If It Weren't For the Mississippi River, We Could Have Kept All That Fresh Water!

Imagine you’re watching the Mississippi river flow into the ocean with a very confused friend. He’s shaking his head at the “waste” he sees. All that fresh water, just flowing into the ocean! Why, if it weren’t for this river, there’d be plenty of water to satisfy all household and industrial needs for fresh water. “Damn this river! If only we could…well…dam this river! Okay, we already do that. I mean, if only we could fill in the entire thing with earth so our precious water would stop escaping into the ocean.”

You’re so taken aback by the silliness of his comment that you momentarily forget that flowing water is useful, in that it provides relatively cheap transportation among other things. Your more immediate thought is that the water will find its way to the ocean, Mississippi or no Mississippi. It’s no good to blame this particular river. Even supposing someone could snap their fingers and instantaneously replace all that water with dirt (perhaps a confused environmentalist with absolute power, like Thanos with the infinity stones), the rains would still come. Without the mighty river and its tributaries, the rain water would simply sit on the land and temporarily cause a lot of flooding. But water flows downhill. It eventually finds its way to the ocean. It would first follow whatever gentle gradients present themselves on the landscape. Eventually the flowing water would carve out a new set of creeks, streams, tributaries, and rivers. A new river would eventually establish itself, because the natural forces of evaporation, condensation, gravity, and erosion compel it. Blaming this particular river makes little sense.

I hope reading this gives you some sense of the frustration I felt reading Fentanyl, Inc.: How Rogue Chemists Are Creating the Deadliest Wave of the Opioid Epidemic by Ben Westhoff. The subtitle is an excellent summary of what the book is about. Don’t get me wrong. It’s a great book, well worth reading. But there were many “Dam this river!” moments in the book. He spends a little too much time fixating on particular individuals and companies that produce synthetic drugs. Fentanyl, for example, is produced in clandestine labs. If you shut them down, others would pop up to feed the market demand. It's synthesized using precursor chemicals that are sold by a few legitimate Chinese chemical companies. If you shut those down or made the precursors illegal, clandestine labs would synthesis those precursors or maybe even discover alternative means of synthesizing fentanyl. I'm sure he realizes this, and he might even issue this caveat once or twice (if he did, I missed it).

Generally, the book is about synthetic drugs and how they are produced and trafficked. Governments are always banning chemicals as soon as some people figure out that they’re fun, and chemists are always coming up with clever synthetic analogues that copy the pharmacology of those chemicals. Sort of. Unfortunately, sometimes the synthetic analogues are not as safe as the originals. MDMA, aka Ecstasy, is basically non-toxic. Purported harms, such as the claim that it turns your brain to Swiss cheese, were either entirely untrue or gross exaggerations. Nevertheless, “do something” politicians can’t seem to help themselves when it comes to banning fun, and MDMA was outlawed basically everywhere. Synthetic analogues of MDMA, often called “Molly”, started popping up, and partiers started dropping dead at raves. The author claims that this is what piqued his interest in the topic. He knew about the rave scene; he's a journalist whose regular beat is music. It was almost unheard of for people to actually die from MDMA use, but every major rave was seeing a death or two. What the hell was going on? It turns out that ravers were using synthetic drugs of unknown origin, often with deadly consequences. Real MDMA was hard to come buy. It seemed that synthetic "Molly" had mostly replaced it.

To take another example, synthetic marijuana (sometimes called "Spice" or "K2") was briefly popular. It was sold in head shops, often packaged as potpourri and labeled "not for human consumption." Obviously such packaging will not give the user appropriate dosing information, and concentration of the active chemical might vary dramatically from one producer to another, or even from one batch to another by the same producer. To make things even worse, it takes a while for Spice to "kick in", so some users would take hit after hit before they felt anything and ended up taking way too much. Initially, users described synthetic weed as producing a cannabis-like high. I actually first heard about it from a friend who said she used it, probably in 2009, and she described it to me in those terms. However, unlike weed it made some users extremely agitated and even psychotic. One bad batch seems to have caused a minor zombie apocalypse. In this particular instance, thirty-three users wandered dazed around a public park and required medical attention. A friend of mine who is an EMT described having to manhandle a guy who was whacked out on synthetic cannabis, warning the several people listening that they shouldn't take it. This whole thing is unfortunate, because legal cannabis would have none of these problems. It's relatively easy for users to appropriately dose (when smoked, not necessarily when eaten) and extremely non-toxic. Wagging our collective fingers at the chemists who synthesized it or the head shops that sell it makes little sense. This is a policy problem. Given a policy of drug prohibition, someone is going to fill this market niche. We will inevitably experience all these problems with new, experimental drugs that are less safe than the drug whose effects they are trying to copy.

Westhoff did some very deep reporting on the Chinese chemical industry. I am impressed by his success in infiltrating those companies, and his sheer balls. He was often traveling in parts of China that he didn't know, with an unreliable GPS, in a vehicle driven by someone who was suspicious of his motives. It certainly took guts to do what he did. He claims to be the first western journalist to actually visit any of these businesses, and for all I know that's true. He sometimes posed as an interested buyer and spoke to sales reps. Remember, these are legitimate companies selling precursor chemicals, not fentanyl itself. Westhoff discovered that these companies were making enormous shipments of chemicals whose only known use was the production of fentanyl. Again, there is a lot of implied finger-wagging. Westhoff discusses whether the people working for these companies knew what they were actually selling, speculating that the sales reps probably didn't but the managers probably did. The undertone of this "Do you know what you're selling?" discussion is that, if they did know, they were morally responsible for the damage caused by fentanyl. The book doesn't come out and say this, but there's no other reason to discuss the company's knowledge of how its chemicals are used. Once again, it's kind of ridiculous to think that we wouldn't have this fentanyl problem if it weren't for these particular Chinese companies deciding to be malfeasors. This is another policy problem. With policy such as it is, with heroin being illegal for recreational use, someone is going to manufacture fentanyl and ship it to the United States. Westhoff does a good job of mapping out particular streams and tributaries in the supply chain, but this mighty river will flow even if we dam those up. The underlying forces that keep it flowing don't change just because you shut down a Chinese firm or two. Westhoff even concedes that the same chemical expertise exists in India, and law enforcement in that country has discovered clandestine operations.

