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Can You Really Recover From a Fentanyl Addiction?

Someday they’ll call me the second-greatest St. Louisan to write about drugs

Good morning! As the fourth anniversary of Drugs + Hip-Hop approaches, I wanted to thank you all for taking this little ride. What started as a covid project now has 2,200 subscribers, and while the $75 per week it generates won’t get me a Tesla Cybertruck anytime soon, this project has been a lot of fun. I enjoy the rhythm — fairly infrequent, yet substantive posts — and also bantering with readers. Thanks for all the great reader questions, many of which I answer below. Also, the winner of the free book is Lashara Wade. Lashara, send me your address!

What is it about drugs that interests you as a subject matter? How did it become your beat? I like absurdity and the beauty in mundane, everyday life, so that's what I tend to write about. For you, why drugs? -Gendy Alimurung

Since the first time I bought weed from a high school classmate I’ve been captivated by drug dealers — how they stomach so much risk, how their supply chain works, how they spend their profits.

From economics to chemistry to public health to criminal justice, this beat has many facets that interest me. I enjoy taking risks in my reporting — to gain access to subcultures I couldn’t experience otherwise — and want to serve the greater good. Plus, it’s fun comparing the messaging I received as a kid (“Taking LSD will make you jump off a building!”) to the realities.

I know there are medications for getting off of fentanyl, but do people really recover from long-term use? -Lashara Wade

Fentanyl, if dosed properly, is not necessarily more dangerous than heroin, and many, many people have fully recovered from long-term heroin addictions. For my naltrexone documentary I’ve met dozens of them.

The problem, of course, is because fentanyl is so potent at such tiny amounts, it’s almost never dosed properly. That’s what causes so many overdose deaths.

But though fentanyl addictions are nasty, withdrawal doesn’t kill you, and if you can get to the other side (best done with the aid of medication) there’s every reason to believe full recovery is possible. One example is Mitch McDonald, who became addicted to carfentanil after doing product testing for the Mexican cartels and is now doing great.

Could using AI in drug design make it easier to generate different fentanyl derivatives and to tweak their effects/potency? More optimistically, could AI help design “safer” fentanyl derivatives? Many thanks and kind regards, Chu Kong

There are literally infinite potential fentanyl derivatives, made by tweaking fentanyl’s chemical structure. These are called fentanyl analogues. Some, like the aforementioned carfentanil, are much stronger than fentanyl itself.

So, yes, AI makes it easier to create these new molecules, but what limits the amount of dangerous analogues on the streets is not the ability to invent them, but the ability to market and sell them.

The analogue trade was stymied when the Chinese government banned all fentanyl analogues in 2019, and though some labs still sell them, the threat of newer, more potent analogues doesn’t really worry me. The problem remains fentanyl itself, already plenty potent, incredibly cheap, and versatile enough to be mixed into any powdered street drug. We’ve never seen a more problematic chemical.

As for a “safer” fentanyl derivative, such a thing is likely impossible. The U.S. Public Health service spent decades looking for a non-addicting opioid — something that would soothe pain, but not leave users craving more — without success. The Mexican cartels, meanwhile, have even been trying to create safer fentanyl mixtures, but that has been a failure as well.

I am a nurse at an OTP in St. Louis. I just read an article about nitazenes. Is that a topic that interests you? Regards, Dan 

Nitazenes are a class of opioids that began showing up on U.S. streets following China’s fentanyl analogue ban in 2019. Since nitazenes are not fentanyls but satisfy the same cravings — and Chinese labs like to stay within the law — the labs immediately switched to making nitazenes. Since then, these chemicals have thoroughly infested the U.S. drug supply.

Like xylazine and novel benzodiazapenes (ie fake Xanax), nitazenes are “downers” that are especially dangerous when mixed with fentanyl, which is also a downer. But nitazines are also frequently mixed with meth, cocaine, and other street drugs. On the streets of St. Louis and many other places, everything’s a speedball now.

From Ioan Grillo's recent story: "Synthetic fentanyl was found in the bodies of more than 71,000 of the 108,000 overdose victims in 2022." How can cartels sell a product that also diminishes their customer base? Are they confident the US has an endless supply of potential addicts? Hugs from Missoula. -Mike 

The overprescribing of opioids like OxyCodone created millions of new addicted users in America. There wasn’t enough heroin to satisfy them, and fentanyl filled the void. Because the cartels had so many new customers, they didn’t seem to care that many were dying. But what’s changed their minds has been Republican threats to send the U.S. military into Mexico. That’s why fentanyl production was recently moved out of Sinaloa, though it was quickly re-established in other parts of the country.

At some point the cartels may begin reaping what they’ve sown. In America, young people are increasingly less likely to try hard drugs like fentanyl, and most of the older users will eventually die. Since there will be no one to replace them, the epidemic should burn itself out in the coming years. By then, however, the cartels will likely be focused on supplying fentanyl to other countries. Beyond the U.S. and Canada, the rest of the world is basically one giant untapped market.

You came from a privileged upper middle class Minnesota family. Have you met anyone in the illegal drug industry who has similar values that you respect? -Joel Goodman 

Drug trade workers are often motivated by economic necessity and/or addiction. Sure, greed often plays in — and not just a desire for fast cars and beautiful women. Wuhan Yuancheng salespeople, for example, seek the same upper middle class lifestyle in which I was raised. More traditional drug dealers often content themselves with dumb rationalizing. (“If they don’t get it from me, they’ll just get it from someone else.”) Some even believe they’re practicing harm reduction. (“It’s cheaper for addicts to get their opioids from me than from Big Pharma.”)

But many Americans working in mainstream industries are doing just as much harm to the world, if not more. Those involved in the raising, distribution, and selling of pork products, for example, are contributing to an epidemic of obesity and heart disease, all the while contributing to climate degradation and the lifelong torture of a very smart animal. People who eat bacon and ham are also morally responsible for these problems; similarly, drug traffickers wouldn’t exist without drug users. I certainly have plenty of moral shortcomings myself, and I don’t believe anyone is “bad,” I just think most of us need to try a little harder!

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