Vivek Ramaswamy rakes up America’s Fentanyl problem. How grave is the issue? - Hindustan Times
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Vivek Ramaswamy rakes up America’s Fentanyl problem. How grave is the issue?

ByNirmalya Dutta | Edited by Arghya Prasun Roychowdhury
Sep 29, 2023 06:25 PM IST

Here's everything you ought to know about fentanyl crisis in America.

One of the strange quirks of democracy is that while it ought to reward the most talented administrator – which frankly is what running an administrative ship ought to be about – instead often ends up rewarding the individual with the most gifted silver tongue (just ask Barack Obama).

 A drug consumer injects a mixture of the opioid fentanyl and heroin at Richman (Echo) Park in the Bronx borough of New York City, U.S., July 20, 2023. (REUTERS)
A drug consumer injects a mixture of the opioid fentanyl and heroin at Richman (Echo) Park in the Bronx borough of New York City, U.S., July 20, 2023. (REUTERS)

Mendacity, or to be more politically correct, being economical with the truth, is a great gift for any aspiring politician, and it’s one that Vivek Ramaswamy seems to have learnt to use with remarkable adroitness. Perhaps that led to Nikki Haley’s outburst during the second GOP Debate when she – sounding remarkably like an angry South Asian tiger mother fed up with her insouciantly imbecilic infant’s infantile behaviour – chided Vivek Ramaswamy by saying: “Honestly, every time I hear you, I feel a little bit dumber for what you say.”

During the second GOP debate – which still had a hole the size of Trump voter base – Vivek Ramaswamy showed his gift of the gab when he evaded a question about America’s fentanyl crisis by conflating it with how the drug was being brought into the country, making it seem like the drug was being smuggled in by migrants seeking asylum through the Southern border. In reality, experts point out that most of the contraband are peddled by legal US citizens who go back and forth across the border.

Speaking about an incident in which a 17-year-old lost his life life after purchasing a drug laced with fentanyl on Snapchat, Ramaswamy said: “I met a family in Iowa, two parents, Kathy and Derek… It is closer to bioterrorism, not drug overdose. It is poison. …it’s also our job to make sure 17-year-olds don’t turn to Percocet through Snapchat.”

Whatever one’s views on Ramaswamy’s evasive manoeuvres, there’s no denying that fentanyl, a synthetic opioid painkiller, that just happens to be 50 to 100 times more potent than morphine, and 30 to 50 times more potent than heroin, and even 2mg can be lethal, making it America’s burgeoning narco problem, a war that the country is grappling to come to terms with.

The Opioid Crisis: An Overview

The US has dealt with three waves of opioid crisis over the years, which have claimed the lives of nearly 645,000 individuals between 1999 and 2021, according to the CDC.

These deaths include prescription and illicit opioids, an issue so ingrained in American culture that it was even the basis of the hit TV show House MD starring Hugh Laurie, where the misanthropic protagonist suffered from a Vicodin-addiction preempted by leg pain.

The CDC divides the opioid crisis into three waves:


1) The first began in the 1990s and mostly involved prescription and illicit drugs.

2) The second wave began in 2010, with a rapid increase in overdose deaths involving heroin.

3) The third wave began in 2013, with a significant increase in OD deaths involving synthetic opioids like illicitly manufactured fentanyl that’s often used in combination with heroin, contraband pills, and cocaine.

Three Waves of America's Opioid Crisis
Three Waves of America's Opioid Crisis

What exactly is fentanyl?

Norman G Bowery, in xPharm: The Comprehensive Pharmacology, explains that fentanyl is a ‘morphine-like’ drug, a phenylpiperidine derivative which is structurally similar to pethidine. Phenylpiperidines, were the first fully synthetic opioids to be discovered and fentanyl is a shorter acting but more potent drug whose pain-relieving effect lasts for 30-60 minutes.

