China should crack down on illicit fentanyl flows regardless of U.S. rhetoric, Zha Daojiong writes

It is a moral imperative and in Chinese interests, says the PKU Professor on functional cooperation with Washington on fentanyl

The first 2024 Republican Party presidential debate is fastly approaching and candidates seeking the Republican presidential nomination have made blaming China for the fentanyl crisis a cornerstone of their China policy. Nikki Haley recently told Face the Nation

And don't think for a second China doesn't know what they're doing. So what I would do is say to China, we will end all normal trade relations with you when- until you stop killing Americans. We are losing too many. We lost more than the Afghanistan, Iraq, and Vietnam wars combined. 70,000 Americans last year, it's unacceptable. We need to be strong with China. They're running all over us. We're waiting to deal with China tomorrow while they're dealing with America today.

Beijing maintains its commitment to narcotic drug control has always been consistent and resolute. For example, China has taken the lead in scheduling and controlling substances similar to fentanyl without waiting for evidence of abuse and harm, while the U.S., which has been deeply affected by the abuse of fentanyl, has yet to officially schedule and control all forms of fentanyl as a class of substances.

China also says the U.S. demand for China to crack down on the export of chemicals, tablet presses, capsule filling machines, and tablet press molds related to fentanyl is illegitimate and impractical: they are not controlled according to the international conventions on narcotic drug control or Chinese and Mexican laws, and China doesn’t have first-hand knowledge of the use of those exported goods, which is the responsibility of importing countries.

Fundamentally, China believes the fentanyl crisis is first and foremost the U.S.'s own making - nobody, not least China, is forcing the import of fentanyl into the U.S. or abusing them, where the inability to regulate fentanyl is a domestic problem, but Washington keeps externalizing its internal problem and scapegoating Beijing.

China, where fentanyl abuse is not a problem, believes it has gone out of its way in controlling fentanyl to help Washington, only to be rewarded with little appreciation and persistent finger-pointing.

Zha Daojiong, a professor of international political economy at the School of International Studies and Institute for South-South Cooperation and Development at Peking University, on August 7, 2023, wrote in 澎湃 The Paper, a Shanghai-based popular Chinese media outlet, that narcotical drug control, including over fentanyl, should continue as functional cooperation between China and the U.S.

Zha specializes in non-traditional security issues and is active in consultations with a wide range of government, business, and academic bodies interested in how China relates to the rest of the world.

He advises that Beijing sticks to its fundamental direction of functional cooperation over fentanyl because it is a moral imperative and also in China’s own interest.

Zha is also an academic advisor to the Center for China and Globalization (CCG).

芬太尼问题：坚持功能性合作的国际道义性

Keep Making Fentanyl an Issue of Functional Cooperation: a case for an international moral imperative

In recent years, "fentanyl" has transformed from a rarely heard or even unfamiliar term into an inescapable topic within the context of U.S.-China relations. The fundamental shift is noticeable on the U.S. side, where the approach has evolved from accusing China of inadequate collaboration in international drug control efforts to adopting measures such as lawsuits, arrests, and sanctions targeting Chinese entities and individuals. On the public opinion front, an increasing number of American scholars focusing on the bilateral political relationship suggest that if China and the United States were to engage in smoother cooperation in the realm of cross-border fentanyl trafficking, it could contribute to reducing the hostility toward China in U.S. political circles.

In an era dominated by emotionally charged social media, engaging in fact-based discussions about bilateral relations and transnational issues holds particular significance for researchers from both countries. Starting with an understanding of what fentanyl is could indeed be a promising beginning.

What is Fentanyl?

Fentanyl is a synthetic opioid drug initially developed for surgical anesthesia and pain management. It is approximately 50 times more potent than heroin and about 100 times more potent than morphine.

Since its emergence in the late 1950s, pharmaceutical products containing fentanyl were approved for sale and distribution, with approvals granted in the United Kingdom in 1963, the United States in 1968, and China in 1974. In 2017, the World Health Organization added fentanyl to its "Model List of Essential Medicines."

Medically (legally) available forms of fentanyl include powders, tablets, injectables, capsules, solutions, patches, and nasal sprays. It is suitable for both adults and children, especially during hospital surgeries, serving as an effective pain control medication. Late-stage cancer patients, under medical guidance, can also use fentanyl to alleviate pain. The potency of veterinary fentanyl is ten thousand times that of morphine, making it unsuitable for human clinical use and restricted to large animals.

Illegally produced and sold synthetic fentanyl exists in various forms, colorless and tasteless, with effects akin to marijuana and heroin. Illicit fentanyl can be mixed with other drugs to make them cheaper, more deceptive, and more addictive. Mixing fentanyl with any substance, legal or illegal, increases the risk of fatal overdoses. For instance, carfentanil, a fentanyl analog that is 100 times more potent than fentanyl, can lead to respiratory depression, arrest, unconsciousness, coma, and death with as little as 0.02 milligrams (equivalent to a few grains of salt).

