Читать книгу Fentanyl, Inc. - Ben Westhoff - Страница 12
ОглавлениеThe 1989 police action comedy Tango & Cash, starring Sylvester Stallone and Kurt Russell as narcotics detectives with outsize opinions of themselves, may not have gotten great reviews, but it did inspire the name of a new fentanyl product, which began killing people in the northeastern United States in early 1991. The deceased included residents of New York City, Newark and Paterson in New Jersey, and Hartford, Connecticut. Almost all of the drug called Tango and Cash seemed to originate from an open-air drug market in the Bronx, near 138th Street and Brook Avenue, described in the Hartford Courant as, “a kind of regional wholesaler to dealers from cities around the Northeast.” Paramedic Steven Harbeson recalled a sudden, dramatic increase in Hartford overdose calls. Before the opioid-antidote Narcan was available as a nasal spray, first responders would inject it straight into the vein. “Many of the heroin users back then would leave a vein available for EMS,” he remembered. Over the weekend beginning February ٢, ١٩٩١, Tango and Cash caused a dozen deaths and more than one hundred overdoses.
The New York Times quoted a thirty-nine-year-old heroin user named Richie, who was pursuing the drug despite its toxic effects. “When an addict hears that someone O.D.’d, the first question they ask is: ‘Where’d they get it?’ Because they want to find some of it for themselves.”
The deaths continued. During 1991 and 1992, 126 people in the Northeast died from this new fentanyl product, which was also sometimes called China White. More than twenty of the deceased came from Philadelphia. “Some of the Philadelphia junkies died so swiftly that syringes were still embedded in their arms,” reported the Baltimore Sun. Alpha-methylfentanyl, even though it had been scheduled in 1981, was discovered in some of the Tango and Cash batches. (News reports from this era weren’t always clear about whether the drugs involved were fentanyl or a fentanyl analogue like alpha-methylfentanyl, so the term fentanyl is used below to reference both.)
For almost two years, police remained stymied in their search for the drug’s source. But then in December 1992, they received a valuable clue from a Boston drug dealer named Christopher Moscatiello. In the midst of a fentanyl sale, he mentioned to a customer that his Wichita, Kansas, supplier had nearly died from a fentanyl overdose. Moscatiello didn’t realize it at the time, but the customer was actually a DEA agent.
DEA began pursuing the tip, despite the fact that Kansas seemed an odd place for a fentanyl laboratory, since the Midwest wasn’t yet associated with deaths from the substance. But it turned out the supplier in question had Eastern ties. He was a Pittsburgh businessman named Joseph Martier. In August 1992 paramedics responding to a 911 call found Martier passed out in a storage building near Wichita, having overdosed on fentanyl. In February, 1993, the DEA arrested Martier and raided his facility, alleging that his was the country’s only lab making fentanyl. This drug, the agency noted, was “the serial killer of the drug world.”
Also taken into custody was Martier’s partner, a drug cook named George Marquardt. No ordinary illicit chemist, Marquardt was an oddly philosophical, hyperintelligent chemistry prodigy. A retired DEA agent later called him “the very best illicit chemist in the history of American drugmaking.”
As a child Marquardt had been fascinated by “an anti-drug film in which a mouse on LSD chased a cat.” Before he was old enough to drive, he was making heroin with a friend, and after doing research for the University of Wisconsin (from which he pilfered lab equipment) he pretended to be a member of the Atomic Energy Commission, falsely adding the claim to his CV in an attempt to trick a Milwaukee college into accepting him as a physics lecturer. The ruse succeeded.
Marquardt single-handedly fashioned his own mass spectrometer, a complicated scientific instrument used to identify chemicals, and became a drug mercenary for hire, eschewing the academic world because it didn’t pay enough. But he was genuinely fascinated with the magic of chemistry and had a selfless streak as well. At one point, he said, he synthesized clandestine AZT for people with AIDS. Marquardt made his name, however, with hard drugs, venturing further and further into a dangerous underworld, emboldened by a belief—similar to one held by Walter White of the series Breaking Bad—that drug kingpins wouldn’t kill him because he made a superior product. He first learned about fentanyl in 1978, while doing jail time after being busted at his Oklahoma meth lab. Upon his release he began producing fentanyl, but not before doing his homework. “I read the forensic science literature religiously,” he said. “I read publications like Police Science Abstracts. Surveyed all the appearances of fentanyl everywhere that I could find out from the literature. And gave careful thought to what these people had done wrong.” He reported spending more than a week at a time cooking up batches, and he sought to make different varieties of fentanyl so his products would appear to come from different labs and thus confuse the authorities.
