tv After Words Ben Westhoff Fentanyl Inc. CSPAN September 22, 2019 9:00am-9:48am EDT
ben westhoff reports on how labs in china manufacture fentanyl. he's interviewed by and mclean custer of new hampshire. founding cochair of the bipartisan opioid task force . it's a weekly interview program with guest posts interviewing, nonfiction authors about their latest work . >> you for all your efforts. >> .. working together, and we have been hit very hard in our state, 471 deaths last year. but the mix of those is really
changing. it's fentanyl but it's as you write about in your book, it's fentanyl mixed with cocaine, that no mixed with methamphetamines. so wanted to start off with the kind of big picture. what got you into this? what gave you the incentive to spend four years of your life in this deep dive and how did you keep going with it? >> guest: i had a friend who died from that no in 2010 before people were much talking about it, before i knew what it was. but it wasn't until about four years ago i was a music journalist primarily then, and i was doing a report on why so many people were dying at raves. these big electronic music whether tens of thousands of people partying.
someone would always die and the deaths would be blamed on ecstasy. i had never heard of ecstasy being such a lethal drug before, and i found out that almost all of the ecstasy was adulterated. >> host: it'd been mixed with other chemicals. >> guest: exactly. there was almost no real to ask ecstasy at all. it was all these new chemicals. i wanted to find out what these drugs were. it turns out that there are hundreds of new drugs that i'd never heard of, that most people had never heard of, all synthetic, all made in a lab and almost all of them in china. i had heard about drugs coming from mexico, places like afghanistan or colombia, but i had no idea that china was where
all these new drugs were being made. and the most deadly of these drugs, i've learned, was fentanyl. and that sent me on this quest to get to the source of the issue. >> host: to try to understand where it came from. what i thought you did such a fascinating job in your book. "fentanyl, inc." was really describing this sort of infrastructure that developed, and one of the hearings we have had with the drug enforcement agency, they literally spoke about criminal chemists in china. tell the story. because you actually went there. how did you make the connections, and what did you learn when you got to china? >> guest: the first thing that is or was that buying drugs online is incredibly easy. you don't even need to go in the
dark web, even the clear way. i started googling the names of drugs like fentanyl and found these chinese lab selling them. and all he did was just send them an e-mail and pretending to be a drug buyer. i have a fake e-mail address, and asked him if i was ever in china if i can visit their lab? some of these different chemists said yes. so i i went. i went early last year, and what i found was pretty shocking. i was expecting something like an underground, cd environment. but it wasn't like that at all. i was expecting something like a mexican cartel or colombian cartel. but these look like legitimate businesses really. >> host: and to some extent you describe that they are
legitimate businesses staying sort of one molecule ahead of law enforcement that's trying to schedule the drugs and make them illegal. describe the process. >> guest: yeah, exactly. when it comes to fentanyl, band in u.s. and china but there's all these little offshoots of fit no and they are called analogues. you can make an analog just by tweaking the chemical structure just a little tiny bit. for years that's how these chinese chemists have been staying one step ahead of the law. so whenever china banned one of these drugs, they were just tweak it slightly and then begin selling this new drug until it was illegal. so their operating within the law, and that is only changed recently, in may, when china
agreed to ban all types of fentanyl, analogues, everything, even before they were invented. even new ones that are not yet been invented. >> host: help to understand or explain to the listeners will, people are in the united states are buying the precursor chemicals to making fentanyl, and then they are mixing the ingredients before they are selling it in a retail capacity. you kept having these visuals that you could understand, and one was a coffee grinder, and using a coffee grinder to mix the substances, but then it seemed that part of the risk that -- can you help people understand just love the fallacy of fentanyl and the small, small
amounts, literally grains of sand that can be a lethal overdose that could kill someone? and if you don't understand when they are buying it, what the mix is. >> guest: you've hit on a really important point, because heroin, like we said, it's grown from poppy. it's a natural plant. but fentanyl is made in the lab and its 50 times stronger. and so drug dealers will not use pure heroin. they will cut their heroin with fentanyl because it's the way to save money. it's so much cheaper to make. it's so much more powerful. the problem is that the way they mix them together, like you said, is very, it's not precise at all. it's not scientific. these street dealers in st. louis, one that i talked to, said they would mix the heroin
