“Absolutely the worst drug I’ve ever seen”: Risk,governance,and the construction of the illicit fentanyl “crisis”

Data and methods

The authors conducted a search for “fentanyl” in two Canadian (The Globe and Mail and Toronto Star) and two American (New York Times and Washington Post) newspapers. These were the most highly circulated daily newspapers (excluding tabloid and business press) accessible in the Factiva database at the time of the search. Our search covered the period of 1 January 2012 to 31 December 2017. The authors employed this methodology because it enabled us to explore the development of the fentanyl scare as well as if and how social context (i.e. a comparison between Canadian and US newspapers) shaped news media coverage. The initial search produced a total of 1266 articles. We then removed duplicates, letters to the editors, articles less than 100 words in length, and those articles not substantively related to fentanyl. We analyzed 1027 articles: 394 in The Globe and Mail; 187 in the Toronto Star; 158 in the New York Times; and 288 in the Washington Post.

Our initial approach to coding was grounded in our interest in how news media framed fentanyl users and commentary regarding different drug policy options. Our preliminary coding scheme reflected this and included categories such as user-white; user-racialized; solution-criminal justice; and solution-public health. The authors read a sample of articles separately and then met to discuss what we had found. A number of new codes emerged from these data. We discovered, for instance, that fentanyl users were portrayed as deceived by dealers, fentanyl was referred to as a painkiller, and China was blamed as the source of illicit fentanyl. The authors communicated with one another and met regularly to discuss the coding process, further refine our coding scheme, and determine how to code specific articles. To ensure inter-coder reliability, we decided to reach consensus whenever disagreements about a particular coding instance arose.

The majority of articles touched on several reoccurring themes and, as such, were counted in multiple categories. For example, a single article might discuss the negative consequences of state criminalization of drug use and the benefits of supervised injection sites. It was possible, then, for an article to be coded as both “criminal justice failure” and “solution-public health”. If a single article referred to a particular theme on multiple occasions (e.g. it mentioned that fentanyl was potent three or four times) it was only coded once. This approach allowed us to track overall themes and ensured that lengthy individual articles did not skew the findings.

We acknowledge this study has limitations. Notably, we recognize that audiences are active, rather than passive, and that we should not assume that others will interpret the content in the same manner as we do (see, for example, Doyle, 2006). Indeed, it would be worthwhile to investigate how audiences respond(ed) to fentanyl news media coverage and drug scares more generally. Moreover, while the Factiva database allowed us to access, retrieve, and analyze a large sample of articles from multiple newspapers, this left us ill-equipped to consider format (see Valverde, 2006) and images accompanying the text, which, as Ayres and Jewkes (2012) note, also support particular ideologies. Finally, it is important to note that for the sake of space and coherence in this manuscript we focus on several themes rather than providing a representative overview of the entire data set. In other words, we acknowledge our own active role as researchers. This active role included making decisions about which themes we found most interesting and wanted to explore further in this manuscript (see also Braun and Clarke, 2006).

“A new class of drug addicts”: ¹ Who is at risk during this crisis?

News media coverage emphasized how risky ingestion of fentanyl was by highlighting the possibility of overdose and/or death. For instance, fentanyl was referred to as a “deadly opioid” (Forrest, 2015b) and as a “poison” (McCaul, 2016). For their part, Staff Sergeant Martin Schiavetta, the head of Calgary’s drug unit, remarked that fentanyl “is absolutely the worst drug I’ve ever seen because of how toxic it is. The equivalent of two grains of sand will kill you, quickly” (Giovannetti, 2015). Across the four newspapers, 841 articles emphasized the various risks associated with fentanyl use (see Appendix).