The DEA, however, believed it could trace the 126 Northeastern deaths back to Marquardt and Martier’s lab, and Marquardt was charged with distributing and manufacturing fentanyl. He immediately confessed to his crimes. “I just don’t bother with the lies,” he said. “When the game’s over, it’s just over. If you can’t deal with the consequences of these things, you should have carried a lunch bucket.” In the end, Marquardt’s products were thought to have killed more people than initially suspected—perhaps two hundred or even three hundred. He served twenty-two years in prison and was released in 2015.
Marquardt now swears he is done with fentanyl, but he has little remorse. “I don’t feel like I’m supplying a product to an innocent or naïve population,” he said. “I attach no blame to them. They are what they are. I am what I am. We’re both criminals.”
The moral discussion of accountability becomes more complicated when one considers legitimate university scientists who, like Marquardt, were also making fentanyls. They sought to patent new chemicals that would benefit the study of medicine and, ultimately, people suffering from pain. For this reason, most people would give them the benefit of the doubt, despite the fact that they were often motivated by financial gain as well—and that such scientists sometimes unwittingly paved the way for rogue chemists to exploit their work.
A fentanyl analogue called 3-methylfentanyl, patented by a University of Mississippi professor of medicinal chemistry named Thomas Riley, provides a case in point. Riley developed it from Paul Janssen’s original fentanyl, and hoped that 3-methylfentanyl might perhaps maintain fentanyl’s potent analgesic (or pain-reducing) qualities, without sharing its dangerous attributes, and catch on as a medical product. In 1973, he and two other collaborators published a paper about their studies of 3-methylfentanyl on rats, but the results were not what Riley hoped. It was never commercially marketed, and he never made any money off it.
With addicted users, however, 3-methylfentanyl was a huge hit. In the late 1980s it killed eighteen people in western Pennsylvania. Predating Tango and Cash, this was the first major case of fentanyl-related deaths since the California overdoses earlier in the decade.
More than a decade later, 3-methylfentanyl was at the center of an armed hostage crisis in Moscow. On October 23, 2002, a huge crowd had gathered in a converted ball-bearing factory for the performance of Nord-Ost (Northeast), a musical celebrating Russian heritage that was the most expensive production of its kind in the country’s history. The show came to an abrupt halt when dozens of Chechen rebels seized control of the facility, taking about eight hundred attendees hostage and threatening to kill them if the Chechen war with Russia wasn’t immediately ended. The standoff lasted for several days, and on October 26 Russian security police pumped a gray aerosol gas into the building, intending to knock out the hijackers before forcing their way in. The guerillas were killed, but so were about 120 of the hostages, who were already weakened by days without food or water. Some died en route to the hospital.
Though authorities initially declined to say what chemical agent had been used, the Russian health minister and a Russian newspaper later identified it as 3-methylfentanyl. Subsequent analysis of survivors’ clothing indicates it was possibly a chemical cocktail containing numerous drugs, including carfentanil.
Russia claimed that the gas used was nonlethal and intended to simply put both the rebels and the civilians to sleep. Though some praised the Russian effort for saving the majority of the hostages, many international observers criticized it as a type of chemical warfare that not only violated international treaties but also was based on foolhardy science.
“There is no way known to medical science that can put a large number of people to sleep without killing a sizable percentage of them,” said Harvard biology professor Matt Meselson. “In medicine you are dealing with one patient. You can see when he is asleep and, assuming your hand isn’t shaking too badly on the valve, you probably won’t kill him. But the military objective is different. You have to put 100 percent of the people to sleep—not 50 percent, not 70 percent—and you have to put them to sleep fast. There isn’t any way to do that effectively and safely.” Analysts continue to worry that fentanyls could be used in large-scale attacks, particularly by terrorists, considering that a tiny amount can do such damage. In January, 2019, Massachusetts senator Ed Markey wrote letters to the State and Defense Departments, warning of the possibility of such an attack on Americans. “To my knowledge, no such strategy exists at present for addressing the threat fentanyl poses,” he wrote.