in the fentanyl using a mr. coffee grinder, you know, just the same thing you would grind the coffee beans. the problem is, you can't do it precisely. and so one does might be pretty weak but another dose might be so strong as to kill someone. and that's exactly why so many people are dying from fentanyl, street fentanyl. >> host: and one of the comments you were quoting people, because it does seem counterintuitive. if you think of this being a product that is literally killing the purchasers of the product, that doesn't sound like a very good business model. but you quoted people saying they find out about a death and they will want to get that batch because it stronger. so help us understand that. is it the level of addiction
that would cause someone to take that step, or did you get more behind talking to the users and the high that are chasing? >> guest: well, for many longtime heroin users, they don't even get high anymore from heroin. all it does is it gets rid of their withdrawal symptoms. it gets them back to baseline. but with fentanyl they can get high again, so much stronger. and so, unfortunately what happens is when someone overdoses, and another i dictate -- addicted user is about that, they say this must be a really powerful batch, i want that. >> host: to get that euphoria. >> guest: exactly. so that's a very unfortunate aspect of this. >> host: and i think it's hard
kind of to get your brain around, certainly for policymakers part of what our task force is about is trying to educate members of congress from communities all over the country that are now dealing with this, to understand kind of what the impacts are and how people are responding. the other part of the book that i felt was really fast dating we should take on the war on drugs, and going back to the history of that, starting with president nixon, president reagan, nancy reagan, just say no. talk about that a little bit, like what your impression is of whether that approach has been successful. >> guest: yeah, ever since i've been a little kid i've been hearing just say no, and about the war on drugs. i think, unfortunately, where we are at right now is that
fentanyl is killing more americans every year than any drug ever. so we've been through the crack epidemic, the meth epidemic, pills likes oxycontin. that was the first part of the opioid crisis, the first wave. inhaling the second way, but fentanyl is the worst, killing to most people. to me it's all evidence that the war on drugs is not succeeding. we help take out pablo escobar, the famous colombian cocaine kingpin, and yet his death did nothing to slow. we are getting more from colombia than ever before. there was a el chapo who is in prison, and tried recently, but it's not stopping the flow drugs from mexico at all. locking people up for a small
drug offenses, nonviolent drug offenses in the u.s. has been devastating for minority communities in terms of the money spent. and so to me it's, the war on drugs isn't working. >> host: to me it really is a public health issue at this point. one of the issues that we're focusing in on is to understand that people who are incarcerated do not get, typically do not get access to system is used reall, any addiction treatment, or even the underlying mental health or trauma that they might have been dealing with. and what we're looking at, the reason for that, if years ago when congress created medicaid, they had an exclusion for people during incarceration.
so their medicaid coverage stop the day they go in, whether it's county jail, state prison, federal penitentiary. and for 50 years all across this entire country, people often had sufficient healthcare and access to treatment. and then they come out and all i shocked that they go back to their addiction and go back to their crime. we live with these incredibly high recidivism rates of people going just back in and back in. and when you think about it, when not surprised they, and they still have diabetes, you know. and i keep talking with law enforcement saying, we're not going to arrest our way out of this, that it's a public health issue. so our legislation is to bring medicaid and treatment for the underlying mental health issues and the substance abuse issues
into our communities and into our jails and prisons. we're having some really great results. >> guest: that's a great piece of legislation. everything you're saying is completely been shown to be the case, as first drug use and recidivism. what you mentioned before, medication-assisted treatment, different names for it, but this is a two-pronged approach that i'm sure you're very familiar with. attacking -- it attacking the chemical problem, a drug problem, on one hand and it do that to use the sort of low opioids, a little opioids like methadone, suboxone -- >> host: you've enough for an. >> guest: exactly. they help people hopefully taper off from these really destructive opioids like fentanyl and heroin. >> host: and it can literally
quell the urge to take the other drug. >> guest: yeah, yes. and then at the same time combining that with therapy, with counseling. because what we found is that it's not just the drug often. in fact, in almost every case there are personal problems that people have in their lives. they are out of work. they got severe health problems. they've got personal issues, and if these things can be addressed in tandem, the ability for someone to get off, even these strong drugs, has been found to be pretty good. >> host: what of the lines i wanted to quote on page 276, this is one of the people working in this world of therapy, and she said,
