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Tag: Opioids

  • Mexican president to hold call with Biden on immigration

    Mexican president to hold call with Biden on immigration

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    Mexico’s president says he will talk with U.S. President Joe Biden by telephone on Tuesday about immigration and the fentanyl crisis

    MEXICO CITY — Mexico’s president said Monday he will talk with U.S. President Joe Biden by telephone on Tuesday about immigration and the fentanyl crisis.

    President Andrés Manuel López Obrador said the leaders will also discuss development programs to help stem the flow of migrants to the U.S. border. The conversation comes two days before the end of pandemic-era immigration restrictions that allowed U.S. authorities to quickly expel migrants who crossed the border illegally.

    López Obrador appealed to migrants not to use smugglers to travel to the U.S. border.

    “Don’t allow yourselves to be fooled,” López Obrador said during his morning news briefing. “Don’t allow yourselves to be blackmailed by coyotes, smugglers, who put you at risk.”

    Mexico agreed last week to continue to accept migrants from Venezuela, Haiti, Cuba and Nicaragua who are turned away at the border, as well as some other migrants from Central America.

    The Mexican president has previously asked the U.S. government to contribute more development aid to Central America so people won’t have to migrate.

    López Obrador has also slammed proposals by U.S. Republican legislators to make it more difficult to apply for asylum and easier for authorities to block migrants at the border.

    “This really degrades them, morally,” he said.

    The two presidents will also discuss the fentanyl crisis. The synthetic opioid, mainly smuggled in from Mexico, has caused about 70,000 overdose deaths per year in the United States.

    López Obrador has denied that drug cartels make fentanyl in Mexico, although he has acknowledged that precursor chemicals — and, he claims, finished fentanyl — are smuggled into Mexico from China, a claim China has denied.

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  • US backs study of safe injection sites, overdose prevention

    US backs study of safe injection sites, overdose prevention

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    For the first time, the U.S. government will pay for a large study measuring whether overdoses can be prevented by so-called safe injection sites, places where people can use heroin and other illegal drugs and be revived if they take too much.

    The grant provides more than $5 million over four years to New York University and Brown University to study two sites in New York City and one opening next year in Providence, Rhode Island.

    Researchers hope to enroll 1,000 adult drug users to study the sites’ effects on overdoses, to estimate their costs and to gauge potential savings for the health care and criminal justice systems.

    The universities announced the grant Monday. The money will not be used to operate the sites, the universities said.

    With U.S. drug overdose deaths reaching nearly 107,000 in 2021, supporters contend safe injection sites, also called overdose preventions centers, can save lives and connect people with addiction treatment, mental health services and medical care.

    Opponents worry the sites encourage drug use and that they will lead to the deterioration of surrounding neighborhoods.

    “There is a lot of discussion about overdose prevention centers, but ultimately, we need data to see if they are working or not, and what impact they may have on the community,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which awarded the grant.

    Sites operate in 14 countries, including Canada, Australia and France, according to the Drug Policy Alliance, a group working for decriminalization and safe drug use policies.

    In the U.S., New York City opened the first publicly recognized safe injection site in 2021 and Rhode Island became the first state to authorize them that year.

    States including Colorado, Nevada and New Mexico have considered allowing them. The governors of California and Vermont vetoed safe injection site bills last year, and Pennsylvania’s Senate last week voted for a ban on them.

    The grant marks another move by the Biden administration toward what is known as harm reduction, a strategy focused on preventing death and illness in drug users while helping them get care, as opposed to punishment.

    The White House’s drug control strategy is the first to emphasize harm reduction, and the Justice Department has signaled it will allow safe injection sites.

    In December, the National Institutes of Health established a harm reduction research network to study programs providing services and supplies such as naloxone, a drug that can reverse overdoses, and materials to test drugs for fentanyl, a powerful opioid driving record numbers of overdoses. The new study will be part of that project.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Sons of ‘El Chapo’ deny US fentanyl indictment allegations

    Sons of ‘El Chapo’ deny US fentanyl indictment allegations

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    Sons of former Sinaloa cartel leader Joaquín “El Chapo” Guzmán have denied accusations made by United States prosecutors last month, saying in a letter that they have no involvement in the production and trafficking of the potent synthetic opioid fentanyl

    MEXICO CITY — Sons of former Sinaloa cartel leader Joaquín “El Chapo” Guzmán have denied accusations made by U.S. prosecutors last month, saying in a letter that they have no involvement in the production and trafficking of the potent synthetic opioid fentanyl.

    The letter was provided to The Associated Press by José Refugio Rodríguez, a lawyer for the Guzmán family. Despite not being signed, Rodríguez said he could confirm that the letter was from Guzmán’s sons.

    The Mexican government did not explicitly confirm the letter’s authenticity, but President Andrés Manuel López Obrador said Thursday it had been analyzed by the country’s security council.

    The sons of Guzmán said “we have never produced, manufactured or commercialized fentanyl nor any of its derivatives,” the letter said. “We are victims of persecution and have been made into scapegoats.”

    Milenio Television first reported the letter Wednesday.

    U.S. prosecutors detailed in court documents last month how the Sinaloa cartel had become the largest exporter of fentanyl to the United States, resulting in tens of thousands of overdose deaths. Guzmán is serving a life sentence in the United States for drug trafficking.

    Guzmán’s sons are known collectively as the “Chapitos”. Iván Archivaldo Guzmán Salazar and Jesús Alfredo Guzmán Salazar are the lead defendants among 23 associates charged in a New York indictment. Ovidio Guzmán López, alias “the Mouse,” who allegedly pushed the cartel into fentanyl, is charged in another indictment in the same district. Mexico arrested him in January and the U.S. government has requested extradition. Joaquín Guzmán López is charged in the Northern District of Illinois.

    U.S. prosecutors say the “Chapitos” have tried to concentrate power through violence, including torturing Mexican federal agents and feeding rivals to their pet tigers.

    The sons deny that too, saying they are not the leaders of the Sinaloa cartel and do not even have tigers. They describe a loose federation of independent drug producers and manufacturers in the state of Sinaloa, many of whom appropriate their name for their own advantage.

    Mexico arrested Ovidio Guzmán in January and has seized some fentanyl laboratories, but López Obrador has repeatedly denied that Mexico produces the drug and accused U.S. authorities of spying and espionage after the indictments were unsealed.

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  • Do Overdoses Look Different Now?

    Do Overdoses Look Different Now?

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    Most likely, the person’s skin color will change. An ashy tone might creep in, or they could turn a shade of blue. If too much fluid pools in their mouth or lungs and mixes with air, foam will appear at their lips. There might be a sound, too—that of light snoring. These are some of the main symptoms of an overdose. Although the drug causing the reaction might be different, the symptoms look the same. “An overdose is an overdose,” Soma Snakeoil, a co-founder of the Sidewalk Project, a harm-reduction organization, told me.

    But although overdose symptoms have not shifted, the ability to treat it has, most notably because of the availability of naloxone, the medication that can quickly reverse an overdose and that was approved in late March to be sold over the counter, as Narcan. This move happened at least in part because in the past few decades, the entire context of an overdose in the United States has changed. The U.S. has entered its fourth wave of the opioid crisis, and the death toll is different now: Overdoses have been steadily increasing for many years, but this wave, also known as the “era of overdoses,” has seen the highest number of fatal overdoses yet. “I think what makes this current crisis so unique is the volume” of overdoses, John Pamplin II, an epidemiologist at Columbia’s school of public health, told me. And that is happening because the drugs have changed too. “It’s not necessarily that more people are using drugs,” Emilie Bruzelius, an epidemiology researcher at Columbia’s school of public health, told me. “The opioids that people are using now are incredibly strong, and they’re more likely to cause an overdose.”

    The result is that any person using drugs has a higher chance of overdosing than ever before. “There’s no population segment that is insulated,” Bruzelius said. “It’s really affecting everybody now.”

    The origins of the opioid crisis can be traced back to 1999. As doctors prescribed opioids more and more—OxyContin prescriptions for non-cancer-related pain alone increased from about 670,000 in 1997 to 6.2 million in 2002—related deaths rose swiftly. In that same period, the number of deaths increased almost 30 percent, to nearly 9,000. This first wave largely affected white people: By 2010, the opioid mortality rate was more than two times higher for white people than Black people.

    That year, a second wave began, in which overdose deaths involving heroin grew most dramatically. By 2015, heroin overdose deaths surpassed the number of deaths attributable to opioid pills. This time, the total opioid mortality rate grew for both Black and white populations; death rates increased by an average of at least 30 percent a year beginning in 2010, and accelerated even faster after 2013. In this same period, illicitly manufactured fentanyl—a synthetic opioid approved for pain relief—was being slipped into heroin, counterfeit pills, cocaine, and other drugs. Many of the people taking these drugs did not realize that they were taking fentanyl at all, leading to a third wave of overdoses. Mortality skyrocketed. In 2017, synthetic opioids were responsible for more than 28,000 deaths, while opioid-pill and heroin overdose deaths had leveled off at about 15,000. The demographics of the crisis continued to shift too, and in 2020, the fastest increases in death rates was experienced by Black and Indigenous Americans, surpassing the death rate of white Americans, Pamplin told me.