Much like terrorism, to which it is sometimes compared (see, for instance, Achenbach et al., 2017), fentanyl purportedly poses a threat to “every layer of society” (Wente, 2016). This question of who is at risk came up repeatedly. On this topic, some journalists lament fentanyl’s “growing prevalence not just among entrenched drug users but also among unassuming recreational drug users” (Woo, 2015: S1) and issue reminders to readers that those “at risk of overdoses are not just stereotypical ‘junkies,’ but people such as cancer patients and your grandmother” (Picard, 2016a). In emphasizing that this social problem cuts across class, race, and geographic boundaries, news media encourage readers to identify with fentanyl users. For instance, Margaret Wente (2016), writing for The Globe and Mail, advocates a re-thinking of substance (mis)use predicated on who is consuming those drugs: “abusers need a lot more sympathy and help. Don’t think of them as junkies. Think of them as the clean-cut couple down the street.”

News media coverage of the fentanyl “crisis” generates sympathy for fentanyl users in three other ways. First, in 357 articles fentanyl is labeled a painkiller or a treatment option for individuals experiencing chronic pain. These labels legitimize some uses of the drug, perhaps encouraging the reader to think of those using fentanyl as patients rather than “addicts” (see Bell and Salmon, 2009; King, 2014). Second, at times users are described as not making a conscious decision to consume fentanyl. Here news media characterize individuals as “unwitting” (Wee and Hernandez, 2017) or “unaware” (Hunter, 2015), noting that other drugs could be “laced” (Forrest, 2015a) or “spiked” (Howlett, 2016a) with fentanyl without the user’s knowledge. Across the four newspapers, 251 articles portray a user in this manner. We suggest this helps absolve these individuals of blame, as they would be unable to foresee the significant risk involved in consuming fentanyl. The third way news articles engender sympathy for fentanyl users is by detailing aspects of their life histories and/or their struggles with opioid addiction. This aligns with extant research (McLean, 2017; Netherland and Hansen, 2016). For instance, a feature in The Globe and Mail profiled Michael Stone, a yoga teacher from British Columbia with bipolar disorder who divulged a desire to self-medicate and subsequently died of a drug overdose. In the feature, his spouse described him as “a man who was always curious about the world”, while students noted he was “approachable and attentive” and “had a sense of humour” (Woo, 2017b: A8). Stories like this provide context for drug use, lessen blame, and humanize fentanyl users. This is especially true because these users leave behind family and friends who mourn their deaths. As we discuss in the next section, this makes it easier to shift blame to the dealers/suppliers who purportedly deceived these “unwitting” individuals.

Following the established drug scare formula, news media coverage of the fentanyl “crisis” frames the issue as an urgent social problem. It does so, in part, by drawing attention to the young age of some fentanyl users (n = 65). As other scholars (e.g. Alexandrescu, 2014: 23; Forsyth, 2001; Manning, 2006) have observed, drug scares that threaten to limit the potential and corrupt the innocence of young people, the “symbolic heart of the nation”, are particularly worrying and create a greater sense of urgency. In line with the concern that fentanyl was “poisoning our youth” (Schmidt, 2017) was the fear that it was “tearing apart families” (Hernández, 2017). Here, the case of the “terrified toddler” wearing Frozen pajamas in Massachusetts who was unable to wake her mother up in the toy aisle of a local dollar store after she had overdosed on fentanyl is illustrative (Bever and Holley, 2016).

In sum, news media coverage constructs fentanyl as a powerful substance that poses risks to individual users, including those who use drugs recreationally or to manage pain, to families, and to entire communities. The rising number of overdoses and deaths constitutes a crisis (n = 474) or an epidemic (n = 370) in part because it crosses demographic boundaries. In numerous instances, drug use is contextualized and deaths are grievable. This informs the thinkable policy solutions, the focus of our next section.

Public health or criminal justice? Debating solutions to the “crisis”