exclusively focusing on the chemical aspect also overlooks another important factor, quote, 100% of my patients have experienced childhood trauma or have a mental health disorder, which are tied in. and it's interesting that statistic, 100%, i was recently at the women's prison in new hampshire, and, because they are starting to bring medically-assisted treatment and mental health therapy in-house, and already having really profound results. and they told me, 100% of the women incarcerated in new hampshire have either 75% are sexual assaults in their lifetime, and 25% abuse and neglect in their childhood. and so if you are not treating the underlying mental health
issues, then you're really spinning your wheels in terms of trying to help someone get over, you know, get past their addiction, get into treatment. and then what i keep telling people, long-term recovery. it's not a 28 day, what an done proposition. there's a a very high rate of relapse and we need to recognize, that's true for lots of different issues, healthcare issues. we don't say to a diabetic, i can't treat you. you just ate cake. we say that's a really difficult disease, , how can we help you d your family? because you really not to eat cake. we need to help you for the rest of your life because there's cake everywhere. and you can't have it, you know? i think that's another thing. talk about the harm reduction model you talked about at the end. >> guest: yeah, well, as you know, new england is really
where the opioid epidemic and that no in particular kicked off. it was the worst, a few years back, worse than anywhere else in the country, but the encouraging thing is that you have actually been saying these deaths drop in new england in the last couple of years. even while they were still go up in places like misery i live. and, unfortunately, -- missouri -- the epidemic is heading west. that was something we have to deal with. but as going to say about harm reduction in new england, there's been this incredible success with the medication-assisted treatment, with the medicaid expansion is helping a bunch of people. >> host: incredibly important for us. we have a program that we call safe stations where you can walk right into a fire station in
manchester, new hampshire, and without risk of arrest or incarceration you can say, i need help, i have health issue, which is addiction to substance use disorder with these opioids. and they will connect you with treatment and get you into treatment. it's hugely successful. but the medicaid expansion is critically important. of the first 100 people to walk through the door, it was like 95 or more were eligible for medicaid expansion. so the reason they were not getting the help they needed is that they had no place to turn. we didn't have sufficient treatment capacity. the hospitals would not help them with getting past detox, that's the critical link. you talked about how they're going to keep taking heroin so
as to not go through withdrawal. and to me that should be, again, a public health issue. they should be able to walk into any hospital and we should help them get through withdrawals. and one of the interesting things i've learned about the medically-assisted treatment, is that in some cases you don't have to go through the withdrawal. you can get directly onto that medication, and then that will help you taper off your use. >> guest: yeah. and then of course there's naloxone, known as narcan. this is basically a miracle opioid reversal drug. it's something out of science fiction. >> host: saving thousands of lives. there really is extraordinary. >> guest: yeah, it is some states they have made us a don't need to get a prescription to get it but it's really a matter of providing funding for firefighters, first responders, and even people like librarians.
because there's the situations now where people are passing out in library bathrooms can overdosing. it's an epidemic across the country, and librarians are not trained to deal with these situations. >> host: they need to narcan on hand. and family members do. and and i think that's one of te things that families are so believers, the communities are so exhausted from this. so talk a little bit about what you learned from europe about this harm reduction model and how we can educate and prevent overdosing and people harming themselves. >> guest: right. so i went to spain, and in particular barcelona. and there they have these facilities called supervised injection facilities. what these places are is where addictive users can go in. they can get clean needles and
they can shoot out, you know, erewhon, fentanyl, whatever the drug. they can even smoke crack cocaine. they can do these drugs, and it's illegal to do so inside the facility, and they are watched over by trained medical staff. and so they've had, it's a little outside the box, especially for americans. >> host: on the offer addiction treatment, mental health treatment? >> guest: it's all part of the package. >> host: we learn more and more about, they call it a moment of clarity when someone is ready for treatment, ready for help, and making that readily available to people so that they can take that step. >> guest: that's absolutely part of it. these centers, they tend to bring the addictive users out of the park, you know, like in barcelona they had this scourge
of needles in parts and kids are stepping onto. they have these addicted users in the street but there brought into these locations and they have been, in canada they have a lot of them. in europe they have a lot of them. no one has him him him. >> host: talk about that. these kits, that no testing strips and narcan and -- >> guest: does these all part f the harm reduction strategy. the fit no testing strips in particular, these are kind of in a way to look like a pregnancy test.