    The new, fourth wave is characterized by more mixing of different drugs. “People are overdosing from cocaine and fentanyl or methamphetamines and fentanyl or methamphetamines and fentanyl and heroin,” Bruzelius told me. Recently, xylazine—a non-opiate sedative also known as “tranq”—has infiltrated the fentanyl supply, resulting in what the DEA has deemed the deadliest threat yet.

    This is the context in which the FDA approved Narcan to be sold over the counter. Narcan packages naloxone as a nasal spray, and the FDA argued that its approval could “help improve access to naloxone, increase the number of locations where it’s available, and help reduce overdose deaths throughout the country.” By binding to opioid receptors, naloxone blocks the effects of opiates in the system. This reverses the impact of an overdose, restoring normal breathing.

    But drug policies in America tend to swing, pendulum-like, from one extreme to the other, David Courtwright, a historian at the University of North Florida, told me: A response focused on care for drug users might give way to a more punitive policy. Already, some critics of Narcan’s availability have pushed to restrict its use on the grounds that an effective overdose treatment could encourage drug use—even though there’s “just no kind of scientific or empirical backing” for those arguments, Bruzelius said. Here, the simplest logic holds: If overdoses are affecting every community in America, better to have an accessible treatment everywhere.

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    Zoya Qureshi

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  • ‘El Chapo’ sons send Mexico cartel’s cheap fentanyl into US

    ‘El Chapo’ sons send Mexico cartel’s cheap fentanyl into US

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    MEXICO CITY — With Sinaloa cartel boss Joaquín “El Chapo” Guzmán serving a life sentence, his sons steered the family business into fentanyl, establishing a network of labs churning out massive quantities of the cheap, deadly drug that they smuggled into the U.S., prosecutors revealed in a recent indictment.

    Although Guzmán’s trial revolved around cocaine shipments, the case against his sons exposes the inner workings of a cartel undergoing a generational shift as it worked “to manufacture the most potent fentanyl and to sell it in the United States at the lowest price,” according to the indictment unsealed April 14 in Manhattan.

    Synthetic opioids — mostly fentanyl — now kill more Americans every year than died in the Vietnam, Iraq and Afghanistan wars combined, feeding an argument among some politicians that the cartels should be branded terrorist organizations and prompting once-unthinkable calls for U.S. military intervention across the border.

    “The problem with fentanyl, as some people at the State Department told me, has to be repositioned. It’s not a drug problem; it’s a poisoning problem,” said Alejandro Hope, a security analyst in Mexico, who died Friday. “Very few people go out deliberately looking for fentanyl.”

    The groundwork for the U.S. fentanyl epidemic was laid more than 20 years ago, with aggressive over-prescribing of the synthetic opioid oxycodone. As U.S. authorities clamped down on its prescription, users moved to heroin, which the Sinaloa cartel happily supplied.

    But making its own fentanyl — far more potent and versatile than heroin — in small, easily concealed labs was a game changer. The cartel went from its first makeshift fentanyl lab to a network of labs concentrated in the northern state of Sinaloa in less than a decade.

    “These are not super labs, because they give people the illusion that they’re like pharmaceutical labs, you know, very sophisticated,” said Mike Vigil, former head of international operations for the U.S. Drug Enforcement Administration. “These are nothing more than metal tubs and they use wooden paddles — even shovels — to mix the chemicals.”

    A single cartel “cook” can press fentanyl into 100,000 counterfeit pills every day to fool Americans into thinking they’re taking Xanax, Percocet or oxycodone. The pills are smuggled over the border to supply what son Iván Archivaldo Guzmán Salazar said are “streets of junkies,” the indictment said.

    Fentanyl is so cheap to make that the cartel reaps massive profits even wholesaling the drug at 50 cents per pill, prosecutors said.

    The drug’s potency makes it particularly dangerous. The narcotic dose of fentanyl is so close to the lethal dose that a pill meant to ensure a high for a habituated user can easily kill a less experienced person taking something they didn’t know was fentanyl.

    Between August 2021 and August of last year, more than 107,000 Americans died from drug overdoses, most from synthetic opioids. Last year, the DEA seized more than 57 million fentanyl-laced counterfeit prescription pills, according to the New York indictment.

    To protect and expand that business, the “Chapitos,” as the sons are known, have turned to grotesque violence.

    Enforcers Ivan Archivaldo Guzmán Salazar and Jesus Alfredo Guzmán Salazar are the lead defendants among 23 associates charged in the New York indictment. Ovidio Guzmán López, alias “the Mouse,” who allegedly pushed the cartel into fentanyl, is charged in another indictment in the same district. Mexico arrested him in January and the U.S. government has requested extradition. Joaquín Guzmán López is charged in the Northern District of Illinois

    According to the Guzmán Salazar indictment, the cartel does some lab testing on its product but conducts more grisly human testing on kidnapped rivals or addicts who are injected until they overdose.

    The purity of the cartel’s fentanyl “varies greatly depending on the method and skill of the particular manufacturer,” prosecutors noted. After a user overdosed on one batch, it was still shipped to the U.S.

    When the elder Guzmán and Ismael “El Mayo” Zambada led the Sinaloa cartel, it operated with a certain degree of restraint. But with Guzmán serving a life sentence and Zambada believed to be suffering from health issues, the Chapitos moved aggressively to avoid a power vacuum that could fragment the cartel.

    “What was really a unique advantage of the Sinaloa cartel and El Chapo was the ability to calibrate violence,” said Vanda Felbab-Brown, a senior fellow in the Strobe Talbott Center for Security, Strategy, and Technology at the Brookings Institute.

    The wide-ranging New York indictment against the Guzmán Salazar brothers details their penchant for feeding enemies to their pet tigers and describes how they tortured two Mexican federal agents, ripping through one’s muscles with a corkscrew then stuffing the holes with chile peppers before shooting him.

    The indictment also provides context to some recent violence in Mexico.

    In August 2022, gunmen shot up Ciudad Juarez across from El Paso, Texas. Two prison inmates and nine civilians in the city were killed. U.S. prosecutors say the Chapitos’ security arm ordered their local gang associates to commit the violence, targeting a rival cartel’s businesses.

    “This is not their father’s Sinaloa cartel,” Felbab-Brown said. “These guys just operate in very different mindsets than their father.”

    The Guzmán Salazar indictment makes an initial attempt at disrupting the cartel’s supply chain, naming four people tied to a China-based chemical company and a broker in Guatemala who allegedly helped the cartel get the chemicals and even instructed them on the best recipes for fentanyl.

    “When they talk about labs and you’re trying to focus in on labs, that’s not going to have an impact unless you get the finished product or the precursor chemicals,” Vigil said.

    Mexico’s government has stumbled through the mixed messaging of its security forces playing up their decommissioning of labs even while President Andrés Manuel López Obrador has asserted that fentanyl is not being produced in Mexico.

    In congressional testimony Thursday, DEA Administrator Anne Milgram was pressed about whether Mexico and China are doing enough to cooperate with U.S.

    “We want the Mexicans to work with us and we want them to do more,” Milgram said, adding that the DEA wouldn’t hesitate to go after public officials in Mexico or elsewhere should it find evidence of ties to the cartels.

    Experts say López Obrador is one obstacle to slowing the cartels’ fentanyl production. After U.S. prosecutors announced the concerted effort against the Sinaloa cartel, López Obrador reacted angrily. The president accused the U.S. government of “spying” and “interference,” suggesting that the case had been built on information gathered by U.S. agents in Mexico.

    The president had already severely reduced Mexico’s cooperation with the DEA, experts said.

    Hope, the security analyst, said a fundamental problem is that López Obrador doesn’t appear to understand fentanyl’s threat. The president rails against a deterioration of family values in the United States and paints addiction as a moral failing.

    “He’s trapped in a moral universe from 50 years ago,” Hope said.

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  • Man arrested after $3M worth of drugs shipped to restaurant

    Man arrested after $3M worth of drugs shipped to restaurant

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    Employees of a Maine restaurant got a surprise when they opened a large wooden crate that they thought was a shipment of mugs they had recently ordered

    AUBURN, Maine — Employees of a Maine restaurant got a surprise when they opened a large wooden crate that they thought was a shipment of mugs they had recently ordered.

    Instead, they found a plastic tote that contained what law enforcement suspect is 14 kilograms (31 pounds) of the powerful synthetic opioid fentanyl with an estimated street value of $3 million, Auburn police Deputy Chief Timothy Cougle said in a statement Saturday.

    The tote had a shipping label with the restaurant’s address but the name of someone who did not work there. Employees who opened it saw what they thought looked like drugs, so they contacted police, Cougle said.

    The crate from Arizona that arrived in the Maine town about 30 miles (50 kilometers) north of Portland was taken to the police department, where a chemical field examination confirmed it contained fentanyl.

    About an hour later, the man whose name was on the shipment showed up looking for the crate and was arrested, police said.

    Jeremy Mercier, 41, of Auburn, was charged with drug offenses and for violating bail conditions. He is being held in a county jail without bail. It could not be determined if he had an attorney.

    Mercier previously spent time behind bars on a 2007 federal drug conviction, Cougle said.

    The investigation is ongoing, and Cougle said he anticipates state and federal law enforcement getting involved.

    Mike Peters, the co-owner of Mac’s Grill, told WMTW-TV in an email that he is glad the drugs did not make it to the streets.