Attorney General Merrick Garland accompanied by U.S. Drug Enforcement Administration Administrator Anne Milgram,​ looks at photographs of people who had died from drugs during the Second Annual Family Summit on Fentanyl at DEA Headquarters in Washington, Tuesday, Sept. 26, 2023. (AP)
Attorney General Merrick Garland accompanied by U.S. Drug Enforcement Administration Administrator Anne Milgram,​ looks at photographs of people who had died from drugs during the Second Annual Family Summit on Fentanyl at DEA Headquarters in Washington, Tuesday, Sept. 26, 2023. (AP)

What are the effects of fentanyl?

Like heroin and other opioids, fentanyl works by binding to the body’s opioid receptors – found in areas of the brain that control pain and emotions. However, when one takes opioids multiple times, the brain gets adapted to the drug, diminishing its sensitivity, and refusing to give pleasure from anything except that drug, which tends to push people towards addiction. The short-term symptoms include extreme happiness, drowsiness, nausea, confusion, constipation, sedation, breathing problems, and even unconsciousness.

How do people consume fentanyl?

Legally, fentanyl is prescribed by a doctor when it can be given as a shot, a patch or lozenges similar to cough drops. The illegally created fentanyl is often sold as a powder, on blotter paper, eye droppers, nasal sprays, or as pills. Drug dealers often mix it with drugs such as heroin, cocaine or MDMA, since fentanyl is a much cheaper option. Fentanyl is far more potent. Users might OD on it since the quantity of the opioid can be signficantly higher than the dosage used by habitual cocaine or heroin users.

How much does it cost?

The price of fentanyl is significantly lower. According to Statista, 1 kg of fentanyl costs drug traffickers 4150 US dollars compared to heroin which costs 6000 US dollars. Additionally, fentanyl is 30-50 times more potent than heroin. It’s estimated that 1 kg of fentanyl generates almost $1.6 million in revenue.

Why is it so dangerous?

As American University Professor of Psychology David Kearns explains, fentanyl is extremely addictive and differs from morphine, codeine, and heroin because of its potency. Kearns told the American University website: “Potency refers only to the amount of a substance needed to produce a certain effect. Fentanyl is 100 times more potent than morphine. This means that if 10 mg of morphine is needed to produce pain relief, only one tenth of 1 mg of fentanyl (0.1 mg) is needed to produce the same effect. Few people have access to a scale sensitive enough to accurately measure amounts that small.”

He further added that in recent years, it had become much cheaper to produce illicit fentanyl than heroin, which explains the shift from the more well-known opioid.

An overdose due to fentanyl leads to people breathing slower or not breathing at all which reduces the amount of oxygen reaching the brain, a condition called hypoxia. Hypoxia often leads to coma, permanent brain damage or even death. Time is of the utmost essence in such scenarios and permanent brain damage usually begins 4 minutes after an unconscious person doesn’t get oxygen while death can occur 4-6 minutes later.

In this Wednesday, Sept. 6, 2023, video image provided by the Irvine Police Department, Irvine police officers hold a pit bull puppy that may have gotten into its owner's fentanyl stash in Irvine, Calif. The puppy was administered an overdose-reversing drug and is recovering, officials said. The dog's owners, a man and a woman, were arrested and could face charges including drug possession and animal cruelty, according to the Irvine Police Department. (AP)
In this Wednesday, Sept. 6, 2023, video image provided by the Irvine Police Department, Irvine police officers hold a pit bull puppy that may have gotten into its owner's fentanyl stash in Irvine, Calif. The puppy was administered an overdose-reversing drug and is recovering, officials said. The dog's owners, a man and a woman, were arrested and could face charges including drug possession and animal cruelty, according to the Irvine Police Department. (AP)

How is it smuggled into the US?

In a grim reverse retelling of the Opium Wars, when the West's prime power Great Britain flooded the cities of China with opium, a tale stunningly captured by author Amitav Ghosh in the seminal Ibis Trilogy, today's China is the primary source of fentanyl smuggled into the US. According to the US DEA, over a two-year period, over $800 million worth of fentanyl pills were illegally sold online in the US by Chinese distributors.

