Is China’s Opioid History Being Repeated in The United States?

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President Xi Jinping of China has reportedly sent a formal invitation to President Donald Trump for a peace summit discussion in Beijing. The importation and trading of opium substances, extracted from the poppy Papaver somniferum flower and often used as a painkiller, is a central question for the future of US-Chinese relations. While in 2019 China agreed on implementing restrictions on the substance, America’s fentanyl crisis has continued to grow. One of the most alarming factors to the Fentanyl crisis is that many addictions and drug abuse cases originate in a professional prescription of the pain killer. Does the responsibility lie with China, the manufacturer, or with the US healthcare system, the distributor?

In the past decade, abuse of the drug Fentanyl has created a crisis in the US. It causes respiratory issues and muscle rigidity when consumed and has led to thousands of overdoses a year. Initially, the drug was being brought into the US in its completed form. However, after the imposition of restrictions from China, drug smugglers began transporting opioid substances that are needed to make Fentanyl into the US in order to produce the finalised product. The drug is a highly powerful painkiller often prescribed in patches, similar to morphine in its use; with a 2023 audit finding that it was prescribed 1.9 million times in America. It is highly appealing for drug addicts as it can act as a stronger substitute for heroin and has euphoric effects on the individual abusing the drug. The drug and its components are brought into America in 2 main ways; smuggled through international mail, or brought across land borders like Mexico and Canada, made possible due to the lack of intensive screening in order to save time and prevent traffic along borders.

The history of opioid abuse in China should have heeded as a warning against making high intensity painkillers so readily available. In the late 1800s there were two conflicts in Hong Kong against the British that followed a similar narrative to what is happening with America in the 21st century. Britain was trading opium through Hong Kong, an interaction that was highly profitable for Britain but acted as the final straw on the Qing Dynasty's back, unable to cope with the financial drain and the vast number of citizens experiencing health problems. China’s drug problem fluctuated in intensity after this time, eventually coming back to full force in the 1980s in the face of the country’s ‘modernisation’ and its growing ties with the West. The key difference in the modern drug problem is that while it has begun as a major social and economic drain for the country, China is now able to benefit financially from the creation of opium. In the case of Fentanyl, because of its medicinal use as a painkiller, it is highly unlikely that its production and trade into the states will halt altogether, but this is where questions are raised regarding who is responsible for bringing the crisis under control.

As of currently, Trump has imposed Fentanyl-tariffs on China and has stated that it will not be lifted until there is noticeable change, indicating that the US believes the solution should start at the root. The restrictions placed by China in 2019 should not be overlooked in this debate, there has already been a major attempt at dealing with the fentanyl crisis, but drug traffickers have found ways to overcome that and the problem has continued. If the problem has continued to expand regardless of restrictions being implemented, the US should then be looked at as to what can be done internally to regulate the availability of the drug.

Opioid abuse can begin in many ways, but the US healthcare system should be put under a microscope. Unlike countries like the UK and Australia, there is not a national healthcare system in the US, forcing many citizens to be dependent on health insurance through their employment but even then, this is unreliable due to the extortionate prices of treatment. Research has shown that Fentanyl is a highly effective painkiller, not only able to stop pain in the short-term but also prevent the recurrence of the pain, therefore, it is frequently prescribed to those suffering with chronic pain. However, due to its highly addictive nature, even the smallest dosages can lead to dependency and when it is no longer being prescribed people will turn to illegitimate sources. Furthermore, even with this knowledge of opium-based medications being highly addictive, they are still being overprescribed by medical professionals in the US.

Another flaw that presents itself is the prescription of Fentanyl for post-surgery pain because there is no clear outline as to how much should actually be prescribed for this type of pain - this has led to people that have undergone the same surgery being prescribed different amounts purely because of who has treated them or the state they are in. The US Commissioner of Food and Drug from 2017 to 2019 published an essay with the New York Times in which he argues that alongside encouraging China to increase restrictions, the companies that are transforming the opium powders into the final medicinal product should be following the process closer to ensure that the entire production is legitimate and remove the products that aren’t - it would be logical for this to fall under the responsibility of Prescription Drug Monitoring Programmes. The Fentanyl crisis begins in China, but US policy allows it to thrive.