    “The instances of overdose in our, and surrounding, communities is awful, and fentanyl seems to be front and center when it comes to fatalities,” he said. “It is very sad.”

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  • Frustration grows over wait on OxyContin maker’s settlement

    Frustration grows over wait on OxyContin maker’s settlement

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    More than a year after OxyContin maker Purdue Pharma reached a tentative settlement over the toll of opioids that was accepted nearly universally by the groups suing the company — including thousands of people injured by the drug — money is still not rolling out.

    Parties waiting to finalize the deal are waiting for a court to rule on the legality of a key detail: whether members of the Sackler family who own the company can be protected from lawsuits over OxyContin in exchange for handing over up to $6 billion in cash over time plus the company itself.

    This week — days before the one-year anniversary of the April 29, 2022, appeals court arguments on the matter — lawyers told judges that the wait is causing problems.

    Lawyers on multiple sides of the case, including those representing Purdue, asked the 2nd U.S. Circuit Court of Appeals in New York to issue a ruling or provide an update soon, saying the efforts to use the funds to fight the opioid crisis can’t begin until the money can start to flow.

    While it’s not unusual for an appeals panel to take a year or more from a hearing until it releases a decision, this case was originally fast-tracked by the court. At the hearing last year, there were signs that the three-judge panel might not rule unanimously.

    A lawyer for creditors told a U.S. bankruptcy court in another filing this week that the wait is a problem for other reasons. The lawyer, Arik Preis, wrote that as long as the funds aren’t distributed, “the vast majority of more than $6 billion that could be put to use to abate the opioid crisis and compensate individual claimants continuing to accrue interest in Sackler accounts.”

    While most of Purdue’s creditors have signed onto the settlement, the U.S. Bankruptcy Trustee is objecting.

    With the case stretching out, the legal costs continue to mount, too. Purdue reported in a court filing that as of March 31, it had spent about $900 million on nonrecurring legal fees since it filed for bankruptcy in 2019 as part of an effort to settle its lawsuits.

    Purdue’s proposed settlement is not the biggest in a series of opioid-related settlements in recent years that totals over $50 billion, but it is large and closely watched because of the blame many have given the company for its role in sparking the crisis with its marketing of OxyContin starting in the 1990s.

    The settlement also is the only one so far where some of the money is to go directly to people who lost loved ones or years of their own lives to opioids. About 149,000 individuals made claims and could receive between about $3,500 and $48,000 each from the settlement.

    One of them, Lindsey Arrington, does not know how much she’ll qualify to be paid. The Everett, Washington, woman whose substance abuse disorder began with OxyContin she used as a teenager, said money would be helpful.

    “I’m 12 years into my recovery from addiction and I’m still cleaning up the financial wreckage,” she said.

    There were debts, including paying back the Washington state government for assistance she should not have received because her son, now 14, was not living with her at the time.

    And some money could help her relationship with him. “I owe it to him to use some of the money to do something for him or with him as a symbolic gesture of the time that we lost, that we could have had together had it not been what I was going through,” she said.

    Stephanie Lubinski, one of about two dozen victims who testified at a hearing last year that Sackler family members attended by Zoom, doesn’t know how much she might be granted under the settlement either. In the grips of an opioid addiction, her husband, a former Minneapolis firefighter, killed himself in 2020.

    Lubinski, who has cancer, hopes to have the settlement in hand while she’s alive so she can pass it to her adult children.

    “It’s like by keeping it going and going,” she said, “we’re replaying all the emotions and suffering.”

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  • Frustration grows over wait on OxyContin maker’s settlement

    Frustration grows over wait on OxyContin maker’s settlement

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    More than a year after OxyContin maker Purdue Pharma reached a tentative settlement over the toll of opioids that was accepted nearly universally by the groups suing the company — including thousands of people injured by the drug — money is still not rolling out.

    Parties waiting to finalize the deal are waiting for a court to rule on the legality of a key detail: whether members of the Sackler family who own the company can be protected from lawsuits over OxyContin in exchange for handing over up to $6 billion in cash over time plus the company itself.

    This week — days before the one-year anniversary of the April 29, 2022, appeals court arguments on the matter — lawyers told judges that the wait is causing problems.

    Lawyers on multiple sides of the case, including those representing Purdue, asked the 2nd U.S. Circuit Court of Appeals in New York to issue a ruling or provide an update soon, saying the efforts to use the funds to fight the opioid crisis can’t begin until the money can start to flow.

    While it’s not unusual for an appeals panel to take a year or more from a hearing until it releases a decision, this case was originally fast-tracked by the court. At the hearing last year, there were signs that the three-judge panel might not rule unanimously.

    A lawyer for creditors told a U.S. bankruptcy court in another filing this week that the wait is a problem for other reasons. The lawyer, Arik Preis, wrote that as long as the funds aren’t distributed, “the vast majority of more than $6 billion that could be put to use to abate the opioid crisis and compensate individual claimants continuing to accrue interest in Sackler accounts.”

    While most of Purdue’s creditors have signed onto the settlement, the U.S. Bankruptcy Trustee is objecting.

    With the case stretching out, the legal costs continue to mount, too. Purdue reported in a court filing that as of March 31, it had spent about $900 million on nonrecurring legal fees since it filed for bankruptcy in 2019 as part of an effort to settle its lawsuits.

    Purdue’s proposed settlement is not the biggest in a series of opioid-related settlements in recent years that totals over $50 billion, but it is large and closely watched because of the blame many have given the company for its role in sparking the crisis with its marketing of OxyContin starting in the 1990s.

    The settlement also is the only one so far where some of the money is to go directly to people who lost loved ones or years of their own lives to opioids. About 149,000 individuals made claims and could receive between about $3,500 and $48,000 each from the settlement.

    One of them, Lindsey Arrington, does not know how much she’ll qualify to be paid. The Everett, Washington, woman whose substance abuse disorder began with OxyContin she used as a teenager, said money would be helpful.

    “I’m 12 years into my recovery from addiction and I’m still cleaning up the financial wreckage,” she said.

    There were debts, including paying back the Washington state government for assistance she should not have received because her son, now 14, was not living with her at the time.

    And some money could help her relationship with him. “I owe it to him to use some of the money to do something for him or with him as a symbolic gesture of the time that we lost, that we could have had together had it not been what I was going through,” she said.

    Stephanie Lubinski, one of about two dozen victims who testified at a hearing last year that Sackler family members attended by Zoom, doesn’t know how much she might be granted under the settlement either. In the grips of an opioid addiction, her husband, a former Minneapolis firefighter, killed himself in 2020.

    Lubinski, who has cancer, hopes to have the settlement in hand while she’s alive so she can pass it to her adult children.

    “It’s like by keeping it going and going,” she said, “we’re replaying all the emotions and suffering.”

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  • Punishment or prevention: California debates fentanyl crisis

    Punishment or prevention: California debates fentanyl crisis

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    SACRAMENTO, Calif. (AP) — Pamela Smith remembers vividly the last time she saw her only son alive.

    It was 3:18 a.m. on July 3, 2016, in Fresno, California, and 22-year-old Jackson Smith was lying motionless on a table in an emergency room while a nurse performed chest compressions. Earlier that night, he had taken an oxycodone pill laced with fentanyl, and then he stopped breathing. Within seconds of his mother entering the emergency room, he died.

    Since then, Smith has dedicated her life to fighting the fentanyl crisis. This year, that has meant advocating for some of the more than 30 bills introduced in the California Legislature to address the issue.

    But a number of those bills have since stalled, caught in a philosophical dispute between lawmakers about the best way to address a crisis that is killing roughly 110 people in the state each week. About half of the proposals focus on public safety measures, such as punishing drug dealers with longer prison sentences, while the others aim to increase accessibility to fentanyl overdose treatments and to create education and prevention programs.

    The bills focusing on public safety measures were at risk of getting lost until Smith and dozens of other protesters converged on the state Capitol last week demanding they be heard. At a special hearing Thursday, the Assembly public safety committee finally made some progress: They advanced four bills including one that would increase penalties for dealers with at least one kilogram of fentanyl products and another that would prohibit people from carrying a gun while also being in possession of fentanyl.

    The committee also voted down two bills that would lengthen prison sentences for fentanyl-related crimes, and another bill to toughen penalties for sales of fentanyl on social media was shelved.

    Smith, who testified Thursday, said she was disappointed that a bill she supported did not advance, “But I hope to believe them when they say they’re willing to have discussions about it and try to work with us and get something done.”

    Imposing tougher sentences on fentanyl dealers has been the common strategy for lawmakers across the U.S., including in Democratic-controlled legislatures such as California, Oregon and Nevada. The tactic has drawn fierce opposition from harm reduction advocates, who say criminalization has historically backfired and worsened the crisis.

    In California it has divided Democratic lawmakers, who hold majorities in both chambers. Republicans and moderate Democrats are pushing for stronger prison sentences for fentanyl dealers, while others are wary of policies that stand to lengthen criminal sentences and incarcerate more people.

    “It’s good for politics and publicity, but it really doesn’t get to the root of the problem of drug addiction,” said Assemblymember Reggie Jones-Sawyer, a Democrat and chair of the Assembly Public Safety Committee, who called bills that increase prison sentences “a Republican playbook.”