what you do is to take your drugs. you don't know what's in it. it could be pure heroin. it could be heroin next with that know. you don't know, so you mix it up in a solution, dip the strip in their him and if there is one stripe that means there is fentanyl, two stripes means there isn't. so what studies have found is that people realize that fentanyl is in their drug, and like is that it could be mixed with anything, cocaine, meth, pills, if people find fentanyl in there, you are less likely to take it and they are therefore less likely to overdose and i. >> host: you were talking about your friend in 2010. for me it was 2014 and a young man named carl messenger had graduated college, had come back to a small dent in new
hampshire, and he was taking some extra courses. his father was a dentist and he wanted to become a dentist, and his parents were aware that he had had a drug problem. he had been to treatment and come back and was living with them. and what happened was he got a respiratory, a bad cold, and went to get medication for the cold. and unbeknownst to everyone, the doctor, the pharmacist, the parents, the young man, it was cough syrup with codeine, in the codeine created this drug seeking behavior in him and immediately he made a call to the heroin dealer. but what was delivered to him turned out to be 100% fit no, and we did know anything about it at that point. his mother like got to know very
well after this all happened came home to find him literally dead on the bathroom floor with the needle still in his arm. and you talk about that in the book, what that means is its a lethal dose instantly. what was it about the chemistry of fentanyl? you got way into the chemistry by the way. do you have any chemistry background? you did a really good job. i was having a hard time following it, but what is it that makes this like a lethal dose that you would literally die? and, of course, he didn't have any idea what he was taking. >> guest: was interesting about fentanyl is that it was created in the late 1950s by a belgian chemist, and he wanted to create a better drug for use in hospitals.
andy did. fentanyl -- and he did. fentanyl was used an open heart surgery, continues to be a very important drug for things like epidurals during childbirth, for men getting colonoscopies are given fentanyl. it still remains an important laboratory drug. excuse me, an important hospital drug, , and also for people with cancer and end-of-life care, is a patch, things like that. but what he didn't realize was that along the way these rogue chemist, like the kind i described in the subtitle, started going to the scientific literature that he and other drug chemists were publishing. so in the old days if you are a scientist at the university, he published a paper and it went into some university library, pretty obscure, hard to find.
but in the internet age, all of these papers were published online. >> host: and publicly available everywhere around the world. >> guest: exactly. and so these rogue chemist begin looking for these files, specifically for these papers, to go through them and appropriate the chemical formula to learn how to make these new drugs. and so they began exploding all over the internet and made in chinese labs, and these different types of fentanyl came about in this way. >> host: well, it was fascinating. the other thing i thought that made the book very, very readable is you told these incredible, personal stories. you met with families who had lost a loved one. one of them was the death of bailey kinky in grand forks north dakota.
tell that story, because it was the city, the interaction with law enforcement and sort of this incredible mystery international mystery, to get to have all came about. >> guest: bailey was an 18-year-old kid. he had just graduated from high school. he had never tried fentanyl until he received it one night at a party, and it was stronger than anything he had ever tried before. he passed out and died. his parents have no idea what fentanyl was. nobody did. this was 2015. grand forks is a pretty small, you know, fairly conservative place pic and i talked to the mayor of the town and he said we don't think of ourselves as a place where we have this big drug problem. but there were more fentanyl deaths, and the community realized they had to take strong
action against this problem. and so they adopted a bunch of these really forward thinking harm reduction approaches. so north dakota, for example, past, it's called the good samaritan law. basically that means if you are with someone who dies from a drug overdose, you're allowed to call the police, and the ambulance, without fear of criminal prosecution. >> host: interesting. because typically there's someone else there and they are afraid frightened to do anything about it because they don't want to get in trouble. >> guest: exactly, and that happens a lot. and so grand forks, it's also pretty isolated place. north dakota doesn't have many big cities, and so they permitted this medication-assisted treatment to
be done remotely, so kind over like skype. so people could talk with doctors in other cities and be put on this type of medicine. so there started to end up fentanyl test strips there, and it's a very impressive show of support from that community. >> host: i do, i was on the house veterans affairs committee. now i'm on the energy and commerce will review the issues. but i did a lot with veterans in my first three terms, and we also, i have a rule district, and they had started doing mental health and now they're starting to do medically-assisted treatment by long-distance treatment over the internet and skyping the interviews and sessions, the mental health sessions. >> guest: that's great. >> host: i was incredibly
