Those is really changing. Fentanyl but, as you write abo about, fentanyl mixed with cocaine or methamphetamines. So i want to start off with the big picture. What got you into this . I have a friend died from fentanyl in 2010 before people were talking about it. Before i knew what it was. It wasnt until four years ago, i was a music journalist primarily narrows doing a report on people dying at raves. These electronic music, or those tens of thousands of people partying. The deaths would be blamed on ecstasy. I have never heard of ecstasy being a lethal drug before and i found out that almost all of the ecstasy was adulterated. Mixed with other chemicals . Exactly. There was almost no real troop ecstasy at all. It was all these new chemicals. So i wanted to find out what the drugs were and it turns out that there are hundreds of new drugs that i had never heard of and most people have never heard of, all synthetic, made in a lab and almost all of them in china. So i heard about drugs coming from mexico, afghanistan or columbia but i had no idea that china was where the new drugs were being made. The most deadly of the drugs, i learned was fentanyl. That sent me on this quest to get to the source to try to come and understand where it came from. What i thought you did such a fascinating job on, fentanyl, inc. Was describing the sort of infrastructure that developed into one of the hearings we had with the agency, they spoke about criminal chemists in china. Tell this story. You actually went there. How did you make the connections and what did you learn when you got to china . The first thing i learned, buying drugs online is incredibly easy. You dont even need to go in the dark lab necessarily, even just a clear lab. I started googling the names of drugs, like functional and found these chinese labs and all i did was just send an email. Pretending to be a drug fire with a fake email address. I asked if i was ever in china, if i could visit their lab. Some of these chemists said yes. So i went. I went early last year and what i found was shocking. I was expecting Something Like an underground environment. But it wasnt like that at all. I was expecting Something Like the Mexican Cartel but these were like legitimate businesses, really. And to some extent, you described that they are legitimate businesses, one molecule ahead of Law Enforcement thus trying to schedule the drug and make them illegal. Describe that process. Exactly. When it comes to fentanyl, and in the u. S. And china but theres all these little offshoots fentanyl called analogs. You can make an analog just by tweaking the chemical structure just a tiny bit. So for years, thats how the chinese chemists have been staying one step ahead of the law. Whenever china bans one of these drugs, they would tweak it slightly and sell the new drug until it was illegal. They were operating within the law that has only changed recently in may when china agreed to ban all types of fentanyl, analogs and everything, even before they were invented. Even knew once i hadnt been invented yet. However they explained to the listeners, people here in the u. S. Buying the precursor chemicals to making fentanyl and then mixing the ingredients before they sell it in a retail capacity . You kept having these visuals that you could understand one was a coffee grinder and using a coffee grinder to mix substances but then it seems thats part of the risk can you help people understand the legality of fentanyl . Small amounts, literally like grains of sand that can be a lethal overdose could kill someone if they dont understand if they are buying it, what the mix is. Heroin, like we said is a natural plant. But fentanyl is made in a lab and its 50 times stronger. So drug dealers will not use pure heroin, they will cut heroin with fentanyl because they want to save money. Its cheaper to make, more powerful, the problem is that the way they mix them together, its not precise. Its not scientific. These street dealers in st. Louis, one that i talked to said they would mix the heroin and fentanyl using a coffee grinder. Same thing to grind coffee beans. The problem is, you cant do it precisely. So one dose might be week but another dose might be so strong as to kill someone. Thats why so many people are dying from fentanyl. You were quoting people because it does seem counterintuitive. Think of it as being a product literally killing the purchasers of the product. That doesnt seemed like a Good Business model. You quoted people saying they find out about a death and theyll want to get that batch because it is stronger. So help us understand is at the level of addiction causing someone to take that step . Did you get more behind talking to the users and the high they are chasing . Many longtime heroin users, they dont even get high anymore from heroin. All it does, its the withdrawal systems it relieves their withdrawal symptoms. But with fentanyl, they can get high again, so much stronger. Unfortunately, what happens is when someone overdoses and another addictive user hears about it, he or she doesnt say, i better stay away from that, they say no, this must be a powerful batch, i want that. That euphoria. Exactly. Its an unfortunate aspect. I think its hard to get your brain around. For policy makers, part of what our force is about, trying to educate members of congress in communities all over the country that are now dealing with this, to understand what the impacts are and how people are responding. The other part of the book that i thought was really fascinating, your take on the war on drugs. Going back to the history of that, president nixon and reagan. Talk about that a little bit. What your impression is of whether that approach has been successful. Ever since i was little, ive been hearing just to say no and the war on drugs. I think, unfortunately where we are at right now is that fentanyl is killing more americans every year end ever every any drug ever. Weve been doing the crack at epidemic, meth epidemic, pills like oxycontin, that was the first part of the Opioid Crisis from a first wave. In heroin but fentanyl is the worst. So to me, it is all evidence that the war on drugs is not succeeding. Pablo escobar, the famous colombian cocaine man and yet, it did nothing to slow. We