Even as the Senate prepares to hold a final vote on a massive bill to address the U.S. opioid crisis, more will be needed to stop the flow of deadly illicit products, like fentanyl and its analogues, into the nation's communities, a panel of witnesses told U.S. senators.
The drugs are mostly made by chemists in China, which has expressed some desire to cooperate with the U.S., but has taken little action to rein in fentanyl makers and traffickers, the witnesses said during an Oct. 2 hearing convened by the Senate Caucus on International Narcotics Control.
"The Chinese are very aware that this is an important political issue in the United States and that it's tied to rule of law," said Derek Scissors, a resident scholar at the American Enterprise Institute, a Washington think tank. "There's no good reason for the Chinese not to be good cooperative partners with us on this."
China does not have the reasons that some other countries do with lack of capacity to take action to curb illegal commerce, Scissors told the senators.
China will only make changes "if it's a priority for them," which right now it is not, he said.
For the U.S. to get China to take action, "it is going to require a coercive threat," Scissors said. "If you're not prepared to coerce them, you're subject to whatever their internal decision-making is."
Fentanyl's spread in the U.S.
Fentanyl is produced at big pharmaceutical labs and by sophisticated amateur chemists in small mom-and-pop shops in China and then easily shipped into the U.S., typically through the international mail system, said Sen. Chuck Grassley, R-Iowa, chairman of the Senate Judiciary Committee, who leads the caucus with Sen. Dianne Feinstein, D-Calif.
"A single individual with a computer, a [post office] box and a pill press can order fentanyl directly from China to his or her home," Grassley said.
Chinese exporters also ship their illegal fentanyl products to drug cartels in Mexico, where the illicit drugs are then funneled over the southern border, he said.
Paul Knierim, deputy chief of operations at the Drug Enforcement Administration's Office of Global Enforcement, said the Mexican drug cartels are the "most significant criminal threat to the United States."
"The cartels continue to be the primary source of illicit drugs that are decimating our communities," Knierim told the senators.
"Now, Chinese and Mexican nationals are increasingly operating in concert, resulting in an alignment responsible for the proliferation of heroin, fentanyl and related synthetics coming across the southwest border," he said.
The products also are being smuggled into the U.S. from Canada from traffickers who buy the products from China, added Feinstein, the Judiciary Committee's ranking member.
Fentanyl is cheaper to produce than other plant-based drugs, like heroin, and it has a bigger profit margin for traffickers, Feinstein noted.
"These synthetics are cheap to make, hard to do detect and dangerously potent," Knierim said.
A $3,000 to $5,000 investment in fentanyl yields a $1.5 million profit, versus $80,000 for a $5,000 to $7,000 investment in heroin, Feinstein said.
"The new economic model for these drug traffickers poses a unique problem never seen before — massive drug rings have been replaced by the sole proprietor," Grassley added.
To make matters worse, drug dealers are using fentanyl as a cutting agent for other street drugs, like black-tar heroin and cocaine, adding to their potency, he said.
The Centers for Disease Control and Prevention has blamed fentanyl as the key driver for the skyrocketing increase in drug overdose deaths in the U.S. — a problem that has gotten worse under the Trump administration, reaching an all-time high of 72,000 in 2017.
Last year, 60% of U.S. opioid deaths involved fentanyl, Grassley said.
Between 2014 and 2016, fentanyl-related overdose deaths increased nearly 600%, he said.
"Fentanyl is now involved in more deaths than prescription opioids or heroin," Grassley said.
Working with China
Various agencies within the U.S. government have been working with Chinese officials to try to stem the tide of fentanyl invading American communities, some witnesses testified.
"Chinese officials have continued to say that they want to deepen counter-narcotics cooperation and we're going to continue to press them to do so," said Kirsten Madison, assistant secretary in the State Department's Bureau of International Narcotics and Law Enforcement Affairs.
Madison said her office has been focused on growing political will within the Chinese government to work with the U.S.
"We exchange chemists with them and we bring them here to see our treatment programs because we're trying to make sure that they understand the depth of this crisis in this country and that they understand that we have a fact pattern that demonstrates that they're a source and that we need their cooperation," she said.
But Madison said "we've seen some pushback" from China and cooperation is "not as much as we'd like."
The stick of influence
It is unlikely that China will acknowledge its role in the U.S. opioid crisis because that would open up a Pandora's Box domestically, giving critics of the Communist Party more ammunition to point out that it cannot halt the production of illegal or tainted drugs, AEI's Scissors said.
He urged against imposing broad national sanctions on China, saying that would be too harsh, since it would also punish the provinces and companies that are cooperating.
Rather, Scissors said, Chinese municipalities and provinces that do not cooperate on fentanyl with U.S. law enforcement, like Guangzhou, can be deemed areas of unsafe production and risky investments — the "stick" to get them to comply.
Given China accounts for 40% of the world's production of active pharmaceutical ingredients and is an active player on the drug company mergers and acquisitions stage, if the U.S. was to threaten to decertify certain companies and regions and identify them as untrustworthy, "they would have a very powerful economic incentive to then cooperate," Scissors said.