There is a long section about the academic literature on synthetic drugs. Often a new drug begins life in the pages of academic journals, and then some enterprising chemist figures out that these substances might make fun club drugs. Westhoff recounts the tale of a young man who dies as a result of using one of these synthetic drugs. He interviews both the academic who invented it and the father of the man who died. The academic points out that this kind of work serves a purpose, and that he can't be held responsible for someone's inappropriate use of a scientific discovery. The father, who obviously blames the scientists for his son's death, responds with something like "Fine, if that helps him to sleep at night." Westhoff isn't necessarily taking sides, but he is suggesting that there might be moral culpability for the scientist who synthesize these drugs and giving voice to people who take this view. Again I found myself longing for some kind of economic analysis, some kind of suggestion that these things happen because of the incentive structure created by drug prohibition, not because particular people discovered particular chemicals.

The final chapter of the book is about harm reduction. Westhoff discusses the various means that ravers use to stay safe. There are some organizations (such as DanceSafe) that show up at raves with drug testing kits so the ravers know what they're taking. Sometimes these organizations will try to set up booths. Rave organizers don't care for this and sometimes turn them away. Because of the absurd RAVE Act (sponsored by Joe Biden, whose record on drug policy is just abysmal), rave venues could be seized by police if they can show the organizers knew there would be drug use on the premises. Some organizers quite reasonably believe that allowing drug testing booth is an admission that you know drug use is going on. Pretending it doesn't exist probably puts them on firmer legal ground, but it doesn't make the drug use go away, and it makes harm reduction that much harder. Luckily, there are organizations that show up to these raves without announcing themselves and secretly distribute testing kits, effectively performing a kind of guerrilla harm reduction.

The book also covers safe injection facilities, where IV drug users can come to inject. There are volunteer nursing staff who can administer naloxone to users who overdose. These facilities tend to have good safety records, but they are often forced to operate underground. Knowingly hosting a lot of active drug users is illegal, but they are lobbying various local governments to figure out the boundaries of the law and how drug laws will actually be enforced.

I like harm reduction, but I need to issue a gripe on this point. Harm reduction advocates need to start talking seriously about legalization. Legalization accomplishes everything that harm reduction is trying to do. It eliminates the problem of users not knowing what substances they're taking, or in what dose they are taking them. Overdoses might still happen because someone miscalculates their tolerance, but the problem is dramatically reduced. Moreover, supposing there are still serious overdose risk factors under a legal regime, in a free market someone will figure this out and administer some kind of paid service to mitigate those risks, possibly provided gratis with purchase of the drug. The phenomena of needle exchanges, guerrilla harm reductionists at raves, and safe injection facilities all demonstrate that there is a massive willingness to supply these services when the market price is zero! (In fact, the market price is quite negative, considering that at least some of these people are exposed to legal penalties.) One sees a similar pattern with psychedelics. Michael Pollan details his experience with psychedelic "shamans" or guides in his book How to Change Your Mind. Not only do these people give away the product for free, they offer guidance to the psychonaut while they are tripping. This is quite labor-intensive, as some of these psychedelics last for hours. Clearly there is an enormous willingness to supply these accommodation services for drug users. Allow legal companies to provide these services for a fee, and we won't need to rely entirely on volunteers. I really don't understand what the harm reductionists have in mind, at least the ones who stop short of legalizing the production and sale. An industrial-scale factory that synthesizes these drugs using modern quality control, audited by third parties, perhaps regulated by the FDA, would solve most of these problems at the front-end. We won't have to rely on volunteers instituting half-measures, with their hands being bound by the frontier of the legal grey-zone they operate in. Are these harm reductionists afraid of the increase in drug use that would probably arise from a legal market? Are they leftists who tend to be skeptical of "big business"? (This is my preferred explanation for what's happening.) Are they secret legalizers who are just seizing on harm reduction as the incremental step that's available right now? (If that's the explanation, maybe I shouldn't be writing any of this.) Incidentally, this is a river that might not flow if the particular individuals didn't exist. Some of these harm reduction practitioners are extremely dedicated individuals with a very wide reach and rare moral courage. There isn't necessarily an economic force providing a "supply of harm-reduction volunteers" as there is a force servicing "the market demand for heroin." It seems like the former is much more reliant on rare individuals; the latter continues no matter how many dealers or manufacturers we arrest.

Apologies to Ben Westhoff, who really did write an excellent book. I hate to do a review where I talk about the book I would have written and the topics I would have covered. Fentanyl, Inc. isn't a book about drug legalization, and it isn't quite fair or me to insist that it should have been. But I do think that an economic understanding of the war on drugs will enlighten the reader as to what's going on and present some context for why these things are happening. What is the point, after all, of studying a massive social problem if we aren't going to talk about policy solutions? If it weren't for the fact that massive  numbers of people are overdosing on fentanyl, this wouldn't even be a book. It's fine to have a "just the facts" presentation of what's happening, and the book mostly achieves this. Let's explore the contours of all those streams and tributaries that feed this mighty river. It's good to know about the world that we live in as it actually exists. But let's also explore the forces that dump all this water on the land in the first place.