    Democratic Assemblymember Cottie Petrie-Norris, of Orange County, whose bill did not advance Thursday but will be taken up again during a mid-May study session, said the fentanyl crisis goes beyond party lines.

    “This is not a red state crisis or a blue state crisis. This is an American crisis, and it’s certainly a California crisis,” she said.

    That tension boiled over last week. In March, Jones-Sawyer announced he was delaying hearings of at least seven fentanyl-related bills that would increase prison sentences, calling them a “Band-Aid approach.” But after members of law enforcement, prosecutors and families of fentanyl overdose victims protested, Democratic leadership in the Assembly ordered a special hearing for seven of them.

    The issue is personal for Jones-Sawyer, who lost his uncle to heroin and a cousin to crack cocaine. He witnessed how public policies during the 1980s crack epidemic resulted in the mass incarceration of people of color, without solving drug problems.

    “We really do need to get to the root of that (by) cutting off the supply and then reducing, if not eliminating, the demand. We got to do both,” Jones-Sawyer said.

    Fentanyl is a synthetic opioid that is 50 times stronger than heroin and 100 times more potent than morphine. Fentanyl overdoses accounted for one in five deaths among people ages 15 to 24 in California last year. Drug overdoses nationwide have claimed more than 100,000 lives annually since 2020, with about two-thirds of them fentanyl-related.

    The current crisis is deadlier than any the U.S. has seen, and in California, Democratic Gov. Gavin Newsom proposed more than $90 million in new spending to combat it. Last week he directed the California Highway Patrol and National Guard to help San Francisco tackle fentanyl.

    Newsom has not publicly supported any fentanyl-related legislation.

    Fentanyl public safety measures may face an uphill battle in California’s Senate. This week the body’s Public Safety Committee shelved a bipartisan bill by Democratic Sen. Tom Umberg that would require courts to warn people convicted of dealing fentanyl that they could be charged with murder if someone they sold to dies in an overdose. The bill, modeled after the state’s DUI advisory, could make it easier for prosecutors to convict repeat offenders, as the warning would serve as evidence of awareness of the overdose risk.

    Public health experts are calling on lawmakers to reject harsher sentences for fentanyl convictions. Ricky Bluthenthal, a professor of preventive medicine at the University of Southern California’s Keck School of Medicine, said they could could deter people from calling 911 for help for fear of arrest.

    “Increasing penalties will likely result in more deaths,” he said at a Tuesday news briefing ahead of the hearing, adding that stronger prison sentences have had little impact on drug use historically.

    Republican Assemblymember Jim Patterson, of Fresno, who authored a bill increasing fentanyl penalties that did not pass Thursday, said not lawmakers failed to make progress on the issue.

    “They aren’t interested in justice, and as a result we will continue to have injustice for victims of fentanyl poisoning,” Patterson said.

    Other measures that would make overdose reversal medication more accessible and increase education on fentanyl have received early support in committee hearings, including one authored by Democratic Sen. Dave Cortese requiring K-12 schools to create a protocol for student opioid overdoses. The bill is named “Melanie’s Law” after 15-year-old Melanie Ramos, who died from a suspected fentanyl overdose at a Hollywood school.

    The Assembly public safety committee also passed bills Thursday to create a statewide task force to study the issue and increase coordination among law enforcement agencies.

    Smith, who plans to return to the Capitol in May for the study session, remains hopeful the Legislature will work together on the fentanyl crisis.

    “I’m never going to stop (speaking out), because I speak for not just myself because of my son Jackson, but I also speak for all mothers that have lost their children to fentanyl,” she said. “We’ve got to do something now.”

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  • U.S. Marine gets 12 years for cross-border drug smuggling

    U.S. Marine gets 12 years for cross-border drug smuggling

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    A former Marine who helped smuggle drugs for years from Mexico into the U.S. and even tried to get a song written about his exploits has been sentenced to 12 years in federal prison

    SAN DIEGO — A former Marine who for years helped smuggle drugs from Mexico into the United States and even tried to get a song written to glorify his exploits was sentenced Friday to 12 years in federal prison.

    Roberto Salazar II, 26, of San Diego was sentenced for importing fentanyl and for conspiracy to distribute heroin, methamphetamine, cocaine and fentanyl, according to a statement from the U.S. attorney’s office.

    Salazar, who pleaded guilty last October, could have faced up to life in prison.

    He was stationed at Marine Corps Air Station Miramar in San Diego. Prosecutors said that before joining the corps and while on active duty, he and couriers he recruited made dozens of smuggling trips across the border.

    Salazar would obtain cars that were driven to Mexico, where drugs were loaded into the engine compartments. Couriers would then drive them back across the border into the U.S., prosecutors said.

    The scheme began around 2015, authorities said.

    By the time of his arrest last year, “Salazar had become so involved in drug trafficking that he was commissioning a Mexican songwriter to write a drug ballad known as a ‘narcocorrido about him,” the U.S. attorney’s office said.

    “In one line that Salazar suggested to the songwriter, he boasted: ‘I wanted to study and became a soldier, but I liked the fast life better,’” the office said.

    Some of the couriers recruited by Salazar were former Marines or classmates at Southwestern College in Chula Vista.

    “This case involved a Marine who was supposed to protect and defend our country, but instead brought great harm to Americans by trafficking fentanyl and other dangerous drugs,” U.S. Attorney Randy Grossman said. “He also betrayed his solemn oath by recruiting other Marines to do the same.”

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  • An emerging threat: Drug mix of xylazine, fentanyl

    An emerging threat: Drug mix of xylazine, fentanyl

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    The U.S. has named a veterinary tranquilizer as an “emerging threat” when it’s mixed with the powerful opioid fentanyl, clearing the way for more efforts to stop the spread of xylazine.

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  • Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US | CNN

    Biden administration declares fentanyl laced with xylazine ‘an emerging threat’ in the US | CNN

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    CNN
     — 

    The White House has declared that the powerful synthetic opioid fentanyl combined with xylazine – an animal tranquilizer that’s increasingly being used in illicit drugs – is an “emerging threat” facing the United States due to its role in the ongoing opioid crisis.

    Administration officials call the threat FAAX, for fentanyl-adulterated or -associated xylazine.

    The move, announced Wednesday, marks the first time in history that any administration has declared a substance to be an emerging threat to the country, said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. The SUPPORT Act of 2018 established that the office has authority to declare such “emerging threats,” and no administration has used it until now. Last year, Congress declared methamphetamine an emerging drug threat but none have been declared by an administration previously. Under other agencies or in separate circumstances, concerns such as bioterrorism, infectious diseases or climate change may be identified as “emerging threats.”

    “This drug, which is an animal sedative, is being mixed with fentanyl and is being found in almost all 50 states now,” Gupta said Tuesday. “It’s become an important part for us to make sure that we’re declaring it an emerging threat.”

    Now that the administration has declared fentanyl combined with xylazine an emerging threat, it has 90 days to coordinate a national response. “We are working quickly to develop and implement a whole of government nationwide plan, with real deliverable action, that will save lives and will be published within 90 days of this designation,” Gupta said.

    Xylazine, also known as tranq or tranq dope, has been linked to an increasing number of overdose deaths in the United States due to its rising illicit use. Between 2020 and 2021, overdose deaths involving xylazine increased more than 1,000% in the South, 750% in the West and about 500% in the Midwest, according to an intelligence report released last year by the US Drug Enforcement Administration.

    And in some cases, people might not even know that xylazine was in the drug they used.

    Just last month, authorities at the DEA issued a public safety alert about the “widespread threat” of fentanyl mixed with xylazine, reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.

    Fentanyl, which has been driving the opioid crisis, is a fast-acting opioid, and people who use it illicitly say that adding xylazine can extend the duration of the high the drug provides.

    Xylazine is not an opioid. It is approved by the US Food and Drug Administration for use as a tranquilizer in veterinary medicine, typically in horses, but it is not approved for use in humans. And xylazine can do major damage to the human body, including leaving drug users with severe skin ulcers, soft-tissue wounds and necrosis – sometimes described as rotting skin – that can lead to amputation.

    “Xylazine is one of the contaminants in fentanyl, but there could be others,” Gupta said. “So, I think with the declaration of an emerging threat, we’re sending a clear message to producers and traffickers of illicit xylazine and illicit fentanyl that we’re going to respond quicker, we’re going to match the challenge of evolution of these drugs supply, and that we’re going to protect lives first and foremost.”

    Now that xylazine has been declared an emerging threat, some of President Biden’s $46 billion drug budget request to Congress can be used to respond.

    This year, the Biden administration announced that the President has called on Congress to invest $46.1 billion for agencies overseen by the Office of National Drug Control Policy to tackle the nation’s illicit drug crisis.

    If the budget request is not approved, there could be the option to reallocate money within the Office of National Drug Control Policy, but “we don’t want to be in a position where moneys that are being utilized for some other important aspect of saving lives has to be moved away for this purpose,” Gupta said Tuesday. “That is the reason we are asking Congress to act.”

    Such funds could be used to test drugs on the street for xylazine, collect data on FAAX, invest in care for people exposed to FAAX and develop potential treatments for a xylazine-related overdose.