Considering the concern that “innocent” middle-class users were at risk, we were not surprised to find that many viewed the “crisis” through a public health lens and promoted corresponding solutions. These public health solutions include advocating for supervised consumption sites, the wider availability of the opioid antagonist naloxone, and other harm reduction initiatives (e.g. Boyle, 2017; Gray, 2017; Ingraham, 2016; New York Times, 2017). This category (n = 488) also encompasses calls for treatment (see New York Times, 2016; Picard, 2017), prevention (e.g. Bernstein, 2017b; Tyndall, 2016), and campaigns educating citizens about the risks of opioids and treatment options (Woo, 2017a). This public health orientation is more prevalent in the Canadian newspapers than the US newspapers. Simultaneously, there is considerable pushback against criminalization (n = 134). In fact, we find recognition among some law enforcement officials that they “will not be able to arrest their way out of this problem” (Dhillon, 2015), while some columnists (Picard, 2016b) observe that “no amount of policing will prevent people who want to use drugs from using them”. Elsewhere there are calls to end the criminalization of drug use because this kind of punitive approach has further marginalized already vulnerable groups and exacerbated inequality (MacCharles, 2017). Again, we argue that the support for treatment and harm reduction rather than incarceration makes sense because these particular drug users could be “us” and warrant our sympathy. We contend it is important to view the proliferation of harm reduction initiatives through a critical lens.

Imbued with neoliberal rhetoric, harm reduction initiatives seek to transform those marginalized by neoliberal policies into healthy and productive citizens. They conceptualize drug users as rational and free to make choices, thereby ignoring and failing to remedy the structural issues that may lead to problematic drug use and limit an individual’s options in life (Moore and Fraser, 2006). For instance, scholars (Bourgois, 1998; Moore, 2004) argue that instructing “street addicts” to avoid “risky” practices—sharing needles, not mixing drugs, not using alone—actually ignores their “lived experiences”. In the wake of the fentanyl “crisis”, the state has sought to responsibilize citizens by increasing access to naloxone, passing Good Samaritan laws, expanding the number of safe consumption sites, and the like. However, each of these policies ignores the consequences of decades of criminalization and makes individual behavioral change the focus rather than structural reform (see also Farrugia et al., 2017). Notably, as they have sought to make naloxone more widely available and educate the public regarding safe administration, governments have transferred risk and responsibility for life-and-death decisions onto citizens (Faulkner-Gurstein, 2017). Similarly, the “war on drugs” has left many people who use drugs with lengthy criminal histories and a suspicion of police, something Good Samaritan laws fail to anticipate (Koester et al., 2017; McLean, 2018). In addition, scholars (Elliott, 2014; Fischer et al., 2004) have suggested safe consumption sites are actually sites of surveillance, discipline, and regulation that serve capitalist interests as they seek to “purify” “chaotic” neighborhoods populated by “uncontrollable” residents, creating order in urban spaces and indicating they are open for business. While these initiatives may be perceived as empowering and foster a sense of collective dignity among people who use drugs (see Faulkner-Gurstein, 2017; Moore and Fraser, 2006), they tend to ignore power dynamics as well as leaving structural inequalities and social conditions untouched (see Bourgois, 1998). Indeed, harm reduction successes leave us less motivated to fundamentally reconsider our problematic approach—criminalization and the promotion of abstinence-based treatment—to drugs (Roe, 2005).

These critiques correspond with our findings. Namely, while we found considerable condemnation of the criminalization of drug use, there was not a complete rejection of the “war on drugs”. Specifically, in 162 articles there is the contention that the criminal justice system can and should play some kind of role in addressing the “crisis”. This is more noticeable in the US context, particularly in the Washington Post (n = 74). With individual fentanyl users frequently absolved of moral blame, these harsh penalties are applied to dealers and suppliers. In fact, some jurisdictions expanded treatment for those with substance use disorder and simultaneously strengthened penalties doled out to dealers and/or distributors in cases involving lethal overdoses (see Hicks, 2017). The rising number of deaths attributed to fentanyl was accompanied by the growing number of calls to conceive of drug dealers as murderers (e.g. Foderaro, 2017). Because of the toxicity and potency of fentanyl, a dealer’s choice to combine fentanyl with heroin was equated to “adding bullets to a revolver before playing Russian roulette” (McKinley, 2014: 20). Notably, then, despite the subsequent proliferation of harm reduction initiatives, the fentanyl “crisis” has not precipitated a fundamental re-thinking of the criminalization of drugs or the role of prison. Rather, we witness a shift in who is considered deserving of punishment for drug-related offenses. While during previous drug scares, like the 1980s crack cocaine scare, racialized inner-city users were criminalized (see Reinarman and Levine, 1989), in this case, where unknowing users are purportedly more likely to be white, working or middle class, and living outside of urban centers, there is more debate about what role the criminal justice system should play. This is what we would expect to find based on extant research (see McLean, 2017; Netherland and Hansen, 2016).