In 1988, an international treaty scheduled 3-methylfentanyl—effectively outlawing it in much of the world—but by the early 2000s it had begun catching on as a street drug in Eastern and Northern European countries such as Estonia. The small former Soviet satellite, known for its brisk economic growth, already had a large heroin problem, but the heroin supply from Afghanistan was squeezed after the Taliban banned opium poppy farming in 2000. Fentanyl and 3-methylfentanyl began to take off, likely entering the country from Russia, which it borders. Over the next decade a thousand or more Estonians died from fentanyl and 3-methylfentanyl overdose, a startling number for a country of only 1.3 million.
Though the heroin supply has reemerged, the destruction from fentanyl and 3-methylfentanyl continues in Estonia. “The dealers realize it’s easier to traffic and package fentanyl than heroin . . . and so they strictly control the market in favor of fentanyl. Even though drug users themselves say they would prefer heroin, it’s simply not allowed [by dealers] in Estonian markets,” observed Aljona Kurbatova, head of the Infectious Diseases and Drug Abuse Prevention Department at Estonia’s National Institute for Health Development.
A 2016 study showed Estonia to have the highest increase in drug-overdose deaths in the world, and the entrenchment of fentanyl and 3-methylfentanyl there serves as a portentous warning for number two: the United States. Despite hopes that the crisis has peaked, experts believe fentanyl and its analogues could be just picking up speed. Fentanyl is also threatening to become an epidemic in other countries. Australia saw 232 deaths from synthetic opioids like fentanyl in 2017, and the number is believed to be surging. The UN Office on Drugs and Crime (UNODC) reported that the most common method of illicit fentanyl use in Australia seems to be extracting the drug from pharmaceutical products such as transdermal patches and that this is also the case in Germany. While Europe’s problem with fentanyl is smaller than North America’s, a sharp uptick in deaths indicates the crisis may also be spreading to the United Kingdom, which according to one survey buys more fentanyl from the Dark Web than any other European country.
Even aside from fentanyl, fentanyl analogues have triggered a crisis in some countries. In 2016, Sweden suffered forty-three deaths associated with acrylfentanyl, an analogue discussed in scientific literature during the 1980s but unknown in Sweden until it started killing people. In 2017 another analogue, cyclopropylfentanyl, caused more than seventy deaths there. Now, because of the fentanyl analogues, fentanyls as a class have displaced heroin as the number-one killer drug in the country. The analogues there are purchased almost entirely over the Internet, from China.
Other European and Eastern European countries are also starting to see fentanyls from China, but that’s a fairly recent development. Until recent years, European fentanyl was procured locally—stolen from pharmacies, for example, or harvested from patches in hospital waste—or received from Russia and its Eastern bloc neighbors.
Russia itself imports vast quantities of ecstasy and synthetic cannabinoids from China, and the country has widespread public-health problems with drugs including heroin and “bath salts.” Russia also harbors a huge psychonaut community, whose members create new drugs and discuss them on Internet message boards. It’s difficult to gauge whether Russia suffers from widespread fentanyl addiction, because its data reporting is very poor. The country has undoubtedly been producing the synthetic drug for a long time, however, both legally and illegally. Before the dissolution of the USSR, it was producing fentanyl for its army. “It was included as a painkiller in the emergency kits for Soviet Union soldiers,” said Roumen Sedefov of the European Monitoring Centre For Drugs and Drug Addiction. “After the Soviet Union collapse, we think there may have been huge stockpiles of fentanyl, in Lithuania and other countries, and a lot of it was diverted into Europe and sold on the illicit market. This may have fueled, partly, the epidemic here in Europe.” William Leonard Pickard, a famed LSD chemist now serving a life sentence for conspiring to manufacture and distribute LSD, studied the Russian fentanyl epidemic in the 1990s while a student at Harvard’s Kennedy School of Government. He uncovered Mafia-run laboratories in Azerbaijan, where chemists who were winners of the Russian chemistry olympiad synthesized fentanyls including 3-methylfentanyl. They were imprisoned, but he feared that other out-of-work chemists formerly employed by the Soviet Union could spread fentanyl far beyond the country’s borders.
The fentanyl analogue 3-methylfentanyl has never been used as a medical drug. There is no legitimate need for anyone to have it, with the exception of official forensic labs in places like Estonia, where tiny quantities are needed to verify the types of street fentanyl that are killing people. Still, numerous Chinese labs make it for illicit use.