surprised at how successful that was, but they can go into a pattern center, a comfortable chair and a plant next to them and a tv in front of them, and then they are having their session. they don't have to drive two or three hours, and it's much more efficient. i was recently visiting one of our hospitals as well that is to help our small rural hospitals to have the expertise that they need to be able to do the medically-assisted treatment. >> guest: and it's also ushering in kind of a shift in mindset. at a talk to the public health coordinator in grand forks, and he said that fentanyl epidemic is changing the way people think about addiction. and so he said it's no longer people think we've got to jail i went out of problem, we have to lock people up. treating addiction as a disease, trying to get people treatment. can use it even its bills over into something like alcoholism,
which is for a long time treated the same way, you know, the drunk tank. the social issue more than a real disease. he said in grand forks naturally changed now. >> host: it's incredible, too, this is ben, beginning with the opioids and then the heroin enough fentanyl, that rural america has been hit so hard, and that's a new phenomenon for most of these communities, certainly in my district that has been a big part of this here and trying to come to terms. we, for example, have 2.4% unemployment. what that means is that you get down to very difficult to find talented work, employees for the workforce. and what i've seen just recently is what they call supported employment where one of our major employers is going to have
addiction specialists on hand in the company to support the people in recovery. and if they feel they are going to relapse or if they need resources. and it's not just the patients themselves but so many families have been hit by this. we have grandparents raising grandchildren, and all of the whole society gets impacted in coming to terms with that as a public health issue, rather than a criminal justice issue. >> guest: it's medical. the conclusion -- critical. the conclusion i come to my book is we can't just address the supply-side. so i went to china. infiltrated these drug labs. i found out all sorts of horrifying things about how the chinese government actually subsidizes the production of fentanyl and fentanyl like drugs
fentanyl precursors, all the stuff. these companies actually receive a tax rebate for exporting fentanyl and these other drugs. there's all sorts of stuff going on right now with the trade or president trump is trying to pressure chinese president xi into making these changes, and these are changes that should be made. but at the same time what i discovered is that even if we are able to control chinese entity, the chemical industry exporting these drugs, the industry will likely move to a place like india which is already starting to make fentanyl. and so my conclusion is that we need to focus on the demand side. that's the only thing we can do here ourselves, and that is the name of the game with harm reduction, with all these things we've been talking about. >> host: you've made a really
interesting comment about that, too, which is that the fentanyl dealers understand the breadth of the demand for opioids right now, and you told the whole story about the oxycontin and oxycodone and you went to a lot of that in the book as well, the shout out to dreamland which is my bible, it's an incredible book to understand this author but your point is very well taken. if we don't get a handle on helping people get well and movie on these drugs, one of the things that's been hopeful for me is to meet so many people in recovery, and to have meeting people with successful lives
that are in long-term recovery that have gotten past this, and recognizing that that's a possibility, that that's a probability. if we can use medically-assisted treatment and mental health treatment and long-term recovery and sober housing, and all the sort of construct toward getting people to a healthy place, then we don't need to worry in the sense that they are not going to be tempted by this lethal drug, fentanyl, coming from china. you had an a credible story. you had so much history. you can tell you're jealous because they're so much depth to the story. you had in a credible story about the opioid war and the ironic twist that the drugs that are being imported to the united states. just tell that story. >> guest: well, china fought a
pair of opium wars in the early 19th century, and what was happening with that, , england s sending all this opium into china and the chinese people are getting addicted, and the chinese leader said we want you to stop bringing this into our country. but england refused and so there were two backwaters were fought over that. now, -- two wars were fought over that. today was going on is a reverse opium war because the drugs to come out of china, now the drugs are coming out of china and it's the people in the west who are using these drugs and getting addicted. talking with chinese officials, and they don't want to take responsibility, which is not surprising. they blame the u.s. for its own culture of drugs.