Understanding the topics related to the transnational circulation of fentanyl involves several crucial concepts.

Firstly, there are Fentanyl Derivatives. Fentanyl, as a compound, possesses a specific chemical structure, and alterations in its pharmacological effects can be achieved by modifying one or more regions of this structure. Theoretically, even subtle changes in the chemical structure can give rise to a new compound with potentially greater potency and toxicity, and this process of change can lead to an infinite variety of new compounds.

Secondly, there are Fentanyl Analogs. Particularly in the context of illegal trafficking, various substances similar to fentanyl exist with chemical structures that are akin but not easily detectable. This poses a significant challenge for frontline personnel engaged in customs and pharmaceutical market regulation. Without the use of fentanyl test papers or reagents, it is nearly impossible to determine whether a material or drug declared as something else contains fentanyl. In fact, even test papers or reagents may not be capable of detecting rapidly evolving fentanyl analogs.

Thirdly, there are Fentanyl Precursors. This concept primarily refers to compounds that serve as raw materials for synthesizing fentanyl. Given that fentanyl and its analogs can be synthesized through various methods, a wide range of chemical substances are involved in this process. On one hand, these materials are legitimate and necessary for medical, industrial, or commercial purposes. On the other hand, since the emergence of fentanyl, preventing its abuse and combating illegal manufacturing and trafficking have been ongoing focal points of international cooperative efforts.

Within the United Nations framework, Single Convention on Narcotic Drugs (1961) and United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988) provide the legal mechanisms for member states to control precursor chemicals and derivatives of fentanyl. These conventions establish obligations for member countries to include these substances on controlled substance lists. The process of identifying, reporting, and internationally controlling a precursor chemical of fentanyl involves a professional assessment. In 2016, there were sixteen fentanyl precursors on the controlled substance list. This number increased by two in 2017 and an additional three in 2022. This evolution reflects the ongoing efforts to address the challenges posed by these substances and their derivatives.

In essence, "fentanyl" is a complex term that encompasses various meanings and scenarios. Legally used, it is a narcotic and psychotropic substance that serves as an "angel" in regulated medical settings, benefiting appropriate patients. However, in inappropriate or illegal contexts, particularly in the realm of illicit drugs, fentanyl turns into a "devil." Different countries have legitimate needs for fentanyl's pharmaceuticals, derivatives, and precursors. Yet, beyond these lawful necessities, fentanyl becomes a global menace. Established international mechanisms aim to effectively regulate and control its circulation, given its potential harm. Fentanyl illustrates the duality of its nature: a valuable therapeutic tool when used responsibly, but a formidable threat when misused or abused.

Fentanyl and Functional Cooperation Between China and the United States

One area of functional cooperation between China and the United States is narcotical drug control. In the realm of international relations research, "functional cooperation" refers to collaborative efforts between governments on social and transnational issues of mutual concern. As these issues transcend politics, both parties tend to downplay diplomatic differences in their interactions to reach a consensus.

China and the United States initiated bilateral drug control cooperation in 1985. The 《中美禁毒合作备忘录》China-U.S. Memorandum of Cooperation in Narcotic Drugs Control signed two years later provided a framework for establishing and maintaining functional cooperation, involving departments related to public health, justice, and customs from both countries. In 2003, a mechanism for narcotic drugs control intelligence exchange was established, and its operation has remained unaffected by shifts in U.S. policy towards competition and rivalry, as evidenced by the successful convening of the 第九届中美禁毒情报交流会 9th China-U.S. narcotic drug intelligence meeting in 2018.

Over the years, the control and cooperation concerning fentanyl have been among the topics discussed by relevant departments from both China and the United States. Against the backdrop of significant shifts in the political and diplomatic landscape of both countries, a visit by the White House Office of National Drug Control Policy Director to Beijing in September 2019 resulted in in-depth discussions on issues such as drug traceability analysis technology, preventing drug-related crimes in postal logistics, and the regulation of fentanyl-related substances, strengthening cooperation in intelligence sharing and data exchange.

China-US cooperation in the fight against narcotic drugs also includes strengthening joint law enforcement efforts and prosecution, with a shared commitment to combating illegal fentanyl-like substances. In November 2019, the two countries for the first time jointly dismantled a case of fentanyl smuggling. China's Ministry of Public Security's Narcotics Control Bureau and the U.S. Department of Homeland Security's Immigration and Customs Enforcement shared intelligence information and exchanged evidence, resulting in the complete dismantling of a criminal group engaged in illegal manufacturing, trafficking, and smuggling of fentanyl and other drugs.