The drugs are usually manufactured in China, then shipped to Mexico where it’s processed and packaged and smuggled into the USA. A lot of it is also purchased online and shipped through the US postal service.

Assistant US Attorney, Matt Cronin said in 2019: “It is a fact that the People's Republic of China is the source for the vast majority of synthetic opioids that are flooding the streets of the United States and Western democracies. It is a fact that these synthetic opioids are responsible for the overwhelming increase in overdose deaths in the United States. It is a fact that if the People's Republic of China wanted to shut down the synthetic opioids industry, they could do so in a day.” However, China says it is doing enough to ensure the drug is not illicitly made and is one of the major bones of contention between the two nations.

A Chinese foreign ministry spokesperson said on 24 June 2023: “Out of a sense of humanitarianism, China scheduled fentanyl-related substance as a class—the first country to do so in the world—which has played an important role in preventing the illicit manufacturing, trafficking and abuse of fentanyl. Instead of giving China the credit for its contribution, the US imposed illegal sanctions on Chinese counter-narcotics institutions and then openly slandered China’s counter-narcotics efforts and illegally sanctioned Chinese companies.”

Beijing has also strongly denied claims that precursor chemicals used by Mexican cartels came from China. On the other hand, the US DEA says the addictive painkillers (and other precursors) are often transported from China to Mexico, the US and Canada, by international mail.

Most of the illicit fentanyl makes its way to the USA from its porous Southern border. According to a report in NPR, people often offer mules money to smuggle illicit fentanyl into the country. Almost 90% are seized at official border closings, unlike say an illegal tunnel being used by the cartel. Most mules are legally authorised to enter the US.

Almost no fentanyl is seized from migrants seeking asylum in the US. At times it’s hidden in tractors carrying cargo into the US but mostly it’s in cars or bodies. Adam Gordon, a federal prosecutor, told NPR: “There's a popular misconception that it is these giant seizures that are driving the numbers. And that's not it. The cases that we see every day are individuals who have five kilos of fentanyl and 10 kilos of methamphetamine. And those cases are happening constantly."

Cartels often recruit couriers or mules and are very picky about who they choose, much like they did while smuggling cocaine and other drugs into the USA.

US Vice President Kamala Harris speaks during a meeting with State Attorneys General in the Eisenhower Executive Office building, next to the White House, in Washington, DC, on July 18, 2023. The meeting is being held to discuss possible actions to address the fentanyl public health crisis. (Photo by SAUL LOEB / AFP)(AFP)
US Vice President Kamala Harris speaks during a meeting with State Attorneys General in the Eisenhower Executive Office building, next to the White House, in Washington, DC, on July 18, 2023. The meeting is being held to discuss possible actions to address the fentanyl public health crisis. (Photo by SAUL LOEB / AFP)(AFP)

What are the politicians saying?

The fentanyl crisis has become a hot-button topic for both Republicans and Democrats. On September 20, the White House issued a memo slamming House Republicans over their “partisan agenda” denouncing their shutdown bill, which they said would also affect the fentanyl crisis.

Meanwhile, Republicans like Vivek Ramaswamy in the second GOP Debate have often sought to conflate the fentanyl issue with the migrant crisis. It's a rather bad-faith argument. Keith Humphreys, a professor of psychiatry and behavioural sciences at Stanford told Axios: “If illegal immigration disappeared tomorrow, the fentanyl supply would be unaffected.”

Republicans have tried to blame Biden’s “open border” policies for empowering cartels, a claim denied by Vanda Felbab-Brown, a senior fellow at the Brookings Institution, who says that Biden has actually authorised money to increase inspections. However, Felbab-Brown added: “I don't think you can stop fentanyl from crossing the border."

Either way, as Felbab-Brown points out, the fentanyl crisis is not a ‘delayed threat, but an immediate life and death situation’. One will have to wait and see how American politicians deal with the issue that’s taking, on an average, 150 American lives per day. Currently, it is just a statistic in the entire blame game Olympics

The views expressed are the author's own.

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