Fentanyl in the form of a highly lethal, synthetic opioid that’s been making its way through the U.S. over the last decade. The largest source of this illicit drug is China.

Ben Westhoff, an investigative journalist and author of “Fentanyl Inc.: How Rogue Chemists are Creating the Deadliest Wave of the Opioid Epidemic,” decided to see firsthand how these drugs are being made.

“I went really deep and tried to learn everything I could about this problem, and that brought me to China,” he said. “I actually went undercover into a pair of Chinese drug operations, including, I went into a fentanyl lab outside Shanghai. And I was pretending to be a drug dealer.”

He continued: “What I learned was that these companies making fentanyl and other dangerous drugs are subsidized by the government. And so when they work in these suburban office parks, for example, the building, the costs for research and development, they have these development zones, they get export tax breaks.”

Shoddy regulations on China’s side has led to these drugs entering the U.S. The U.S.-China Business Council stated this is in large part because local governments were prioritizing economic growth and development objectives “above all else,” in addition to “the fragmented nature of China’s administrative system that oversees the production and export of chemical and pharmaceutical products.”

Lax postal service regulations have also contributed to the drug’s rise in the U.S. Initially, those who were shipping fentanyl from China to the U.S. would mislabel the packages and ship them through another country as an extra precaution.

The U.S. government enacted the Synthetic Trafficking and Overdose Prevention (STOP) Act, which was signed into law in October 2018. The legislation mandates that the USPS require being supplied with advanced electronic information for all shipments arriving internationally.

“I think the first thing that really needs to be done is China has to curtail these policies,” Westhoff said. “We can only really control what’s happening at home. And we needed to start figuring out: Why are people taking fentanyl? How is it getting into the drug supply? How can people better be prepared to deal with fentanyl when it’s discovered? And that’s something I put a lot of time and thought into.”

Back in February 2019, the medical journal JAMA published research detailing how the Food and Drug Administration (FDA), pharmaceutical companies, and doctors overprescribed fentanyl as a painkiller from 2012 to 2017. And so the drug — which is sometimes administered when patients with chronic pain are physically tolerant to other opioids — reached more people than it should have and spilled over into the street trade.

The street trade is where China’s responsibility lies, Westhoff said. It’s part of the reason why between 2016 and 2017, synthetic opioid overdose deaths, including fentanyl, increased by 45%. Data from the National Institutes of Health (NIH) shows that “synthetic opioids, including fentanyl, are now the most common drugs involved in drug overdose deaths in the United States.”

“At heart, I think this story is really about global capitalism,” Westhoff said. “And as much as we might want to say, it’s the evil Chinese leaders who are inflicting this horrible poison on Americans, really it’s the same things that drive global capitalism. The internet age, these drugs are sold on the internet, the speed of shipping has been increased.”

He continued: “The giant China and the U.S. normalized trade relations in the year 2000, and that cutting down barriers to trade. All of these things are fueling the drug crisis, and people who don’t even realize they’re involved with it, like the UPS workers, for example, the people driving these barges going across the ocean that are filled with fentanyl, and they don’t even realize it. And so it’s such a complicated problem that, at the end of the day, it can all be traced back, like everything else, to profit motive.”