    The medication naloxone, also known as Narcan, is an antidote for an opioid overdose, but people who have overdosed on a combination of opioids and xylazine may not immediately wake up after taking naloxone, as it may not reverse the effects of xylazine in the same way it does opioids.

    “We need to recognize, first of all, that there is a shift that is occurring from organic compounds and substances like heroin and cocaine to more synthetics,” Gupta said of the state of the nation’s illicit drug crisis.

    “Both the types of drugs have changed – from predominantly organic to predominantly synthetics – but the way drugs are bought and sold have also changed,” he said. “Now, all you need is a phone in the palm of your hand and a social media app to order and buy some of the most dangerous substances on planet Earth.”

    Xylazine is just one of the many adulterants – or substances that are typically added to others – found in the nation’s illicit drug supply.

    “All of a sudden, you can synthesize hundreds of compounds and kind of mix them together and see what does the best in the market,” Joseph Friedman, a researcher at the University of California, Los Angeles, told CNN in March. “People are synthesizing new benzodiazepines, new stimulants, new cannabinoids constantly and adding them into the drug supply. So people have no idea what they’re buying and what they’re consuming.”

    Some of these adulterants may be as simple as sugar or artificial sweeteners added for taste or additives or fillers that bulk up the drug. Sometimes, they may be contaminants left over from the manufacturing process.

    But all of these things can carry real-life health harms, says Naburan Dasgupta, an epidemiologist and senior scientist at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

    Like an opioid, xylazine can depress the respiratory system, so the risk of overdose multiplies when it’s combined with heroin or fentanyl.

    Also, “in the veterinary literature, we know that it causes a really bad severe form of anemia. And so when people are injecting heroin that’s contaminated with xylazine, they can end up with a near-fatal form of blood iron deficiency,” Dasgupta said in March. “We had one person here who ended up going to the hospital needing multiple blood transfusions. And it was all because of the xylazine.”

    US lawmakers are moving to classify xylazine as a controlled substance.

    In March, bipartisan legislation – the Combating Illicit Xylazine Act – was introduced in the House and Senate. It describes illicit xylazine as an “urgent threat to public health and safety” and calls for it to be a Schedule III drug under the Controlled Substances Act, a category on the five-level system for substances with moderate to low potential for physical or psychological dependence. Xylazine would be one level below opioids like fentanyl.

    “Our bipartisan bill would take important steps to combat the abuse of xylazine by giving law enforcement more authority to crack down on the illicit distribution of this drug, including by putting stiffer penalties on criminals who are spreading this drug to our communities,” Sen. Maggie Hassan, D-N.H., said in a statement in March.

    The bill would also require manufacturers to send reports on production and distribution to the DEA so the agency can ensure that the product is not being diverted to the black market.

    “This bill recognizes the dangers posed by the increasing abuse of animal tranquilizers by drug traffickers, and provides new tools to combat this deadly trend,” Sen. Chuck Grassley, R-Iowa, said in the statement.

    “It also ensures that folks like veterinarians, ranchers and cattlemen can continue to access these drugs for bona fide animal treatment.”

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  • Police union director fired after opioid smuggling arrest

    Police union director fired after opioid smuggling arrest

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    The executive director for a Northern California police union who was charged with attempting to illegally import synthetic opioids from India and other countries has been fired from her job

    SAN JOSE, Calif. — The executive director for a Northern California police union who was charged with attempting to illegally import synthetic opioids from India and other countries has been fired from her job, officials said Friday.

    Joanne Marian Segovia, who was the executive director of the San Jose Police Officers’ Association, was arrested last week on charges she attempted to unlawfully import valeryl fentanyl, a synthetic opioid. If convicted, she faces up to 20 years in prison.

    Starting in 2015, Segovia had dozens of drug shipments mailed to her San Jose home from India, Hong Kong, Hungary and Singapore with manifests listing their contents as “wedding party favors,” “gift makeup,” “chocolate and sweets” and “food supplement,” according to a federal criminal complaint.

    Segovia, 64, at times used her work computer to make the orders and at least once used the union’s UPS account to ship the drugs within the country, federal prosecutors said.

    Her attorney, Will Edelman, did not immediately respond Friday to a voicemail seeking comment.

    The police association fired her after completing an initial internal investigation, union officials said in a statement.

    An outside investigator will be hired to conduct a comprehensive “no-holds-barred” probe of Segovia’s alleged crimes, determine to what extent she utilized union resources and whether that could have been prevented, they said.

    “The abhorrent criminal conduct alleged against Ms. Segovia must be the impetus to ensuring our internal controls at the POA are strong and that we enact any changes that could have identified the alleged conduct sooner,” said Sean Pritchard, president of the union.

    Federal officials began investigating Segovia last year after finding her name and home address on the cellphone of a suspected drug dealer who is part of a network that ships controlled substances made in India to the San Francisco Bay Area, according to the complaint. That drug trafficking network has distributed hundreds of thousands of pills in 48 states, federal prosecutors said.

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  • Fentanyl caused ‘Gangsta’s Paradise’ rapper Coolio’s death

    Fentanyl caused ‘Gangsta’s Paradise’ rapper Coolio’s death

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    The Los Angeles County coroner’s office says “Gangsta’s Paradise” rapper Coolio suffered an accidental death from the effects of fentanyl, heroin and methamphetamine last year

    LOS ANGELES — LOS ANGELES (AP) — “Gangsta’s Paradise” rapper Coolio suffered an accidental death from the effects of fentanyl, heroin and methamphetamine last year, the Los Angeles County coroner’s office reported Thursday.

    The county agency also cited cardiomyopathy, a disease that makes it more difficult for the heart to pump blood to the body, as a “significant condition.” Investigators also determined Coolio’s severe asthma and cigarette smoking played a role in his death.

    Coolio’s former longtime manager Jarez Posey also confirmed the cause of death Thursday.

    Coolio — born Artis Leon Ivey Jr., on Aug. 1, 1963 — died at the Los Angeles home of a friend on Sept. 28, 2022. He was 59.

    Coolio won a Grammy for best solo rap performance for “Gangsta’s Paradise,” the 1995 hit from the soundtrack of the Michelle Pfeiffer film “Dangerous Minds” that sampled Stevie Wonder’s 1976 song “Pastime Paradise.”

    Coolio was born in Monessen, Pennsylvania, and later moved to Compton, California.

    He started rapping at 15 and knew by 18 it was what he wanted to do with his life, he said in interviews. Coolio attended community college before devoting himself full-time to the hip-hop scene.

    His career album sales totaled 4.8 million, with 978 million on-demand streams of his songs, according to Luminate. He was nominated for six Grammys.

    With his distinctive persona, he became a cultural staple, acting occasionally, providing a voice for an animated show and providing the theme music for a Nickelodeon sitcom.

    Coolio’s estate plans to release a studio album later this year that he had been working on in the days before he died.

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  • Fentanyl caused ‘Gangsta’s Paradise’ rapper Coolio’s death

    Fentanyl caused ‘Gangsta’s Paradise’ rapper Coolio’s death

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    Coolio, the rapper best known for hits in the 1990s including “Gangsta’s Paradise” and “Fantastic Voyage,” died last year because of fentanyl

    LOS ANGELES — Coolio, the rapper who was among hip-hop’s biggest names of the 1990s with hits including “Gangsta’s Paradise” and “Fantastic Voyage,” died last year because of fentanyl, his manager said.

    Coolio’s former longtime manager Jarez Posey told The Associated Press Thursday that Coolio’s cause of death was fentanyl and that he also had traces of heroin and methamphetamine in his system.

    The Los Angeles County Medical Examiner’s Office listed his death as accidental and cited cardiomyopathy as a “significant condition.” Posey also confirmed that investigators determined Coolio’s severe asthma and cigarette smoking played a role in his death.

    Coolio — born Artis Leon Ivey Jr., on Aug. 1, 1963 — died at the Los Angeles home of a friend on Sept. 28, 2022. He was 59.

    Coolio won a Grammy for best solo rap performance for “Gangsta’s Paradise,” the 1995 hit from the soundtrack of the Michelle Pfeiffer film “Dangerous Minds” that sampled Stevie Wonder’s 1976 song “Pastime Paradise.”

    Coolio was born in Monessen, Pennsylvania, and later moved to Compton, California.

    He started rapping at 15 and knew by 18 it was what he wanted to do with his life, he said in interviews. Coolio attended community college before devoting himself full-time to the hip-hop scene.

    His career album sales totaled 4.8 million, with 978 million on-demand streams of his songs, according to Luminate. He would be nominated for a total of six Grammys.

    With his distinctive person, he became a cultural staple, acting occasionally, providing a voice for an animated show and providing the theme music for a Nickelodeon sitcom.

    Coolio’s estate plans to release a studio album later this year that he had been working on in the days before he died.

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  • Dealer pleads guilty in death of actor Michael K. Williams

    Dealer pleads guilty in death of actor Michael K. Williams

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    A New York City drug dealer has pleaded guilty to providing “The Wire” actor Michael K

    ByLARRY NEUMEISTER Associated Press

    NEW YORK — A Brooklyn drug dealer pleaded guilty Wednesday to providing “The Wire” actor Michael K. Williams with fentanyl-laced heroin, causing his death.

