Las Vegas Sun

March 29, 2024

Analysis:

China’s regulations of fentanyl are one small step in a global problem

Yuejin

Sam McNeil / AP

Liu Yuejin, vice commissioner of the National Narcotics Control Commission, speaks during a press conference in Beijing on Monday, April 1, 2019. China announced Monday that all fentanyl-related drugs, as a group, would become controlled substances, effective May 1, a step U.S. officials have long advocated as a way to stem the flow of lethal opioids from China.

When China announced this week that it would tighten regulation on the production of fentanyl, it was cause for some relief.

Chinese pharmaceutical and chemical manufacturers are the source of much of the illicit supply of the powerful opioid in the U.S., where it is causing tens of thousands of deaths annually. So reining them in would no doubt help address what’s become a public health crisis in America.

But as experts were quick to point out, it could easily turn out to be a very small step. China’s regulatory structure is painfully inadequate, with only about 2,000 inspectors responsible for covering tens of thousands of manufacturing facilities where fentanyl can be made. Throw in the nation’s rampant corruption, and experts are concerned that the push for greater regulation may have little effect.

The Brookings Institution’s Vanda Felbab-Brown says that unfortunately, the announcement represents only one of the many complexities involved in addressing the opioid crisis. The epidemic has grown tentacles that spread across the planet.

“The fundamental base of the problem is indeed American-made,” Felbab-Brown said during a visit to UNLV this week. “But it has very many international repercussions.”

Among those global concerns, she said, is that U.S. pharmaceutical companies are exporting the same approach that led to over-prescription of opioids domestically. That movement has come in the aftermath of lawsuits against U.S. companies, such as one that recently resulted in a $270 million settlement from Purdue Pharma in Oklahoma.

“It’s exactly what happened with Big Tobacco when that industry became highly regulated and taxed in the U.S. The companies started focusing abroad,” she said, adding that the companies are active in Eastern European nations as well as India and Africa.

Closer to home, the opioid crisis sparked a surge in heroin production in Mexico, where cartels stepped in to provide a cheaper and more readily available product to the huge body of people who’d become addicted to painkillers.

Then there’s fentanyl. Extremely powerful even in tiny doses, the synthetic drug is easy to conceal and ship, making it a lucrative product for illicit manufacturers. Felbab-Brown said India, Mexico and other nations are expected to follow China in becoming hotbeds for production.

Meanwhile, the human cost of the crisis continues to spiral.

“The projection is that if there’s not some radical change over the next decade, probably a half-million Americans will die as a result of the opioid epidemic,” Felbab-Brown said.

While steps like China’s regulatory structure are constructive, she said, much larger reforms are needed.

Among them:

• Beef up U.S. regulatory and investigative efforts. Building a southern border wall and reducing the flow of legal immigration won’t put a significant dent in the crisis, Felbab-Brown said. Rather, the government needs to add inspectors to the staff of the Food and Drug Administration and ramp up enforcement by the Drug Enforcement Administration.

• Create more separation between the government and the pharmaceutical industry. In 2017, The Washington Post and “60 Minutes” produced a bombshell story: Under pressure by a handful of members of Congress with strong ties to pharmaceutical companies, the DEA and the Justice Department had capitulated on a bill that short-circuited DEA efforts to investigate drug manufacturers who failed to report large and otherwise suspicious orders for narcotics. One former DEA administrator who’d been forced out after leading aggressive efforts against manufacturers said: “The drug industry, the manufacturers, wholesalers, distributors and chain drugstores, have an influence over Congress that has never been seen before. I mean, to get Congress to pass a bill to protect their interests in the height of an opioid epidemic just shows me how much influence they have.”

Among the lawmakers involved was Rep. Tom Marino, R-Pa., who at the time was Donald Trump’s nominee for drug czar. Marino withdrew from consideration after the report came out.

Felbab-Brown said the situation was one example of government being too close to the industry to effectively watchdog it.

“You have real regulatory perversion that needs to be undone,” she said.

• On the prevention side, Felbab-Brown calls for opioid prescriptions and overdoses to be tracked in databases, with doctors being mandated to check the information before prescribing addictive medications.

Felbab-Brown has written extensively about the global drug trade and a range of other international affairs, including five books and a variety of policy reports, academic articles, and opinion pieces.

On Wednesday evening at UNLV, she offered findings from her research and a number of policy recommendations in a presentation titled, “The U.S. Opioid Epidemic and Lessons for the World.” For video of the presentation, visit unlv.edu/brookingsmtnwest.