Definition and pharmacology
In the episodes, fentanyl is described by Dr. Jeffrey Singer as a synthetic opioid, meaning that nothing in it is derived from the opium plant and that it is made in a lab. Singer states that it has been around since the 1960s and that it is a useful, effective opioid used in the operating room, for anesthetics, and for people in intensive care; it is usually used in an injectable form, and sometimes as a skin patch called Duragesic that is slowly absorbed through the skin over a few days. He describes it as about 50 times the potency of heroin, with heroin about twice the potency of morphine, making fentanyl about 100 times the potency of morphine. Because of that potency, he says, a very small amount can get a lot of bang for the buck. The Iron Law of Prohibition (2022)
Singer also distinguishes licit from illicit fentanyl. He says licit fentanyl is manufactured in the United States, with pharmaceutical companies making it for use in a hospital in the medical setting, and that the Drug Enforcement Administration sets quotas on how much of every category of painkiller or controlled substance — whether fentanyl, morphine or oxycodone — may be made, deciding for the next year how much of each the United States with a population of 330 million people will be needing and telling each company how much it can make that year. He calls that an impossible thing to be able to figure out. The Iron Law of Prohibition (2022)
The immigration-fentanyl narrative
Bob Zadek opened one episode by asking what the claimed relationship is between the crisis at the border and what he called the flood of black market fentanyl, and whether open borders contribute to the fentanyl crisis. David Bier described the public claim as being that illegal immigrants are bringing fentanyl into the United States and selling it to Americans who are dying as a consequence, and that because there is not enough Border Patrol and immigration laws are not enforced strictly enough, people are dying. Bier further said members of the public are being told that asylum seekers — people seeking asylum because they have a fear of return to their home country — are contributing to the fentanyl crisis, and that this has been used as a justification for ending asylum and immediately expelling people back to Mexico or the country they are fleeing. Who’s to Blame for the Opioid Crisis? (2022)
Bier called the claim that illegal immigrants primarily traffic fentanyl into the United States entirely untrue. He said the truth underlying the narrative is that most of the fentanyl coming into the United States now comes from Mexico, but that it enters through legal ports of entry where legal travelers bring fentanyl in luggage and in cargo, and that this is supported by every law enforcement agency in the federal government — Customs and Border Protection, the Drug Enforcement Administration, and the FBI — which testified before Congress on the issue that year. Because fentanyl is so potent, he said, it is easy to conceal in luggage or in a package as part of a larger shipment in legal cargo. He gave figures: the rate of apprehension of people crossing the border illegally is greater than 50%, while the rate at which fentanyl coming into the country is intercepted is below 5% and has been for years. Who’s to Blame for the Opioid Crisis? (2022)
Bier also said that 86% of drug traffickers who are convicted are US citizens, and rejected the objection that immigrants get away with it, arguing that if crossing illegally with fentanyl were easy, US citizens would be doing it rather than smuggling through a port of entry. Who’s to Blame for the Opioid Crisis? (2022)
The Iron Law of Prohibition
Singer introduced the term “the Iron Law of Prohibition” to the audience, summarizing it as: the harder the law enforcement, the harder the drug. His example of the mechanism was the COVID-era restriction of immigration to what was called “essential” immigration. Bier said that policy eliminated about 75% of all entries at the Southwest border over that summer, and that fentanyl trafficking picked up because it was much more difficult to bring in the same quantity of heroin as in the past; the market found a way to supply the same users with a different substance, with tragic consequences because no one was prepared for the shift. The Iron Law of Prohibition (2022)
Singer argued that restrictive immigration activates the Iron Law, giving drug makers and dealers an incentive to produce something they can make in smaller quantities and get much more economic value for when smuggling. He said that if immigration policy were fixed, immigration would be besides the point for him, and that at bottom the overdose problem — which he prefers to call a drug overdose problem rather than a drug problem, and possibly an HIV and hepatitis problem — is a prohibition problem. He compared it to alcohol prohibition, when people died from drinking denatured and tainted alcohol and big gangsters and gang wars developed, and said alcohol, though pharmacologically more dangerous than opioids, became much safer when legal because the bottle states the ingredients and there is recourse if the manufacturer lied. Who’s to Blame for the Opioid Crisis? (2022)
Bier offered a pandemic-era statistic: Customs and Border Protection tracks seizures of fentanyl and heroin feeding the same market, and at the beginning of the pandemic about a third of seizures were fentanyl, while by the end of restrictions on trade and travel with Mexico 90% were fentanyl. He said the restrictions shifted the black market away from less potent heroin to something that could supply the same market with 50 fewer trips. Singer added that after the restrictions were lifted the cartels would not go back to moving heroin, because they had learned it is much more economical to move fentanyl, and that users who might prefer heroin had adjusted to fentanyl. The Iron Law of Prohibition (2022)
Harm reduction and prohibition
Zadek drew on Singer’s phrase “harm reduction” to describe how the market changes when users are forced to buy unlabeled, poorly manufactured imported black market fentanyl: with legal fentanyl manufactured under controls and labeling as to what it is and its potency, the user can make a more informed decision, including about quantity, whereas with the black market product the user is uninformed and cannot control the quantity as much. Who’s to Blame for the Opioid Crisis? (2022)
Singer placed the overdose crisis as a direct result of drug prohibition and characterized the competing explanations as deflection: first doctors and pharmaceutical companies were blamed, then, when it became fentanyl coming across the border, immigrants and illegal immigrants and a porous border were blamed. He said that even an entire wall around the country would not fix it, because something much more potent than fentanyl would emerge very quickly. Who’s to Blame for the Opioid Crisis? (2022)
On why fentanyl is made abroad rather than domestically, Singer said it is easier to make cheaply and out of the view of law enforcement outside the country, and compared it to methamphetamine — a legal drug made in the United States used to treat ADHD under the brand name Desoxyn — whose production moved from local domestic meth labs mostly to Mexico because it is easier to operate out of the purview of law enforcement, which is always trying to surveil you. The Iron Law of Prohibition (2022)
Across episodes
The same question — whether immigration or prohibition explains fentanyl — is argued in the November 13 and November 18, 2022 episodes, with the same guests, David Bier and Dr. Jeffrey Singer, advancing the same positions both times; the later episode adds the Iron Law of Prohibition framing and the pandemic-era seizure shift, rather than reversing or revising the earlier treatment.
What the sources do not cover
The excerpts do not state the chemical composition of fentanyl beyond its being a synthetic opioid made in a lab, do not give overdose figures, and do not name the Washington Post article Singer refers to. They do not state what any bill, case or amendment provided, or the title and field of any participant beyond the labels used on the show. Where an excerpt ends mid-sentence, the sources stop.