    Irvin Cartagena’s plea to a charge of conspiring to distribute drugs was entered in Manhattan federal court. Sentencing was set by U.S. District Judge Ronnie Abrams for Aug. 18, when Cartagena will face a mandatory minimum of five years in prison and the possibility of as many as 40 years.

    The famed actor, who also starred in films and other TV series including “Boardwalk Empire,” overdosed in his Brooklyn penthouse apartment in September 2021. Authorities said he died hours after buying the heroin from Cartagena on a Brooklyn sidewalk in a deal that was recorded by a security camera.

    Cartagena, 39, signed a plea agreement with prosecutors stipulating that the mix of heroin and fentanyl he sold Williams resulted in his death. His lawyer, Sean Maher, declined comment.

    U.S. Attorney Damian Williams, who is not related to the actor, said in a statement that the sale occurred in “broad daylight in New York City, feeding addiction and causing tragedy.”

    “In doing so, he dealt the fatal dose that killed Michael K. Williams,” Williams said.

    Prosecutors said Cartagena and his alleged co-conspirators continued to sell fentanyl-laced heroin around residential apartment buildings in Brooklyn and Manhattan even after they learned of the actor’s death. Another defendant in the case pleaded guilty Tuesday.

    Williams’ death came despite an investigation by the New York Police Department that placed a paid informant making controlled heroin buys on the same block where Williams bought drugs.

    The day after, the informant went back to buy more drugs from the same group and recorded a conversation in which some of them talked about Williams’ overdose. One denied selling any drugs containing fentanyl.

    Williams’ “stick-up boy” character Omar Little on “The Wire” — a fictionalized look at the underpinnings of Baltimore that ended in 2008 but remains popular in streaming — was based on a real-life figure.

    He created another classic character as Chalky White in HBO’s “Boardwalk Empire” and also appeared in “12 Years a Slave,” “Assassin’s Creed” and other films.

    In interviews, Williams had spoken about his battles with addiction.

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  • Pandemic Saw Rise in Opioid Prescriptions Given After Childbirth

    Pandemic Saw Rise in Opioid Prescriptions Given After Childbirth

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    By Cara Murez 

    HealthDay Reporter

    WEDNESDAY, April 5, 2023 (HealthDay News) — New mothers who gave birth early in the pandemic filled far more opioid prescriptions than American women did previously, raising concerns about the potential for narcotic misuse.

    About 38% of more than 460,000 women who gave birth from July 2018 through December 2020 were prescribed opioids for postpartum pain management, according to the University of Georgia study.

    But there was a nearly 3 percentage point increase in the number of opioid prescriptions filled after March 2020 — when a national emergency was declared in the United States — than before the health crisis began.

    The opioids these mothers were prescribed were also higher strength, the researchers noted.

    “A lot of women receive opioids for treatment of pain during the postpartum period, but they are a particularly vulnerable group because many of them haven’t used opioid medications before,” said Emily Lawler, co-author of the study and an assistant professor in the School of Public and International Affairs.

    “That makes them high risk for potential opioid abuse,” Lawler said in a university news release.

    The findings were especially concerning because opioid overdose deaths increased during the pandemic, surpassing 100,000 deaths annually, the study authors said.

    Opioids are typically a last resort for pain management after pregnancy.

    The American College of Obstetricians and Gynecologists (ACOG) recommends health care providers use an approach for postpartum pain that starts with a basic pain reliever like ibuprofen (such as Motrin or Advil) or acetaminophen (Tylenol). If that doesn’t alleviate the pain, physicians are advised to then move to a low-strength opioid, such as codeine or tramadol.

    Patients prescribed opioids should not take them for extended periods and should be switched to over-the-counter pain medications as soon as possible, ACOG recommends.

    “Prior to the pandemic, opioid prescriptions were decreasing not only in terms of the number of women prescribed opioids but also the strength of the opioids being prescribed and the number of days covered by each prescription,” said Shelby Steuart, lead author of the study and a doctoral candidate in the School of Public and International Affairs.

    “But right after the COVID-19 lockdowns happened in March 2020, we saw a sharp spike in opioid prescription fills,” she continued. “We don’t know whether physicians were writing more opioid prescriptions or if more women were just taking their prescriptions to the pharmacy and filling them, but it is concerning.”

    Physicians may have worried they wouldn’t see their patients as frequently during the pandemic, the study team suggested, because of COVID-19 surges and lockdowns. They may have been attempting to compensate for that, the researchers said. 
     

    Anxiety from the pandemic may also have exacerbated women’s feelings of pain, causing them to fill those prescriptions.

    “It’s really critical for this population to be in continued contact with health care providers because they are at high risk of chronic pain,” Lawler said. “It is important to appropriately manage pain, but postpartum women who do develop opioid use disorder are much harder to connect to treatment. And we need to be aware that there is potential for this group to become addicted to opioids, and we need to be on the lookout to connect them to treatment if needed.”
     

    The study findings were published online April 3 in JAMA Network Open.

    More information

    The U.S. Centers for Disease Control and Prevention has more on opioids.

     

    SOURCE: University of Georgia, news release, April 3, 2023

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  • More Pregnant People Are Overdosing, and Stigma Plays a Role

    More Pregnant People Are Overdosing, and Stigma Plays a Role

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    March 30, 2023 – For Hendree Jones, PhD, executive director of an addiction clinic in Chapel Hill, NC, too many of her patients wait to seek addiction treatment because they’re afraid of facing backlash. They fear having their children taken away or going to jail and leaving them behind in an unsafe environment if they test positive for drugs.

    Jones, who runs UNC Horizons, a drug treatment facility for pregnant women and their children, said she’s seen a number of cases where these fears have been realized. Most recently, one of her patients made it through pregnancy, but when her newborn tested positive for drugs, child welfare stepped in. The woman desperately wanted help with her addiction, but there were concerns that she might not be able to take care of her baby. 

    “We were able to advocate for her so she could bring her child along to the treatment facility, but all too often these families end up separated,” Jones said. 

    The introduction of fentanyl into the drug supply has been driving an increase in overdose deaths among the entire population, and pregnant people show these same patterns of addiction. A recent article published in JAMA found that among pregnant and postpartum people, drug overdose deaths increased by 81% from 2017 to 2020. Recent reports have also shown that maternal mortality is on the rise in the United States and overdose rates are partially driving the increase.

    Pregnant people also face additional barriers to care. For starters, penalizing them for drug use has become more common in recent years as a result of the opioid epidemic. States like California and nearly a dozen others now have laws on the books that classify drug use as child abuse and can result in many parents losing custody of their children, according to an article in JAMA Pediatrics.

    They may also be turned away from emergency rooms or arent believed when they say that theyre in pain from withdrawal, Jones said. According to an October 2022 report from the White House Office of National Drug Control Policy, pregnant people are 17% less likely to be accepted into a treatment facility than the general public and when they are accepted, they’re often met with disdain. 

    Many women are treated so badly within health care settings that they go in once for treatment and never go back, Jones said. While we’re seeing a greater understanding around addiction as a medical condition within many populations, that same understanding has not been extended to pregnant people. “It takes a lot of guts to walk into a treatment facility and say you need help and when there isn’t a compassionate response, these women get scared and leave,” she said.

    Only around 19% of treatment facilities in the U.S. treat pregnant people, and in recent years that number has been on the decline, according to a report from the American Counseling Association. The decline is due to poor funding and the pandemic, when social distancing forced many facilities to reduce residential numbers. Staffing these treatment centers with properly trained counselors has also become more difficult because people are dropping out of the profession, not entering it. All of this has resulted in a lack of care for those who need it the most, said Emilie Bruzelius, an epidemiologist at Columbia University in New York who studies how the opioid crisis has impacted child welfare.

    “Nobody starts using opioids when they’re pregnant. It’s people who have opioid use disorders and then may or may not have access to treatment and the social support that they need to get through it,” said Bruzelius.

    Additionally, for many people who are able to stay drug-free during pregnancy, the postpartum period can become even more dangerous. Bruzelius’s research shows that the greatest number of opioid deaths happen after the birth of a child. A February 2021 study published in the Journal of Women’s Health found that the risk of overdose was highest 7 to 12 months after pregnancy.

    “Pregnancy can be a motivating time for women to seek help, but as time passes the risk of relapse is higher in the postpartum period, and if women have managed to cease drug use during pregnancy, their risk of overdose gets even higher because they don’t have the same tolerance that they had before,” said Bruzelius.

    The postpartum period is already at a critical point because of the risk of postpartum depression and an overall lack of postpartum health care. While pregnant people might see their obstetrician weekly, most only have one visit with their doctor after giving birth. And for the most at-risk population, this just isn’t sufficient, Bruzelius said. “There are so many stressors that come with a new baby, and stress is not conducive to drug use cessation.”

    Still, when people are able to get the help they need, research has shown that it works. Patients who are treated with methadone and buprenorphine (two medications widely used for the treatment of heroin dependence) are much less likely to die, according to a report from the American College of Obstetricians and Gynecologists.

    “There is clear-cut evidence showing that these medications help women have better outcomes, and there’s no evidence to show that they negatively impact the development of the fetus,” said Nora D. Volkow, MD, director of the National Institute on Drug Abuse

    In some cases, when pregnant people use these medications, their babies may be born with neonatal abstinence syndrome (NAS), caused by withdrawal from drugs they’re exposed to in the womb. This outcome is more pronounced with the use of methadone over buprenorphine. Volkaw said one of the recommendations for treatment is to breastfeed because if the mother is taking these medications, breastfeeding can help to alleviate some of the withdrawal symptoms in the baby.