Though 3-methylfentanyl has likely killed thousands of people, its inventor, Thomas Riley, who died in 2005, appears to have been unaware of the fallout. His widow, Phyllis Riley, doesn’t believe he knew the drug was used illicitly. One of his former colleagues, retired University of Mississippi pharmacology professor Marvin Wilson, was Riley’s coauthor, along with Danny B. Hale, of a 1973 paper about 3-methylfentanyl published in the Journal of Pharmaceutical Science. Wilson acknowledged, to me, that drug peddlers could have learned about 3-methylfentanyl from their paper. “Chemists of the [DEA] believe that any competent chemist could make the substance after reading Dr. Riley’s description in the chemical literature,” concurred a 1980 New York Times article on the subject. Wilson recalled they weren’t much concerned with its abuse potential. “Because it was so potent, a lot of us at the time thought that it probably won’t get into the abuse channels, because it would be so potentially dangerous, and small changes in the dose could have dramatic effects on the body. We weren’t thinking of it as a new heroin.”
The conflict between legitimate medical science and illicit drug chemistry has come to the forefront as NPS have spread. Not just fentanyls, but deadly hallucinogens, synthetic cannabinoids, fake ecstasy, and other stimulants have all gotten their starts in scientific labs. Academics say nothing can stop legitimate scientific creations from crossing over into the realm of abuse—without stifling science. Nonetheless, the trend has caused some outraged family members of overdose victims to demand that the university-sanctioned creators of these drugs be held accountable.
“We as scientists just haven’t been able to differentiate the receptors that lead to abuse from those that are associated with the analgesic,” Wilson laments. “And that’s a conundrum. Scientists come up with knowledge, and people choose to use that knowledge in different ways. Some beneficial, and some not so beneficial. But to not continue the scientific endeavor, certainly is not a good option for mankind either.”
Marvin Wilson and his colleagues were not alone in underestimating the potential popularity of fentanyl. Experts ranging from health-care professionals to top scientists knew how powerful and addictive fentanyl was, and yet very few of them expected it to seize hold in the general population. The underestimation of fentanyl’s potential extended to the DEA, even as recently as 2015. That year the agency’s National Drug Threat Assessment Summary, which focuses on drug abuse trends, read: “Fentanyl will remain a threat while the current clandestine production continues; however, it is unlikely to assume a significant portion of the opioid market. Fentanyl’s short-lasting high, coupled with its high mortality rate, renders it unappealing to many opioid users who prefer the longer-lasting high that heroin offers and who wish to avoid the increased danger from fentanyl.”
One year later, fentanyl had shot past heroin and was killing more Americans annually than any other drug in American history. And the fentanyl analogues, which are being developed and marketed at a rapid clip, threaten to make the problem worse. Seventeen analogues were reported to the UN Office on Drugs and Crime between 2012 and 2016, some of which were developed from information found in scientific papers published thirty or forty years ago. These fentanyls—including ocfentanil, furanylfentanyl, acetylfentanyl, and butyrfentanyl—had never been made into marketable drugs. They could have existed only on paper, but at a time when old research is more accessible than ever before, these chemicals have roared to life.
We are now living in pharmacology professor Gary Henderson’s dystopian future, which he described in his 1988 paper “Designer Drugs: Past History and Future Prospects.” Just as Henderson predicted, the production of illicit fentanyl has become an international business. Like most NPS, the majority of illicit fentanyl is made in Chinese drug laboratories. It’s then sold over the Dark Web to individual dealers or shipped to Mexican drug cartels, who press it into counterfeit pills, cut it into heroin, coke, or meth, or package it up as powder and bring it into the United States.
What Henderson didn’t predict is that many fentanyl users don’t even realize they are taking it. Thinking they are buying another drug, they instead receive a product cut with fentanyl. They don’t know they have put a potentially lethal drug into their system until it’s too late. Today, in many places, little heroin can be found that hasn’t been cut with fentanyl. “There are very few people that just make pure heroin nowadays, because of the quality of ‘El Diabolito,’ ” a Sinaloa trafficker told Fusion, referencing fentanyl.
That dealers would kill off their own clients may seem counterintuitive.
