Fentanyl, the real social drama in the USA with an international “direction”.

You immediately recognize the modern “zombies” walking along the streets, especially those on the outskirts, far from the downtown areas. It can happen in Philadelphia where, if you move away from the famous “Rocky steps”, always full of tourists who try their hand at the classic race up the steps that ends with their arms in the air, you can notice “them”, the young people they drag themselves along, with their eyes lost. Sometimes they are slumped along the benches and, if you ask passing police to check, the officers shrug their shoulders with an expression that betrays the virtual impossibility of intervening.

The silent massacre. They are the victims of fentanyl, which is killing 100,000 people a year in the United States. An army of young people who fall into the trap of the so-called “zombie drug”, but do so in silence. While in Italy, in fact, the number of news reports increases regarding seizures of substances “cut” with fentanyl or possible alarms for the spread of the substance, in States it is not as visible on the front pages of newspapers. There is little talk about him even on TV, despite him having entered President Joe Biden's agenda. There is a fear of making it a topic of public knowledge, as if it remained a taboo. Yet the numbers of victims are staggering.

The emergency from San Francisco to New York. San Francisco is one of the cities most affected by the emergency. Mayor London Breed is implementing extraordinary measures: “Drug dealing could lead to murder charges,” he declared, while the city is resorting to the double strategy of repression and surveillance at levels never seen before. It was also established Street Response Team, an emergency response team for increasingly frequent overdose cases. Moving to the east coast, to New York, the situation does not improve. “Overdose deaths have reached unprecedented levels,” warns the United States Department of Health, while the health commissioner, Ashwin Vasan, speaks of one death from fentanyl every three hours in the Big Apple alone.

It is also a geopolitical problem. But to understand the dimensions of the phenomenon, which goes beyond statistics, we need to broaden our gaze, as the Biden Administration was also forced to do. The topic has rightfully entered the international agenda, so much so that it was discussed by the US Secretary of State, Anthony Blinken, on a visit to Beijing in April. Even before that, Biden himself had talked about it with Xi Jinping in California at the end of 2023, because the majority of fentanyl supplies come from the Dragon Country, where the drug is produced and from which it is often marketed via the online market. So far Washington has followed a double track: on the one hand the search for collaboration with the Chinese authorities to stop the flows, on the other, however, there has been no shortage of explicit accusations of co-responsibility and complicity. This is why some experts speak of a “new opium war”.

The new opium war. In an article published in the Chinese People's Daily, released in early 2023, read: “Attacking and defaming China will not cure the chronic problem of drug abuse, but will only delay America's drug control problem,” causing “a more serious social crisis.” . «In the USA there have long been many centers specialized in detoxification, but in the case of fentanyl the situation is much more complicated. It takes a very strong will of the people who take it to get out of addiction”, says today Graziano Pinna, neuroscientist, associate professor at University of Illinois Chicago. «The massive availability of this product (and its illegal versions) on the market does not facilitate a solution to the problem. The problem has worsened during the pandemic period, so much so that there is talk of a 'pandemic within the pandemic' due to the increase in the use of alcohol, marijuana and indeed opioids”, adds Pinna.

Why fentanyl is so worrying. «The case of fantanyl is particularly dramatic: it is a painkiller approved by the US Food and Drug Administration, 50 times stronger than heroin, 100 times stronger than morphine. This also makes it a cause of overdose deaths when used as a drug. In the USA there are an average of 152 victims per day. If in 2011 there were 2,600 deaths, from 2012 to 2021 an estimated 250 thousand deaths – recalls the neuroscientist – It causes addiction problems because like other narcotic substances it activates the so-called reward system, a gratification upon intake with an effect of relaxation and apparent well-being. As a painkiller it is prescribed after surgery or cancer but, in case of abuse, it can cause very serious effects, especially because it is often associated with the consumption of alcohol, marijuana and cocaine, or is combined with other molecules that increase its danger.” The symptoms are the classic ones of overdose: «Constriction of the pupils, difficulty staying awake, loss of consciousness and weak or absent breathing, leading to a drop in body temperature with a pale color of the skin», explains Pinna again.