and that, you know, they have a good point. in the u.s., for example, we use four times as many opioids as even a country like the uk, for example. and so some recently released documents that you were alluding to, referencing these big lawsuits against the opioid and pharmaceutical companies. now, the most famous of these of courses purdue pharma, which was responsible for oxycontin, and they were shown to be really pushing this drug trying to make sales even while their own internal studies showed out addictive it was. and so purdue pharma silicates a lot of blame. but from these new documents we learned that and much less well-known company which is based in st. louis where i live actually make more of these
pills, these oxycodone pills, than any other company. they were responsible for something like 29 billion opioid pills. and so now we're getting -- it's comparable to the big tobacco lawsuit in the '90s. >> host: the lawsuits that are being brought by states and cities and towns that have been consulted in a federal court in ohio, actually oklahoma, a judge recently ruled against johnson & johnson, another the company. but the judge in ohio has said that he thinks this will be a massive come on the skill of the tobacco settlement, a massive settlement. and i think, you know, , everyoe needs to be held accountable because it's shocking, really, when you read the documents that are coming out of discovery. he knew how addictive the medications were and it's
agreed, essentially. i have to ask you one question just because it's been on my mind. back to china. it seems to me if you were in a foreign country trying to threaten the well-being of our country, that this would be a brilliant strategy to just hollow out america and these communities and the sounds. do you ever think of this as a homeland security issue? i mean, shouldn't we be looking at this in a different way in terms of our international relationships? >> guest: yeah, it is definitely a national security issue, when you think about it. 70,000 americans dying from these drug overdoses. and so the question which you getting at is, is china doing this on purpose? a lot of people have been asking
me, is china going to were essentially with the u.s.? that's a term that trump and chris christie and others have used, war. and so the way i think about it is that it didn't start out that way. it started out because china wanted to encourage its chemical industries, it's exports, wanted to go the chinese economy through all these chemical exports. the problem is that these tax breaks, these government incentives that were designed to go to legitimate chemical companies have also been going to these rogue companies, these companies exporting fentanyl and fentanyl like drugs. and at one point though you have got to say who's in charge, whose steering the ship. and one example is, laster in the midst of the trade war, the trade war was really ramping up between the u.s. and china.
and right in the middle of all this china raised its tax rebate for exporting fentanyl from 9% to 10%, right in the middle, in the middle of this huge opioid crisis, all these people dying. china raised this rebate. so it makes me wonder, is this intentional or not? there's not a smoking gun but it's certainly something to consider. >> host: well, i appreciate the depth of your research in this is just extraordinary. >> guest: thank you. >> host: and a couple of minutes we have left, is there any other one story that stands out or any other message that you want to be sure to get across to our listeners? >> guest: well, one thing that was so interesting to me was that these new drugs, it's not just drug abusers who are
suffering. it's not long time addicted users. it's not all junkies. fentanyl can be in any powder or in any pill. so, for example, the senior prince, he thought he was taking a legitimate narcotic pharmaceutical pain. it even had the percocet i believe stamped right on it. it looked totally legitimate right it was cut with fentanyl. that's how he died. people are taking what they think is cocaine and dying, math, the unfortunate thing is that these types of drugs just are not safe anymore. i have experimented with drugs when i was younger, but the sad thing is, maybe if i did that same thing today i could be one of these casualties, too. >> host: well, i think that's your message at the end of the
day, is the fascinating story, the chemistry, history, science, international relations, community relations, family relations. but at the end of the day, really word needs to get out to every parent, to every young person, and certainly to every policymaker. so i plan to share it with my colleagues. i really appreciate the effort that you put into it, and just how serious you were and thank you. the book is "fentanyl, inc." and we highly recommend it. >> guest: thank you for all the good work you're doing, congresswoman. you are really making a difference it absolutely. >> host: thank you. thank you so much. thanks a lot. >> this program is available as a podcast. all "after words" programs come
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the book is called "panick attack: young radicals in the age of trump." the author is the associate editor of reason magazine or reason.com, robby soave. who are these young radicals? >> guest: these are activists who are particularly causing issues on college campuses although you could find in the streets a places like portland as well who are different from kind of the old left that was all about free speech, due process, aclu values. what we're seeing now is a lot of attempts to shut down speakers who come to college campuses. even the professors of activist students who are purported on