are getting more cocaine from columbia than ever before. There was al chappell who was imprisoned recently but its not stopping the flow of drugs from mexico at all. Laughing people up, its been devastating for minority communities in terms of the money spent so to me, the war on drugs is not working. To me its a Public Health issue at this. One of the issues we are focusing in on is to understand that people who are incarcerated, do not get access to treatment, any kind of exit Addiction Treatment or even the Underlying Mental Health or, they might have been dealing with. What we are looking at, the reason for that, 50 years ago when congress created medicaid, they had an exclusion for people during incarceration. So there medicaid coverage stops the day they go in. County jail, state prison, penitentiary and for 50 years, all across the country, people havent had sufficient healthcare and access to treatment. They come out and we all act shocked that they go back to the addiction and crime. We live with these incredibly high rates of people going back in and when you think about it, we are not surprised that they come out and still have diabetes and i keep talking with Law Enforcement same, we are not going to arrest our way out of this. Its a Public Health issue. So our legislation is to bring medicaid treatment for the Underlying Mental Health issues and Substance Abuse issues into our communities and jails and prisons. Thats a great piece of legislation. Everything youre saying is completely shown to be the case as ours drug use, recidivism, what you mentioned before, medication and treatment, different names for it but this is a twopronged approach but im sure youre very familiar with. Attacking the chemical problem, the drug problem on the one hand and to do that, using these low level opioids like methadone and what they do is help people sort of hopefully taper off from these really destructive opioids like fentanyl and heroin. They could really wealth the purge to take the other drug. Yes. And at the same time, combining that with therapy, counseling because what we found is that its not just the drug often. In fact, almost every case, there are personal problems people have in their lives, they are out of work, they got Severe Health problems, personal issues and if these things can be addressed in tandem, the ability for someone to get off, even on drugs, has been found to be pretty good. Page 276, one of the people working on this in therapy, she said exclusively focusing on the chemical aspect, also overlooked an important factor, one 100 of my patients experienced childhood trauma or have a Mental Health disorder, which are tied in. Its interesting that it took one 100 , i was recently at the womens prison in New Hampshire because they are starting to bring treatment and Mental Health therapy in. In already having profound results. They told me one 100 of the women incarcerated in New Hampshire have either had 75 Sexual Assault in their lifetime and 25 abuse and neglect in their childhood. So if you are not treating the Underlying Mental Health issues, your spinning your wheels in terms of trying to help someone get past their addiction and into treatment. In the longterm recovery, its not a 28 day, one in done proposition. As a high rate of relapse. We need to recognize thats true for lots of different issues. We dont say to a diabetic, i cant treat you, you just ate cake. Thats a really difficult disease. How can we help you and your family . You ought not to eat cake. We need to help you for the rest of your life. Theres cake everywhere. You cant have it. Talk about the Harm Reduction model that you talked about at the end. As you know, new england is really where the Opioid Epidemic and fentanyl in particular kicked off. The worst a few years back, worse than anywhere else in the country, but the encouraging thing is that weve been seeing these deaths drop in new england in the last couple of years. Even while they are still going up in places like missouri where i live. Unfortunately, the epidemic is less. Thats something we have to deal with. But in new england, theres incredible success with the medication assisted treatment, Medicaid Expansion is helping a bunch of people. We have a program we call safe stations, we can walk into a fire station and without risk of an incarceration, you can say i need help, i have a health issue, which is addiction to Substance Abuse disorder with opioids and they will connect you with treatment and get you into treatment. Hugely successful. But the Medicaid Expansion is critically important. The first 100 people to walk through the door, it was like 95 or more eligible for Medicaid Expansion. So the reason they werent getting the help they needed was that they had no place to turn. We didnt have treatment, the hospitals would not help them with getting past the detox and that is the critical link. He talked about how they will keep taking heroin so as not to go through withdrawals and to me, that should be a Public Health issue. They should be able to walk into any hospital and we should help them get through withdrawals. One of the interesting things ive learned about the medically assisted treatment is in some cases, you dont have to go through withdrawal. You can get directly onto the medication and that will help you taper off. Then theres narcan and this is basically miracle opioid reversal drug. Its not science fiction. It really is extraordinary. In some states, theyve made it so you dont need to get a prescription to get it but its really a matter of dividing, funding firefighters, First Responders and they from people like librarians because her situations now where people are passing out in library bathrooms, its an epidemic across the country. Librarians are trained to deal with these situations. They need arc narcan on hand. Family members do. I think thats one of the things, the communities are on this. Talk a bit about what you learned about this Harm Reduction model and how we can educate and prevent overdoses people harming themselves. I went to spain, barcelona and philly have these facilities called supervised injection facilities. What these places are, addicted users can go in, get clean needles and shoot up heroin, fentanyl, whatever the