Here are some numbers from the Drug Enforcement Administration (DEA) that should, in addition to the challenges noted by Mike Riggs, put a damper on Donald Trump's dream of stopping the illicit fentanyl trade.
"Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier," the DEA says, "transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit." Taking the average of two actual sales cited by the DEA, a kilogram of fentanyl that costs $2,600 can be pressed into 666,666 fake pain pills, each containing 1.5 milligrams of the active ingredient, generating about $10 million in revenue at $15 each.
By comparison, a kilogram of Mexican heroin might generate something like $840,000 in revenue, based on the average retail price per pure milligram reported by the DEA in 2016. In other words, fentanyl is more than 10 times as profitable as heroin, which helps explain why the former has displaced the latter in the United States, especially since smugglers are keen to squeeze as many doses as possible into a given volume.
Given those incentives, cutting off the illicit fentanyl supply will not be quite as easy as the president seems to think. "US government agencies have made considerable efforts to interdict fentanyl and its precursors from entering the US market, but the combination of its small size and high value makes this difficult," Roger Bate notes in a new American Enterprise Institute report. "Mexican gangs and Chinese criminal enterprises find it easy to hide the products through a variety of transit methods."
Bate found that it is easy to buy fentanyl through the Chinese business-to-business trading websites Weiku and Mfrbee. "Via Weiku and Mfrbee, it was possible to buy fentanyl, its analogues such as carfentanil, and their precursors," he says. "Some sellers would only trade in significant volumes (more than a kilogram of fentanyl), but many were happy to sell less than 100 grams of the potent product….Although I had no intention of making the purchases, I was only one click away from doing so….Even if the UK and US authorities did prevent or intercept these deals, I doubt other nations would intercept them, and a motivated user or dealer could use a more circuitous path."
Trump says "the results will be incredible" if the Chinese government cracks down on such websites. Bate is less sanguine. "While the US may come to an agreement with Beijing about closing down sales to the US from business sites such as Weiku, it is unlikely to be fully successful," he writes. "And even if it managed to stop 100 percent of direct sales to the US, enterprising dealers will simply sell into nations such as the UK, repackage the product, and then resell it into the US. Intercepting all packages from the UK and other EU nations to the US will not be possible." Furthermore, "whether or not drugs are available to the general public via the mail, drug dealers have domestic production and overland and sea routes and other courier services that deliver the product to the US."
The fentanyl conundrum is just the latest example of how prohibition undermines itself by enabling criminal organizations to earn a risk premium that motivates all manner of creative evasion. To the extent that increased enforcement has an impact, it tends to makes drug use deadlier. Interviewing drug users and dealers in the Philadelphia area, Bate found that fentanyl has swiftly replaced diverted pain pills, which are less dangerous because their potency and dosing are predictable. "It is arguable that policies to drive oxycodone and other prescription opioids from the illicit market are the main cause of the rise of fentanyl in these markets, and regrettably the resulting spike in fatal overdoses," he writes. "By making prescription opioids harder to come by, government policy has probably driven illicit actors to supply—and drug users to ingest—fentanyls."
That certainly seems to be what is happening. Nor does it stop there. If efforts to restrict the fentanyl supply are at all successful, they will encourage the shift toward still-more-potent fentanyl analogs. Earlier this year, the U.S. Centers for Disease Control and Prevention (CDC) reported that the number and proportion of deaths involving fentanyl analogs "nearly doubled" between the second half of 2016 and the first half of 2017.
In a blog post yesterday, Bate noted signs that fentanyl-related deaths may be leveling off. If so, he does not think the government's drug control efforts should get the credit. "While the numbers may be falling," he writes, "I think the main reason is not because of improvements in federal, state, or local policies, but because dealers—those breaking the law and supplying the deadly stuff—are getting better at controlling dosing. After all, it's bad for business to keep killing your clients and authorities are likely to clamp down on your activities if you keep doing so."
Despite the deadly effects of cracking down on pain pills, Bate says in his AEI report, "lowering the number of prescription opioids in circulation is the right policy—assuming that preventing new opioid addicts is of paramount importance." Even leaving aside the impact on bona fide patients who are losing access to the medication they need to make their lives bearable, that conclusion seems dubious to me.
As Jeff Singer notes on the Cato Institue's blog, data from the National Survey on Drug Use and Health (NSDUH) indicate that both nonmedical use of prescription opioids and "pain reliever use disorder" were essentially flat from 2002 (when the current version of the survey began) to 2010, a period when the volume of opioid prescriptions doubled. Those numbers remained flat from 2010 through 2014, while prescriptions declined. (The wording of the relevant NSDUH questions changed in 2015, so the numbers for more recent years are not comparable.)
According to the CDC, deaths involving pain pills more than doubled from 2002 to 2010. But they continued to rise after 2010, even as prescriptions fell by about a third between 2010 and 2017. More important, total deaths involving opioids, including heroin and fentanyl, rose dramatically, more than doubling between 2010 and 2017.
The NSDUH data suggest the relationship between pain pill prescriptions and "new opioid addicts" is not as tight as Bate implies. But opioid use clearly has become more dangerous during the last decade and a half. That may be partly due to larger doses or more reckless drug mixing. But the biggest factor in recent years has been the proliferation of fentanyl, the impact of which has been magnified by the deadly substitution effect that Bate notes.