    While there aren’t enough facilities available to pregnant people to meet the current need, there are examples of treatment centers that are doing it right. UNC Horizons, a state-of-the-art facility, for example, not only helps pregnant people with addiction but also treats the underlying trauma that causes them to relapse. 

    Other treatment facilities, like Hope Clinic at Massachusetts General Hospital in Boston, provide addiction and psychiatric care throughout pregnancy and early postpartum when people are most vulnerable to dying. 

    According to Volkaw, we can’t expect pregnant people to get help if their basic needs aren’t met. They need to be able to trust that those in the health care system have their and their children’s welfare in mind. 

    Rather than treating these people as criminals, we need to understand that this is a medical condition and without treatment many women will die, Volkaw said. 

    At a most basic level, Volkaw said, these people need to be able to bring their children with them to treatment. In some cases, they may need transportation, financial help finding a safe place to live, and proper nutrition. 

    “These are elemental needs and if they aren’t met, it becomes very hard for women to stay in treatment whether or not they’re pregnant,” she said.

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  • Fatal Drug ODs Among U.S. Seniors Have Quadrupled in 20 Years

    Fatal Drug ODs Among U.S. Seniors Have Quadrupled in 20 Years

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    By Cara Murez 

    HealthDay Reporter

    THURSDAY, March 30, 2023 (HealthDay News) — Drug overdose deaths — both accidental and intentional — have quadrupled over the past 20 years among older adults in the United States, a new study finds.

    This increase in people ages 65 and older suggests the need for greater mental health and substance use policies, the authors said.

    “The dramatic rise in overdose fatalities among adults over 65 years of age in the past two decades underscores how important it is for clinicians and policymakers to think of overdose as a problem across the life span,” said co-author Chelsea Shover, an assistant professor of medicine at the University of California, Los Angeles David Geffen School of Medicine.

    “Updating Medicare to cover evidence-based treatment for substance use disorders is crucial, as is providing harm reduction supplies such as naloxone to older adults,” Shover said in a school news release.

    About three-fourths of those who died accidentally were using illicit drugs, including synthetic opioids such as fentanyl, heroin, cocaine and methamphetamine. In 67% of intentional overdoses, seniors used prescription medication, including opioids, antidepressants, benzodiazepines, antiepileptics and sedatives.

    The researchers calculated overdose deaths among seniors from 2002 to 2021, using a database from the U.S. Centers for Disease Control and Prevention. The investigators compared demographics, specific drugs, and whether the deaths were intentional, unintentional or undetermined.

    They found that fatal overdoses quadrupled from 1,060 in 2002, which was 3 per 100,000, to 6,702 in 2021, or 12 per 100,000. Black seniors had the highest rates, at 30.9 per 100,000.

    By 2021, 1 in 370 senior deaths was from an overdose, the report noted. About 57% of those involved opioids, 39% involved stimulants and 18% included a combination of the two types of drugs.

    About 13% of overdoses in 2021 were intentional and 83% were unintentional. Another 4% were undetermined, and 0.7% — five people — were murdered.

    Women comprised 57% of the intentional overdoses and 29% of the accidental overdoses, according to the study.

    The researchers also determined that 37%, of overdoses among Asian-Americans were intentional compared to 17% among white people and 1% among Black people.
     

    Deaths from alcohol poisoning rose from less than 0.03 per 100,000 to 0.5 per 100,000 during the study period.

    “Even though drug overdose remains an uncommon cause of death among older adults in the U.S., the quadrupling of fatal overdoses among older adults should be considered in evolving policies focused on the overdose epidemic,” the researchers wrote. “Current proposals to improved mental health and substance use disorder coverage within Medicare, for example, applying mental health parity rules within Medicare, acquire greater urgency in light of this study’s results.”

    Study findings were published March 29 in JAMA Psychiatry.

    More information

    The U.S. National Safety Council has more on drug overdoses.

     

    SOURCE: UCLA, news release, March 29, 2023

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  • The US sanctioned Chinese companies to fight illicit fentanyl. But the drug’s ingredients keep coming | CNN

    The US sanctioned Chinese companies to fight illicit fentanyl. But the drug’s ingredients keep coming | CNN

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    CNN
     — 

    The seller, who went by the name Linda Wang, was curt when asked if she sold a chemical often used to create fentanyl.

    “That’s banned,” Wang replied, before quickly providing an alternative: “CAS79099 powder is best. U can have a try.” 

    After more than a week of back and forth, she seemed impatient. “Ok. 79099 powder in USA warehouse now…if you need. Pls order asap,” she wrote in a text message exchange.

    The interaction is part of a CNN investigation that explored whether US-sanctioned chemical companies in China are evading Washington DC’s crackdown on illicitly made fentanyl – finding at least one China-based company that had links to a sanctioned entity, and a seller eager to ship potential ingredients for the lethal drug.

    More than 100,000 Americans died from drug overdoses in 2021, and two-thirds of the fatalities involved synthetic opioids – much of it believed from illicitly made fentanyl, according to the Centers for Disease Control.

    The drug can be 50 times stronger than heroin and 100 times stronger than morphine – and pharmaceutical grade versions of it can be prescribed by doctors for severe pain. But illegally manufactured fentanyl has turbocharged the US’s opioid overdose crisis in the last decade, according to data from the CDC.

    Controlling the illegal trade of the drug has turned into a geopolitical headache for the Biden administration, as China’s vast chemicals market – which supplies the world with raw materials for everything from perfume to explosives– is also a major pipeline of the building blocks of fentanyl, known as fentanyl precursors, according to US officials. 

    Further complicating the fight against fentanyl is the sheer variety of precursors that can be used to make fentanyl and other illicit drugs. Most such precursors also have legitimate uses – including for medical research – and are perfectly legal to sell, making up part of the booming transnational trade.

    China has strict anti-drug policies domestically, but critics in the US say it is not doing enough to help monitor or regulate purchases from buyers aiming to use Chinese-made ingredients to manufacture illegal drugs overseas.

    In 2019, Beijing stepped up its crack down on the production and sale of finished fentanyl and its variants, but US-China anti-drug cooperation has since stalled amid disagreements on trade, human rights, the Covid-19 outbreak and Taiwan. Hopes that US Secretary of State Antony Blinken would bring up fentanyl during a planned visit to Beijing died in early February, when Blinken postponed his trip after a surveillance balloon from China floated over the continental US. 

    As the opioid crisis topped the domestic agenda in 2021, the US sanctioned four companies in China accused of exporting fentanyl or fentanyl precursor chemicals. Online commercial records suggest ties between one of those sanctioned companies, Hebei Atun Trading Co., Ltd., and another China-based company called Shanxi Naipu Import and Export Co., Ltd., that continues to sell fentanyl precursors legally.

    According to official public records in China, Hebei Atun Trading Co., Ltd., began liquidating in June 2021 and was formally dissolved in August that year. Shanxi Naipu Import and Export Co., Ltd. was registered in the same period, according to official records, and it shares a number of key things in common with Hebei Atun.

    For example, Hebei Atun’s still-active Facebook page once linked to a now-defunct website of Shanxi Naipu – which is where CNN found Wang’s phone number.

    The two companies’ websites are registered to the same email address, and at one time appeared to share an IP address. Today, Shanxi Naipu’s websites appear to be carbon copies of Hebei Atun’s since-deleted page – with the same navigation tabs, email address and stock photo of a pipette dropping amber-colored liquid into a cell tray. The Russian and Portuguese versions of the site list “Hebei Atun Trading Co. Ltd.” as their copyright holder.

    One post on a Shanxi Naipu website was titled, “Hebei ATUN Trading Co., Ltd. Wishes you a Happy New Year!” (sic). It has since been deleted. 

    When presented with CNN’s findings, Shanxi Naipu denied ties to Hebei Atun, saying, “we are not related at all.” In statements emailed to CNN, Shanxi Naipu said it had purchased the sanctioned company’s Facebook account, email and cell phone number in order to “attract internet traffic.”

    Shanxi Naipu also denied selling the fentanyl precursor that Wang offered by text, and stressed that everything they sell is legal, and said that they were taking steps to stop the repercussions from the apparent links to Hebei Atun.

    “To prevent further impact from Hebei Atun, we have immediately removed relevant promotional websites and platforms,” the company said in an emailed statement.”

    Logan Pauley, a China analyst who tracks criminal and drug networks, told CNN, “It’s easy on the Chinese side to start a new company to copy and paste the same text that you’re posting on social media or you’re posting on a trade website, and then just to recreate the same operation over and over again.”

    And Gary Hufbauer, trade expert at the Peterson Institute for International Economics and former US treasury official, likens it to a game of cat-and-mouse. While the US government can add an entity to its sanctions list “overnight,” said Hufbauer, there may not be the resources in the US Treasury’s Office of Foreign Assets Control, which enforces sanctions, to keep tabs on new companies that may leverage sanctioned companies’ branding or operations. 

    In a statement to CNN, a spokesperson for the US Treasury said it “had not hesitated” to go after “bad actors” – citing the four sanctioned Chinese companies – and would continue to sanction companies and individuals involved in the drug trade.

