You may have read of the drug bust that found enough fentanyl to kill 26 million people That is a massive number so I was shocked to lead that the total haul was just 118 pounds, which works out to about two milligrams per fatality. Mark Kleiman explains that fentanyl is one of the most potent drugs, which is why a tiny amount can be so dangerous. He says that fentanyl is just one of a class of synthetic opioids that are far more dangerous than prescription opioids and heroin and also much easier to produce since they do not require an agricultural crop as its starting point but can be made entirely in a lab.

First, a little bit of chemistry and pharmacology. “Fentanyl,” in its precise use, is the name of a single molecule. It’s a purely synthetic opioid: that is, it binds to the same μ opioid receptors as oxycodone or heroin does and has most of the same effects, but it’s not made from the opium produced by the poppy plant; its raw materials are chemicals, not crops. It’s about thirty times as “potent” as morphine: that is it takes about thirty times as much morphine as it does fentanyl to get the same pain relief.
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But the “parent” fentanyl compound turns out to be one member of a very large chemical family, known generically as “fentanyls,” each with its own name and a varying set of pharmacological properties. Some of them are astoundingly potent: carfentanil, for example, has something like 100 times the potency of fentanyl itself, which makes the effective dose for a human a fraction of a microgram.

He says that these drugs have a very narrow ‘therapeutic window’, which is the difference between the median effective dose and the median lethal dose, which is why it is so easy to overdose and die. And since the doses are so small, it is hard to split and thus easy to make a mistake.

To make things even worse, neither users nor dealers have reliable ways of knowing just what’s in the white powder they’re consuming or selling: someone who injects what he thinks is the right dose of heroin, but has in fact purchased fentanyl, is likely to stop breathing. Even someone who intends to take fentanyl could die if he’s actually been given, say, 3-methylfentanil or some other high-potency analogue.

Kleiman says that after authorities started cracking down on prescription opioid abuse, people shifted to heroin because the price of that drug had dropped dramatically. And fentanyl was the next logical step because its high potency and the fact that it could be easily produced synthetically and required such tiny amounts made it highly attractive to dealers and producers.

Instead of using complicated smuggling schemes, sellers simply put these products in the mail; for about $20, you can get a package of up to four pounds mailed from China to New York.

It didn’t take long for some of those Chinese outfits to start making fentanyl; unlike heroin dealers, they didn’t need a source of opium. The chemistry involved isn’t especially challenging (not, for example, like making LSD). Fifty grams of fentanyl – an ounce and a half – has the potency of a kilogram of heroin, and it’s way, way cheaper.
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For law enforcement, the parcel-post approach makes a hard problem nearly impossible. The volume of legitimate parcel post from China to the U.S. means that there’s no way to scan every package, or even a high enough fraction to make the traffic uneconomic. As more and more potent molecules appear, I’d expect another shift, from parcel post to regular international mail, moving the drugs in quantities of a gram or less, perhaps dissolving them, soaking a sheet of ordinary paper in the solution, typing a letter on the paper, mailing it, and then extracting the drug at the other end of the process.

So that’s why the fentanyls are a big factor now when they weren’t before. And I don’t see a snowball’s chance in Hell of stopping the flow. It’s possible that, with adequate urging from the U.S., the Chinese authorities might succeed in cracking down on illicit manufacture and sale. But there’s nothing magical about China. India also has skilled chemists and a huge flow of mail to the U.S. So, for that matter, does Canada. And so does the U.S.; if international sources dry up, the stuff will be made here.
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From the retailer’s point of view, [the old style of street dealing of drugs] meant exposure to both enforcement risk and the risk of robbery. It also greatly decreased the number of transactions a dealer could consummate in an hour, since most of his time was spent waiting for customers to arrive. Much of the retail price of illicit drugs represented compensation to the retail dealer for those risks and costs.

But with mobile phones, texting, and social media, transactions can now be arranged electronically and completed by home delivery, reducing the buyer’s risk and travel time to near zero and even his waiting time to minimal levels. In the recent Global Survey on Drugs, cocaine users around the world reported, that their most recent cocaine order was delivered in less time, on average, than their most recent pizza order.

Kleiman’s article alarmed me more than any other article I have read on the drug problem because we seem to be headed for a drug nightmare. The supply side of the equation seems to limitless and unstoppable. The demand side will have to be the place where we can hope to limit the damage, not by indiscriminately locking up users, but by helping people wean themselves from dependency. As a start, we may need to make the antidote drug naloxone as widely available as possible to at least stem the number of deaths from overdoses.