In China, there has been no wide abuse of legally produced fentanyl-related pharmaceuticals, and there is no societal issue concerning the misuse of fentanyl-like substances. However, in April 2019, the Chinese Ministry of Public Security, the National Health Commission, and the National Medical Products Administration fully scheduled fentanyl-like substances in the supplementary control list of non-medicinal narcotic drugs and psychotropic substances. This signifies that any potential future fentanyl-like substances in China will be strictly regulated as non-medicinal narcotic drugs and psychotropic substances, including production and legal export. China's approach is pioneering among member states of the United Nations Commission on Narcotic Drugs.

In the United States, the abuse and illicit use of fentanyl have led to a significant public health crisis. According to statistics from the Centers for Disease Control and Prevention, in 2021, around 80,000 Americans died from drug overdoses, primarily due to fentanyl abuse. U.S. agencies such as the Drug Enforcement Administration assert that China is a major supplier of fentanyl to the U.S. drug market. Fentanyl-like substances from China, as well as pill presses and other machinery used in fentanyl production, enter the U.S. directly or through Mexico.

During the Biden administration, the U.S. escalated unilateral judicial actions against Chinese entities and individuals. For instance, in May 2020, the U.S. Department of Commerce added China's National Narcotics Laboratory and China's National Forensic Science Technology Center to its Entity List for export controls. However, these entities are crucial to China's efforts in combating the illicit circulation of fentanyl, as they are responsible for identifying and monitoring fentanyl and its analogs, and they provide data to the United Nations.

In June 2023, China's National Medical Products Administration and the U.S. Food and Drug Administration resumed contact to discuss cooperation for 2023 and beyond. Drug control is part of the regulatory work, implying that drug control cooperation between China and the U.S. is shifting back to the functional cooperation track.

China's Options

"Fentanyl," regardless of its specific context, is just one of the substances that the United States is prominently addressing in its efforts to combat opioid misuse. The U.S. "war on drugs" dates back to as early as 1971, and the lessons learned from it indicate that a comprehensive approach is needed to manage the public health crisis caused by inappropriate drug use, rather than solely relying on controlling foreign supply sources. However, despite controversies surrounding policy design and measures, this ongoing war continues to influence domestic public health governance and extends into the realm of diplomacy.

Given the current situation where the overall direction of U.S. policy towards China is unlikely to change in the short term, how can China effectively address its interests in the transnational circulation of fentanyl?

Firstly, China doesn't need to categorize statements like "China is a major source of global fentanyl" as hostile. This is because fentanyl, including its precursors and derivatives, has legitimate uses worldwide as a substance and product. Issues arise with fentanyl-like substances produced illegally, which are related to drug regulation and other public health governance aspects. The jurisdiction for international public health governance is defined on a national basis. These are well-established facts.

Secondly, even though there is an element of "treating the internal illness externally" in the U.S. response to the fentanyl crisis, this shouldn't change China's fundamental direction of pursuing functional cooperation by continuing to engage and seek collaboration with the U.S. The lessons from any drug abuse crisis in one society serve as a warning to another society. The knowledge and alerts gained from exchanges with the U.S., involving China's professionals, research institutions, public health, and judicial sectors, are valuable and contribute to preventing large-scale drug abuse crises domestically.

Thirdly, the transnational circulation of illicit drugs is a persistent phenomenon throughout human history, necessitating routine responses from pharmaceutical regulatory and judicial agencies in various countries. For the regulatory and judicial bodies of any government, the common occurrence of the challenge of "plans not keeping up with changes'' is evident. Especially in the context of the internet, where channels such as the "dark web" are frequently exploited by criminals and wrongdoers, engaging in communication with other countries like the United States and multilateral mechanisms like the United Nations proves beneficial for China in combating illegal activities that may also unavoidably exist within its own society.

Fourthly, U.S. politicians associating the "fentanyl crisis" with "China" have their own motivations and logic, which are part of the domestic political ecosystem in the United States. China should not underestimate the inflammatory power of such rhetoric within the U.S. domestic political sphere and even in the broader international community. Whether the U.S. changes or lifts sanctions imposed on relevant Chinese entities may not necessarily be closely related or even relevant to China's future actions. Nevertheless, maintaining the functional and cooperative nature of mechanisms like the China-U.S. narcotic drug information exchange meeting remains valuable and necessary.

In conclusion, when it comes to the fight against drug abuse, including issues related to fentanyl, China's commitment to professional and functional cooperation, engaging with all countries including the U.S., and international organizations, is more significant than whether it can reduce political animosity towards China, as some U.S. scholars predict. 

What matters is that through international narcotic drug control exchanges and cooperation, China upholds its moral high ground in the present and future world, while also creating more favorable conditions for cooperation with other countries in the field of drug circulation, including cases involving narcotic drugs entering China. This way, China’s principles of 有理、有利、有节 "reasonable, beneficial, and balanced" can be achieved.