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News Roundup: May 24, 2018: A Visit to a Chinese Fentanyl Lab
By ROGER PARLOFF|May 24, 2018
Quick Takeaway
  • Bloomberg reporters visit an "illicit" fentanyl lab in China.
  • John Oliver and others expose egregious rehab scams.
  • AG Jeff Sessions' crackdown on a Louisiana drug distributor backfires.

We’ve written a fair amount about the menace of illicit labs in China and elsewhere, producing potent and lethal synthetic opioids, like fentanyl and its analogs, often marketed over the darknet. Illicitly produced synthetic drugs now account for fully half the opioid overdose deaths in this country. Drug policy analyst Robert DuPont has warned us that “the global illegal market is switching from agricultural products to purely synthetic drugs,” and that this fact is driving the future of the epidemic.

But what we’d frankly not known was that some of these illicit labs abroad are actually operating so openly that a couple Bloomberg journalists could go visit the owner of two of them at his home in Wuhan and casually inform him, to his apparent surprise, that he’d been indicted last September as a drug kingpin in Gulfport, Miss. We’d also not realized that China would react to all this by expressing offense that the US had “unilaterally” indicted one of its nationals and by arguing that the defendant had not violated any Chinese law—notwithstanding that he allegedly exported 22 drugs, including four fentanyl analogs, into the US, where they are banned.

We’ll have more on that remarkable story, by Bloomberg’s Esmé E. Deprez and Ken Wills. Otherwise, this week was dominated by powerful exposés—including, but not limited to, a segment on Last Week Tonight by John Oliver—about hucksters, scams, and frauds in the addiction rehab and treatment industry, where there is no federal regulation, scant medical protocol, and altogether insufficient guidance for desperate families trying to find their way to science-based, affordable, reputable treatment centers.

 

Fentanyl and Other Synthetic Drugs 

“They would take two puffs and bam, they’d drop right there,” a witness told the New York Times. “People just started falling to the ground.”

That was from the paper’s story on May 20, after 14 people in the Bedford-Stuyvesant/Bushwick sections of Brooklyn overdosed on something believed to be K2, a synthetic cannabinoid sprayed onto plant material and sold as synthetic marijuana. By the time a followup story came out two days later, the overdose toll had risen to 56, with 84 emergency room visits linked to the same batch.

Synthetic marijuana, found in the trunk of a car after a traffic stop in Ocean Springs, Miss., in 2013 also ignited the DEA investigation that eventually led to the indictment of Yan Xiaobing. Yan ran a company called 9W Technology, which had two chemical labs. According to the indictment, Yan was supplying a wide range of synthetic drugs, including fentanyl analogs, to more than 100 distributors in New Orleans, Baltimore, Portsmouth, NH, and dozens of other US cities, not to mention locations in Russia, Kuwait, Sweden, Brazil, and 16 other countries. (An American street dealer can make far more profit off synthetics than heroin, the article explains, because synthetics are so cheap and potent. With the same investment, a dealer in Gulfport, Miss., could make $4,000 off heroin, or $7.8 million from off fentanyl, the reporters calculate.)

Yan has not been arrested in China. In December, an official with the Chinese National Narcotics Control Commission told Vice that the US had failed to show that Yan or a codefendant had violated Chinese law. Moreover, he said, the United States’s “unilateral indictment of Chinese nationals” had caused “practical difficulties” for China in investigating them. According to Bloomberg: “American officials speak in the language of diplomacy when they address China’s cooperation. They applaud its addition of more than 130 synthetic drugs — including at least 10 fentanyl analogues — to its list of controlled substances since 2015. In Beijing, presidents Xi Jinping and Donald Trump in November discussed ways to enhance coordination on drugs and fentanyl in particular.”

Addiction, Families and Treatment

  • John Oliver’s powerful exposé of hucksterism in the rehab center industry shows the daunting array of dubious characters that are currently permitted to prey on addicted individuals and their families, charging exorbitant fees and claiming 80-percent success rates for highly unproven techniques, including “equine therapy” (i.e., petting horses). Oliver also mentions, among other things, the deadly Florida Shuffle, which we have also written about. Furious patients tell of how they were exploited. The quasi-comic tone turns unambiguously tragic at the end, when one learns that some of the most articulate patients you’ve heard from during the segment have, since the time of their videotaping, already died.
  • Exposing an even more dastardly variation on this theme, Reveal—the website of the Center for Investigative Reporting—reports that an addiction recovery facility in North Carolina was putting patients to work 16-hours-a-day, for no pay, in local adult care homes for the disabled and elderly. Some of these unfortunate recovery patients had even been sent to this facility by drug courts, as an alternative to prison.
  • Such abuses are so extreme that it’s tempting to dismiss them as aberrations. That would be a mistake. These abuses are symptoms of a broader, more pervasive failure, which Laura Hilgers puts her finger on in a succinct New York Times opinion piece. “It makes no sense,” she writes, “that what is fast becoming our greatest health care crisis is still dealt with mostly outside the mainstream medical system.” As a result, “there is no national standard of care for treating addiction.” She quotes Anna Lembke, the Stanford medical school professor and addiction psychiatrist, who says: “It’s not really that there’s no road map. It’s that the road map has not been recognized or embraced by the house of medicine.” It also doesn’t help, Hilger notes, that “the $35 billion rehab industry is regulated piecemeal, state by state.”
  • Fortunately, for a family navigating this daunting landscape there are some trustworthy places to begin. The Partnership for Drug-Free Kids, for instance, has a helpful list called What to Look For and What to Avoid When Looking for an Addiction Treatment Program. That is just one of a number of reliable resources for families now made available at the new MedicineSafe site, which was launched earlier this month by The Partnership and the Center for Safe Internet Pharmacies, in a coalition that includes the Offices of the Governor and Attorney General of Connecticut, the North Carolina Department of State, and AARP of Connecticut.
News Roundup: June 8, 2018: Pain Refugees

