. response to drug addiction depends on race. Opioids, such as synthetic Oxytocin, gained notoriety in the 1990s for prescription abuse among white suburban and rural citizens. As it became more difficult to renew opioid prescriptions, people turned to a cheap, potent and available alternative: heroin.

Now that Fentanyl is a deadly filler in heroin, the rising death toll has prompted legislators to take notice of the opioid epidemic.

As addiction grew in the white community, so did the response in search of a solution. By the early 2000’s, Suboxone was on the market as an addiction treatment. America’s drug policy focused on pharmaceutical technology, legislation and decriminalization. By creating a separate system that treats addiction as a biomedical disease, legislators have carved out a far more clinical and less punitive treatment for heroin addicts.

However, America had a very different response to the crack epidemic that devastated the African American community in the 1980s. Instead of crafting public health interventions, or creating safety nets to combat drugs, authorities in most states chose to leverage the threat of incarceration.

Marc Mauer, director of the Sentencing Project, a group that targets racial disparities in the criminal justice system, has been tracking this issue for over 20 years. Mauer responded to comparing the two drug abuse responses:

“When the perception of the user population is primarily people of color, then the response is to demonize and punish. When it’s white, then we search for answers. Think of the difference between marijuana attitudes in the ‘reefer madness’ days of the 1930s when the drug was perceived to be used in the ‘racy’ parts of town, and then the 1960s (white) college town explosion in use.”

Just how easy is it to buy?

Currently, Instagram and Facebook are working to prevent hashtags related to drug use and sales. However, there are a few sites that haven’t adopted these guidelines. By merely typing heroin in the search bar, this author was met with hundreds of blogs posting about people who abuse opioids, tips on the best way to obtain heroin and safe injection practices.

Heroin use has become a sub-culture among white youth. Hashtags such as #nodsquad, which refers to nodding off after using, is often linked to videos social media users post of themselves injecting heroin.

Pretending to be a first-time buyer, the author reached out to a seller via email, who replied within three hours.

The seller offered three different price points between $200–800 and $40 for overnight delivery. Shipping options included: UPS, FedEx, and EMS, and a valid tracking number would be provided. Payment options included: Bitcoin, Money Gram and Western Union.

The seller offered reassurance shipping has never been an issue and to reply with my order, shipping information and payment option.

After 10 email exchanges, the seller offered a couple of grams of heroin for $150, shipping included. The seller also provided a list of fillers to cut the heroin with such as sucrose, baking soda and painkillers. This author was then given a name and address of a man in Douala, Cameroon, with instructions to send money.

With no intention of actually buying heroin, the author excused herself from the transaction, and like a gracious shopkeeper, the seller said they’d still be there if one’s mind was changed.

China and Cameroon 

While there is no evidence that China and Cameroon have a joint effort in the distribution of heroin, it is worth noting that China has been bolstering Cameroon’s economy and military alliance. China’s actions can be perceived as a new form of colonialism, an innovative way to exert influence over a developing country.

Currently, China is building a port in Kribi, Cameroon, to relieve trade pressure from Douala, Cameroon’s oversaturated trade port. The locals refer to it as El Dorado, as cranes sweeping overhead indicate a bright future for locals and as new jobs help bolster their developing economy.

Additionally, military cooperation between the government of Cameroon and the People’s Republic of China was reinforced again when the two country’s signed a convention worth 4.5 billion francs to assist Cameroon’s defense forces in acquiring military equipment.

While Cameroon does not provide information about domestic heroin use, the Central African country has been in the spotlight for trafficking before. In August 2011, 141.5kg of cocaine was found inside bottles of vegetable oil at Douala’s port.  In 2012, more than six kilos of heroin was seized at Douala’s airport.

Even though the source of fentanyl-laced heroin is unclear, the U.S. will continue to crack down on overseas shipping and electronic information collection of international packages.

 

Editor’s note: The 11th paragraph of this article has been edited and corrected.

 

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