Because it spread so quickly. «Unlike other drugs, there was originally no demand, it didn't even have a particular name in jargon, no one among the young people was specifically looking for fentanyl. Its spread was desired by criminal trafficking organizations, including Mexican narcos, and has various reasons, which also involve countries such as Afghanistan and China. The circulation of the opioid is certainly due to ease of production and low costs”, explains Riccardo Gatti, doctor, psychiatrist and drug expert, called to the USA in the 1980s to study the phenomenon of the spread of crack and cocaine. , together with a group of international experts. Today Gatti is coordinator of the Technical Table on Addiction of the Lombardy Region, but continues to look at the “American observatory” and underlines: «It is often said that what happens in the USA is then replicated in Italy, which is why the problem should not be underestimated and we need to know its dynamics.”

From drug to zombie drug. Experts have no doubts: what facilitated its circulation as a drug was a problem that in the past affected the sale of drugs in the United States. Faced with an excess of 'easy' opioid prescriptions by American doctors, with an increase in overdose cases, the authorities had imposed restrictions. But the effect was that patients turned to the underground online market. Today the largest producer is China. What favored its transition from medicine to narcotic was its very low cost and ease of production: in fact, it is not linked to any cultivation, because it is a synthetic drug, made in a laboratory. Furthermore, being very powerful, minimal quantities are enough to have many doses. Finally, it is easily transportable and concealable, even by narcoswho understood the economic potential of drug dealing.

A potentially global market. «The Sinaloa cartels in Mexico and the international mafias are creating a sort of global market, which is no longer local or regional as the drug dealing markets once were. Production is Chinese, synthesis takes place in Mexico, distribution – for now – is mainly in North America. But let's remember that the starting point of drugs arriving in Europe and Italy is above all South America, as in the case of cocaine. Already last autumn, the then EU Commissioner, the Swedish Ylva Johansson, had met with the Interior Ministry of Latin American countries, fearing the risk of preliminary agreements between the fentanyl producer cartels and criminal organisations”, comments Gatti.

Lethal mixes that scare. Another characteristic of fentanyl is also worrying the American authorities for now. In addition to creating addiction, therefore pushing young people into a form of consumption that is very difficult to escape from, the opioid is not a product that can be bought “as is”: it is generally found in a mix together with other substances, such as cocaine or heroin , which together strengthen each other. Just think of the singer Prince, who passed away in 2016 due to a cocktail of substances that also included fentanyl. Now, however, it is found in counterfeit medicines sold online and in this case the risk of harmful effects is even greater because it could also involve people who are unaware of what they are taking, who perhaps purchase products from 'parallel' markets via the internet.

A risk even for non-drug addicts. In Italy, attention to the phenomenon has grown, especially after the recent seizures of drugs “cut” with fentanyl. «It's a worrying sign. The fear is that it is almost a test on a new product to be peddled. In this case the risk is of finding ourselves in a situation similar to that of North America, where products that are compounds of fentanyl combined with other substances circulate. This would be even more worrying because the consumption of these products is not limited to the classic and old image of the drug addict, but are designed for the entire population. The fact that it is called a 'zombie drug' does not mean that it is only consumed in degraded areas. Furthermore, its very nature as a synthetic substance leads to a broadening of the gaze. In Afghanistan, for example, the Taliban have stopped producing opium poppies. This leads to a shortage of stored product, which therefore needs to be replaced: hence the interest in heroin cut with other synthetic products”, explains the doctor.

The geopolitics of drugs: an improper weapon? «Another aspect also concerns the current conflicts, which increase global instability and also make international drug trafficking from producing countries more difficult. A substance like fentanyl, easy to make in the laboratory, simplifies management by drug traffickers. Finally, it is useful to ask ourselves a question: what interest could there be in illegally selling such a dangerous drug, which claims so many victims and therefore potential consumers and buyers?”, asks the expert. «The discussion shifts to the level of balance of power at the level of global powers, such as the USA and China. Why discuss fentanyl? Why did it spread to North America? There are those who believe that it could even be some sort of improper weapon. The problem, however, is not just China where most of the substance's precursors come from or the substance itself.

India also ready to produce fentanyl. «Assuming Beijing stops producing fentaynl, it could be replaced by other competitors, such as India, which has large drug production capabilities and human resources capable of doing so. So the problem would no longer be just the spread of a dangerous substance, but the changes in the world of drugs (with new types of products) and the meaning of drug dealing, the reasons why criminal organizations could have an interest in killing 100 thousand or more customers per year.”