Regs, Laws & Politics

  • Attorney General Jeff Sessions wanted to send a powerful message to prescription opioid distributors. And he did. Unfortunately, the message was that portions of his department have become either incompetent or politicized. On May 2 the DEA issued the first immediate suspension order (ISO) against a drug distributor since 2012, halting all opioid shipments by Morris & Dickson, a Shreveport, La., company. The agency claimed M&D posed an “imminent danger” to the public health because it was shipping suspiciously large orders of opioids to certain pharmacies. M&D, a family business founded in 1841, employs 787 people, and had never before been fined or subjected to an enforcement order in its 177-year history. Six days after the ISO, a federal judge issued a temporary restraining order against the DEA, allowing M&D to resume normal operations. M&D had presented evidence that the DEA had misapplied its own methodologies with respect to 70 percent of the challenged sales. The judge concluded that it was the DEA that was creating an “imminent danger to the public health,” not M&D, according to the Washington Post. On May 18, the Justice Department rescinded the ISO rather than defend it further.
  • The FDA approved the first drug to fight migraines: Aimovig, made by Amgen and Novartis. A JAMA editorial calls the drug “Progress, but not a Panacea.”
  • Joe Davidson of the Washington Post argues in an editorial that the Trump Administration’s opioid policy is “missing in action.”
  • The Hill has a story about “the Bridge,” a device worn behind the ear that is supposed to help mitigate withdrawal symptoms. The FDA approved the neuromodulator for this purpose last November, but ethical and legal issues have since been raised about the study that was used to vouch for its safety and efficacy.

Also of Note

  • With Mayor Bill de Blasio eager to open safe injection sites in New York City, the New York Times takes a look at how they’re working in Canada. In Toronto 214 overdoses have been reversed since August. (The Canadian sites prefer oxygen to to naloxone for reviving overdose victims. “The goal is to treat the overdose without reversing the high — a result when naloxone is used — so that the user is not thrust into immediate withdrawal and a new search for drugs.”)
  • The AP concludes, after a lengthy investigation, that involuntary commitment of people with addiction—i.e., by court order—“largely doesn’t work and could raise the danger of overdose for those who relapse after treatment.” Though it’s a rare remedy, use of civil commitment orders is increasing, with Florida (10,000 requests in 2016) and Massachusetts (6,000) in the lead. Massachusetts is considering a bill that would permit 3-day commitments ordered by “medical professionals” without a judge’s order.
  • Nigeria is suffering an opioid crisis revolving around the synthetic painkiller tramadol, per Buzzfeed.
  • The supply of opioid prescriptions is driving the epidemic more than economic woes, says the Wall Street Journal, reporting on a study by two economists at the Federal Reserve Bank of Cleveland. “People in areas with higher opioid prescription rates are less likely to participate in the labor force, and have lower employment rates. Yet the share of people abusing opioids didn’t increase because of the last recession.”
  • Opioid deaths appear to have finally crested in three hard-hit, northeastern Ohio counties, according to the Cleveland Plain Dealer. Credit is given to the greater accessibility of naloxone (the overdose reversal drug) and law enforcement crackdowns on fentanyl and carfentanil suppliers.
  • Fortune has the definitive story on the current shortage of injectable opioids. It turns out that this shortage is a subset of a broader set of shortages involving “generic sterile injectable drugs”—mostly nonopioids—a market dominated by Pfizer. As of May 11, Pfizer had 370 products that are “depleted or in limited supply, 102 of which the company has indicated will not be available until 2019.” The main causes of the shortages, reporter Erika Fry concludes, are production problems at two Pfizer plants (formerly run by Hospira) and general market failure. (Though these generic drugs are medically crucial, they are low-margin and, hence, low-priority from a profit-generation perspective.) Though some have speculated that lowered DEA ceilings on opioid production have contributed to the injectable opioid shortage—perhaps even driven by miscalculations by IQVIA—nothing in this article supports that theory.
Filed under: Fentanyl/ News Roundup