    “Treasury continues to monitor the effects of our designations,” they said. “If additional information becomes available that can assist sanctions compliance efforts, when appropriate, we provide that information to industry and/or the public.”

    Asked if Beijing was knowingly lax in its efforts to stem the flow of precursor chemicals from its country, the Chinese Foreign Ministry pointed out that most were not controlled substances, in a lengthy statement that also questioned US efforts to treat addiction and demand for opioids.

    “China has always strictly controlled precursor chemicals in accordance with international conventions and domestic laws. The US side’s so-called ‘fentanyl precursors,’ a small number of them are listed substances by the United Nations, and China has always been resolute in implementing the listed measures. But most of the rest are common chemicals that are not listed by the United Nations, China or even the United States itself,” it said in a written statement to CNN.

    “Government departments do not have the right or the possibility to regulate non-listed chemicals and common commodities,” it added.

    The ministry statement went on to highlight China’s harsh domestic penalties on drug trade and consumption. “The Chinese people deeply resent drugs. the Opium War was the beginning of China’s modern history of humiliation. The Chinese government has always cracked down on drug crime, and China is a no-go area for international drug dealers.”

     Such unregulated precursors, like the one offered by Wang, are not illegal to sell but can be used in the manufacture of illicit substances like fentanyl, methamphetamine, and cocaine.

    Several precursors used to create fentanyl have been put under international control since 2017, but a savvy chemical engineer can combine legal precursors further up the synthesis chain to make similar compounds.

    “What we have seen illicit chemists doing now is that certain components of the synthesis are now … harder for them to purchase, so what they’re doing now is they’re buying compounds that are structurally very, very similar,” Alexandra Evans, a forensic chemist with the D.C. Department of Forensic Sciences, told CNN from her lab in the US capital.

    Or they can create fentanyl analogues, substitutes that are chemically similar to fentanyl and which has made the crisis more deadly in recent years. One fentanyl analogue was found to be 10,000 times stronger than morphine, according to a 2021 US government report.

    Controlling the stream of chemicals has turned into a deadly game of whack-a-mole – where manufacturers are able to use a variety of precursors to synthesize fentanyl and its analogues faster than either can be identified, banned, or regulated. 

    Many of the building blocks to fentanyl have benign purposes and are legal to buy, but a menu Wang sent of Shanxi Naipu’s chemical products for sale appeared designed to support illegal drug manufacture, according to a synthetic chemist who analyzed the list for CNN. 

    It was “obviously a list curated to help people create illicit drugs,” Lyle Isaacs, a professor in the Department of Chemistry and Biochemistry at the University of Maryland, told CNN of the more than 25 chemical compounds on the menu. 

    At least three compounds on the list could be made into fentanyl, he said. One of the compounds, CAS 79099-07-3, also known as 1-Boc-4-piperidone, was what Wang offered to sell CNN; the other two compounds also have legitimate uses and can be found, for example, in academic laboratories researching future medicines, Isaacs said. 

    Still more compounds on the list appeared to be building blocks for meth, ecstasy, ketamine, and the cutting of cocaine, as well as over-the-counter drugs like paracetamol, a common pain medication that can also be used to cut heroin and other narcotics, he added. 

    Asked about the list, Shanxi Naipu reiterated in its statement to CNN that all products on it are legal in China, stating: “We are not professional chemists but just a trading company. Even though we don’t have an intimate knowledge of the composition and use of thousands of chemicals, we have always strictly ensured the legality of our products!”

    Attempts to contact Wang through the company for comment were not successful, and the company said in its statement that she no longer works for them.

    There are measures that responsible chemical sellers can take to avoid their products being used for illegal drugs.

    Identity checks are a hallmark of reputable sellers, said a former Drug Enforcement Administration (DEA) official. The source spoke to CNN on the condition of anonymity because they were not authorized to speak to the media. To sell non-listed chemicals, a good-faith seller would normally ask a buyer about the intended use of the compound, and whether the buyer had the backing of a company or institution, such as a research organization or university.  

    American buyers of regulated chemicals require licenses from the DEA, depending on how hazardous they are. Reputable sellers may also ask for tax identifications even for chemicals that are not controlled, like precursor materials, the source said.

    At no point in the conversation was Wang aware, nor did she ask for the identities of the CNN reporters speaking to her or what CNN planned on using it for. She even offered a “door to door” precursor delivery service via warehouses in the US or Mexico – locations that CNN has been unable to verify.

    In its statement to CNN, Shanxi Naipu denied that it had warehouses in either country.

    The small quantity of precursor needed to manufacture fentanyl ultimately makes shipments destined for illicit ends hard to catch at the border, points out Martin Raithelhuber, an illicit synthetic drugs expert at the United Nations Office on Drugs and Crime.

    “You have hundreds of thousands of tonnes (of chemicals in a shipment), and you are looking for a few kilograms, which are sufficient to produce a supply of millions of doses (of fentanyl),” he said. 

    Since China banned the production of fentanyl and related substances in 2019, Mexican criminal organizations have largely taken control of the drug’s production and sale, smuggling finished fentanyl to consumers in the US, according to a 2022 report from the Congressional Research Service.

    Mexico is now the source of “the vast majority” of meth, heroin and illicit fentanyl seized in the US, according to the US International Narcotics Control Strategy Report (INCSR) released in March 2023. “In 2022, the United States identified Mexico as the sole significant source of illicit fentanyl and fentanyl analogues significantly affecting the United States,” it reads.

    “Criminal elements, mostly in the People’s Republic of China, ship precursor chemicals to Mexico, where they are used to produce illicit fentanyl,” Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, told the Senate Foreign Relations Committee earlier this year. 

    “The only limit on how much fentanyl they can make is the amount of precursor chemicals they can get,” DEA Administrator Anne Milgram told CNN in early March.

    The Biden administration has taken aim at these groups and in February sanctioned a network of Sinaloa Cartel members and associated entities for their involvement in the fentanyl and methamphetamine trade. 

    Mexico’s law enforcement has also fought the trade, seizing and impounding hundreds of kilos of fentanyl precursors and pills – including a cache of over a million potential fentanyl pills in the Mexican border city of Tijuana on March 13.

    Ultimately, tackling fentanyl requires close coordination between the US, Mexico, and China. Even if countries like Mexico had the best national control measures, international cooperation is needed to understand “which flows are the ones we need to watch or [be] worried about,” Raithelhuber said.

    Former DEA official Matthew Donahue told CNN he would like to see Mexico do more, including cracking down on properties and other assets of those involved in the drug trade.

    But as the US pressures other governments to help slow the flow of illicit fentanyl, relations between the three countries have turned into a three-way blame game.

    Following the kidnapping of four Americans in a Mexican border town by cartel members in early March, US Republicans called for the US military to be allowed to fight cartels and destroy drug labs in Mexico – something Mexican President Andrés Manuel López Obrador called “an offense to the people of Mexico.” 

    “We are not a protectorate of the United States or a colony of the United States. Mexico is a free, independent, sovereign country. We don’t take orders from anyone,” López Obrador said at a news conference on March 9. 

    Washington has also called on Beijing to do more, with the latest US INCSR report describing China’s oversight functions as “poorly staffed and under-resourced to oversee its massive chemical industry.” Though it acknowledges Beijing’s harsh penalties for drug trafficking, the report laments ineffective controls on shipment labeling, customer vetting and pill-making equipment.

    The Ministry of Foreign Affairs’ statement to CNN emphasizes its “stringent” control of listed chemicals that could be used for drug-making and argues that Beijing has “improved” several “regulatory mechanisms such as end-user verification, leakage monitoring, and source backtracking, and has strengthened management of more than 200,000 chemical companies.”

    Both China and Mexico have called on the US to do some soul-searching about demand for illicit fentanyl.

    “US legislators and the authorities there are not doing their job because they are not addressing the causes (of addiction); there are no care programs for young people in the US,” López-Obrador said last week.

    “Using China as a scapegoat will not solve the drug crisis in the United States … ,” the Chinese Foreign Ministry’s statement to CNN read. “We advise the US side to reflect on itself, stop shifting blame, strengthen domestic prescription drug control, enhance publicity on the dangers of drugs, and take practical measures to reduce domestic drug demand.”

    Prescription opioids like oxycodone and hydrocodone – which have a similar chemical structure to heroin and fentanyl – were major contributors to the early opioid crisis in the US. Pharmaceutical giants, notably Purdue Pharma, downplayed the potentially addictive properties of the drugs and incentivized US doctors to prescribe the painkillers. But prescribing was curtailed as overdoses from prescription opioids climbed and now waves of heroin and illicit fentanyl took over, making the crisis far more deadly. 

    Amid the recriminations, fentanyl products continue to pour through US borders and Americans continue to die. 

    To raise awareness of the human toll, the US Drug Enforcement Administration last year created “The Faces of Fentanyl” exhibit at its headquarters in Arlington, Virginia where families can submit a photo of a loved one lost to the fentanyl crisis. So far more than 5,000 photos have been submitted.

    “We can’t be desensitized” to the number of lives lost to drug overdoses,” Donahue, the former DEA official, said. “The pain and suffering that these families are going through. That has got to mean something.” 

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