drug. They can even smoke crack cocaine and it legal to do so inside the facility and they are watched over by Trained Medical staff. Its a little outside the box. They offered Addiction Treatment . Its all part of the package. We have learned more and more about this, a moment of clarity when someone is ready for treatment, help and making that readily available to people so they can take that step. Yes, that is absolutely part of it. These centers, they tend to bring the users out of the parks, like in barcelona, they had these needles and parks and kids were stepping on them. They had addicted users in the street but they are brought into these areas and they have them in canada a lot, and europe, no one has ever died at one of these facilities but in the u. S. , they are banned, they are illegal. There is a number of cities that have tried to help them including philadelphia recently. The federal government has banned them and its something you need to think about, Something Else probably fentanyl testing strip. Yes, talk about that. These kids, narcan and they are all part of that strategy. The functional testing strips in particular, these are kind of, they look like a pregnancy test. Figure two is, you dont know whats in it, it could be pure heroin or heroin with fentanyl, you dont know. So mix it up in a solution, dip the strip in and if theres one stripe, that means there is functional which means there isnt. So what studies have found is that if people realize there is fentanyl in their drugs, like you said it could be mixed into anything, cocaine, meth, if people find fentanyl in there, they are less likely to take it and therefore less likely to overdose and die. You are talking about your plan in 2010, for me, 2014, a messenger graduated college and come back to a small town in New Hampshire and he was taking extra courses, his father was a dentist and he wanted to become a dentist and his parents were aware he had a drug problem. He had been to treatment and come back. He was living with them and what happened was, he got a respiratory, a bad cold and went to get medication for the cold and unbeknownst to everyone, the doctors and pharmacists, the parents, the young man, it was cough syrup with codeine. The codeine created this drug seeking behavior in him and immediately medical to the heroin dealer but what was delivered to him turned out to be one 100 fentanyl. We didnt know anything about it at that time. His mother, who i got to know very well after this happened, came home to find him dead on the bathroom floor with the needle still in his arm. You talk about that in the book, what that means is, a lethal dose, what was it about the chemistry of fentanyl . Not weigh into the chemistry. You have a chemistry background . I was having a hard time following. What is it that makes this a lethal dose . That you would literally die. He didnt have any idea what he was taking. With fentanyl, it was created in the late 1950s by a chemist and he wanted to create a better drug for the hospitals and he did. Fentanyl was used in an open heart surgery and continues to be an important drug for things like epidurals during childbir childbirth, meant getting colonoscopies and it still remains an important laboratory drug. Also for people with cancer and for patching things but what he didnt realize was that along the way, these chemists, like the kind i describe in the subtitle, started going through the scientific literature that he and other drug chemists were publishing. During all of this, if youre a scientist at the university, you publish a paper and it went into some University Library, its pretty hard to find but the internet age, all of these papers were published online. And publicly available. Around the world. Exactly. They began looking for these files, specifically for these papers, to go through them and appropriate chemical relents, learn how to make these new drugs. They began exploiting all over the internet and made in chinese labs, different types of functional came about in this way. The other thing that made the book very readable, you told these incredible personal stories, you met with families who lost loved ones. One of them was the death of bailey in north dakota. Tell a story. Its fascinating, the interaction with Law Enforcement and this incredible mystery International Mystery to get to have all came about. Bailey was an 18yearold kid, he had just graduated from high school, he had never tried fentanyl until he received it one night at a party and it was stronger than anything hed ever tried before. He passed out and died. His parents had no idea what fentanyl did. This was 2015, nobody knew what fentanyl was. Its a pretty small, fairly conservative place. I talked to the mayor of the town and he said, we dont think of ourselves as a place where we have a drug problem. There are more functional thats in the community realized they had to take strong action against this problem. So they adopted a bunch of these forward thinking Harm Reduction approaches. And they are frightened to do anything about it because they dont want to get in trouble. And to be pretty isolated place so they permitted this medication and assisted treatment to be done remotely like skype so talking with doctors and other cities and it is a very impressive show of support in that community. On the house veterans but i did a lot and also i have a rural district and now they are starting to do medically assisted treatment over the internet to skype those interviews. I was incredibly surprised how successful that was that center and a comfortable chair and then have their sessions to drive two or three hours was recently visiting one of our hospitals that has the expertise that they need. And also to usher in a shift of a mindset with a Public Health coordinator who said the fentanyl epidemic is changing the way people think about addiction and we have to jail our way out of the problem treating addiction as a disease to give people treatment even spilling over into Something Like alcoholism and was treated the same way. Was social issue more than a real disease. It is incredible beginning with opioid and heroine and now fentanyl that role america has been hit so hard certainly in my district and trying to come to