“It brings more business,” said Detective Ricardo Franklin, of the St. Louis County Police Department’s Bureau of Drug Enforcement. “Sure, it kills more people, but from a user standpoint, they’re not thinking about the death. When they hear someone OD’d, they think it must be an amazing high. A friend who will tell a friend who will tell a friend, and in the end it’s promotion.”
“If addicts find something that killed somebody, they flock to it,” said Jack Sanders, a former fentanyl dealer from St. Louis. “They want the strongest product possible. Most people, they want to be drooling. The dealers don’t look at it as if we’re losing customers. They look at it as if we’re gaining more customers.”
Today, Janssen Pharmaceutical of Johnson & Johnson makes only one fentanyl product—the fentanyl patch. Marketed as Duragesic, it helps relieve chronic pain, including in cancer patients. Patented in the United States in 1986, Duragesic was approved by the FDA for advanced pain treatment in 1990, with medical fentanyl no longer required to be diluted with droperidol. By 2004 it was a certified blockbuster, clearing $2 billion in worldwide sales. But like Purdue Pharma, the makers of OxyContin, Janssen Pharmaceutical engaged in deceptive marketing, suggesting Duragesic had less abuse potential than other opioids. In 2000 the FDA said that this and other claims Janssen made about the patch were “false or misleading,” and four years later the FDA instructed the company to “immediately cease” such claims, including the claim that the patch was less abused than other opioids.
Sales dipped after Duragesic’s patent expired in 2006, and Janssen stopped marketing it two years later, according to a company spokesperson, but the patch is still used in medicine, and different companies sell other fentanyl medical products, including a lollipop. The patch in particular continues to be trafficked on the black market. Not long ago on the Dark Web emporium Wall St. Market, for example, Duragesic patches were being offered for one hundred dollars each, from a vendor called BigPoppa7777.
Even as it devastates communities in North America and around the world, fentanyl remains a critical pharmaceutical product. Overall, fentanyl was prescribed by doctors 6.5 million times in 2015, according to the DEA, a number that dropped to about 6 million in 2016, and about 5 million in 2017. Still producing many medicines, the Janssen division within Johnson & Johnson continues to prosper, today boasting more than forty thousand employees in labs and offices around the world.
Paul Janssen didn’t live long enough to see the mass destruction fentanyl has wrought. Upon his death in 2003, at age seventy-seven, he was widely celebrated as a lifesaving innovator. Obituary tributes noted Janssen’s passion for the country of China. Janssen was the first Western company to set up a pharmaceutical factory there, and in 1993 Paul Janssen became the first non-Chinese person to receive a pharmaceutical honorary doctorate in China. Janssen’s factory was in Shaanxi province, near the excavation site of the famous army of terra-cotta soldiers, sometimes called the Xi’an Warriors, buried more than two thousand years ago with China’s first emperor, Qin Shi Huang, to protect him in the afterlife. When the statues were threatened by mold, Janssen analyzed the damage and provided antifungal sprays developed by his company to save them, even setting up an on-site lab. The soldiers remain one of the most popular tourist attractions in China.
The opioid epidemic sweeping through the United States, Canada, and Estonia undoubtedly would have horrified Paul Janssen, as would the fact that Chinese laboratories today produce most of the world’s illicit fentanyl. According to Andrew Wheatley, spokesperson for the Janssen Pharmaceutical Companies of Johnson & Johnson, Duragesic patches sold in the United States are manufactured in the United States, and those sold outside the United States are manufactured in Belgium, and none of the controlled-substance active pharmaceutical ingredients in either Janssen or Johnson & Johnson products are manufactured in China.
Janssen and other pharmaceutical companies like Purdue are now facing lawsuits from states and other entities around the United States for their contributions to the opioid epidemic, but Paul Janssen continues to be remembered as an unparalleled medical drug innovator. Since 2005, Johnson & Johnson has been giving out a biomedical research award named for him. But the proliferation of illicit fentanyl may alter his legacy. His focus throughout his professional life—up until the day he died, while attending a scientific conference in Rome—was the science and business of creating chemicals to help ease suffering. To his core, Janssen believed in medical science’s ability to benefit humanity. When fentanyl was first synthesized in 1959, nobody could have predicted that it would eventually create so much suffering. Nobody could have known it would become as common as cheap liquor in America’s inner cities and much more deadly, or that anyone with an Internet connection could have it sent to his or her door.