terms so that means its very difficult to find talented employees for the workforce. And what we have seen just recently is supportive employment where one of our major employers will have specialist on hand in the company if they feel they will lapse in need resources for so many families have been hit by this. The whole society is impacted in coming to terms with that as a Public Health issue rather than a criminal justice issue. It is critical. That we cannot just address the supplyside. So i went to china and i found all sorts of horrifying things about the government subsidizing the production of fentanyl and fentanyl like drugs as a precursor. And then to receive a tax rebate to export fentanyl. Also at the trade war and President Trump is trying to pressure the chinese president to make these changes and these are changes that should be made. And even with this Chemical Industry to export these drugs the industry will likely move to a place like india that is already starting to make fentanyl. So we need to focus on the demand side thats only thing we can do ourselves. That is the name of the game with Harm Reduction. You make a really interesting comment that the fentanyl dealers understand the demand for opioids right now. And to tell the whole story about oxycontin and oxycodone. Then the shout out. But your point is well taken that if we dont get a handle and then to meet so many people in recovery and then to recognize that thats a possibility or a probability. And Mental Health treatment. And to get people to a healthy place. And there is so much history. You had an incredible story of the opioid wars and those drugs that are imported to the united states. Tell that story. With those opium wars in the early 19th century and what was happening is england was sending opium into china and the Chinese People were getting addicted. The chinese leader said we want you to stop bringing this into our country. But england refused so there were two wars fought over that. Now today whats going on is a reverse opium war now its those in the west who are getting addicted. Now talking to chinese officials they dont want to take responsibility which is not surprising. They blame the us for its own culture of drugs. And they have a good read part one they have a good point to have four times as many opioids so some recently released documents that you are alluding to to reference the big lawsuits with the pharmaceutical companies now the most famous that is responsible for oxycontin pushing the drug trying to make sales even when their own internal study show so Purdue Pharma gets a lot of the blame but with these new documents a much less wellknown Company Based in st. Louis made more of these oxycodone pills more than any other Company Responsible for like 29 billion opioid pills so now we are getting back to her the cities and towns that are consolidating and actually oklahoma and even Johnson Johnson even a judge has said on that scale that Everyone Needs to be held accountable because of the statistics and that medication but i do have to ask you one question back to china. It seems to me if you were a foreign country trying to threaten the wellbeing of our country that this would be a brilliant strategy to just follow up america. Do ever think of this as a Homeland Security issue . Should we be looking at this in a different way with International Relationships . It is definitely a National Security issue when you think about it. 70000 americans die from the Drug Overdose so what you are getting at is what chided doing is they going to war essentially with the us . And thats a term that Chris Christie and trump have used. War. The way i think about it is it didnt start off that way because china wants to encourage the Chemical Industry exports and to grow the chinese economy through the chemical exports. The problem is that the tax breaks they have government incentives designed to go through legitimate Chemical Companies through these rogue companies exporting fentanyl and fentanyl like drugs. And at one point you have to say who is in charge and steering the ship . And one example is last year in the midst of the trade war it was ramping up between us and china. So china raised the tax rebate to some fentanyl from 9 percent at 10 percent right in the middle of this crisis so many people dying to raise the rebate it makes me wonder is it intentional or not . There is not a smoking gun but thats something to consider. I appreciate the depth of your research. Is there any other stories that stand out or any other message you want to get across . Thing that was interesting to me its not just addicted users that are suffering are all junkies. Fentanyl can be in any powder or in any pill. For example the singer prints thought he was taking a legitimate narcotic pharmaceutical pain pill i believe it even had percocet stamped right on and was probably legitimate but was cut with fentanyl and thats how he died. People are taking what they think is cocaine and they are dying. The unfortunate thing is that these types of drugs the sad thing is i could be a casualty also. So that is your message at the end of the day chemistry, history, science, inl relations, and then with every policymaker and we appreciate the effort the book is fentanyl ink and we highly recommend that. Thank you for all the good work you are doing congresswoman making a difference. Thank you so much. Madison knew this when he wrote the constitution. Thinking that we did not even need the bill of rights and the key to your liberty is keeping power so if you are a scientist or university and publish the paper and it went to a University Library it can be hard to find but in the internet age all of these papers were published online and are publicly available. So they began looking for these files specifically for these papers to go through through them to look at the chemical formula how to make the new drugs. Those who were separate in a walmart i went to find out about it. And they didnt want me to see what was going on and they call the police and the video went viral now all of america was hearing about cages in secret warehousing of migrant children. The book is called panic attack young radicals in the age of trump. Associate editor of reason. Com