The re-education of medical professionals and monitoring of patients were also considered prerequisites to slowing or stopping fentanyl-related overdoses and deaths. News media coverage (n = 99) contained pleas to re-train doctors about appropriate prescription practices. While some of these calls to re-educate medical professionals explicitly stated that doctors were partly responsible for this social problem and that the way to combat the “crisis” was “putting away the prescription pad” (Weeks, 2014a), others let readers infer as much (e.g. Svrluga, 2014). State agencies have also sought to intensify surveillance and monitoring of those using prescription drugs. In both Canada and the USA, there have been calls (n = 145) to track prescription painkillers (e.g. Bernstein, 2017a; Howlett and Church, 2015) and increase surveillance of overseas mail (McGinley, 2017). In response to the fentanyl “crisis”, then, we see the state increase efforts to gather information about, to know, and to discipline its citizens.

Sinophobia and a border wall: Blaming China and Mexico

Mainly in the early days of the news media coverage that we analyzed, the primary causes of fentanyl-related overdoses and deaths were thought to be an over-reliance on and over-prescription of opioids to treat various types of pain in Canada and the United States as well as the irresponsible marketing of pharmaceutical companies (e.g. Meier, 2012; Ubelacker, 2015; Weeks, 2014b). In these and other instances, columnists and observers identified serious flaws within the social structure, particularly with both countries’ healthcare systems, the education and oversight of medical professionals, and the privileging of corporate interests at the expense of patient well-being. While this narrative never completely disappears, as the number of fentanyl-related deaths and overdoses grew we discovered that the blame for the escalating fentanyl “crisis” increasingly shifted outward to China—a development anticipated by Linnemann (2016)—and Mexico. Simultaneously, news media coverage distinguished the fentanyl used by medical professionals to treat chronic pain from the fentanyl found in street drugs (e.g. Howlett et al., 2016). The latter, referred to as “bootleg” or “illicit” fentanyl (n = 292), was systematically linked to Chinese producers (e.g. Howlett, 2016a; Howlett et al., 2016; Woo, 2016) and Mexican cartels (e.g. Ahmed, 2016; Seelye, 2016). In short, this “illicit” form of the substance was constructed as foreign and blamed for the increasing number of fentanyl-related overdoses and deaths despite research suggesting otherwise (Fischer et al., 2018). Reiss (2014) insists that the process by which a substance is designated as licit or illicit, a threat or a blessing, is inevitably political and not necessarily rooted in physiology.

China was portrayed as the primary source of the fentanyl that made its way to Canada or the United States in a total of 112 articles. For instance, Burton (2016) states that data from the Canadian Security Intelligence Service indicate “almost all the fentanyl comes from small synthetic chemical factories all over China”. Similarly, Howlett (2016a) notes “the bootleg version of fentanyl that is often made in clandestine labs in China and smuggled into Canada has been linked to overdose deaths”. We contend that this coverage encourages readers to redirect blame for the illicit fentanyl “crisis” to Chinese producers. Like previous drug scares (see, for example, Alexandrescu, 2014; Reinarman and Levine, 1989), news media stoke fears of racialized outsiders.

Notably, US newspaper coverage regarding fentanyl production in China was more explicitly focused on crime. One example is particularly illustrative. In October of 2017, the US Department of Justice laid charges against two “Chinese nationals” who ran multiple chemical factories in China and operated websites that sold fentanyl (Horwitz, 2017; Wee and Hernandez, 2017). These indictments received more attention in the US newspapers (two articles in the New York Times and six articles in the Washington Post) than in Canadian newspapers (one article in The Globe and Mail), despite the fact that several Canadians were arrested and said to be members of this conspiracy (Woo and Ha, 2017). We suggest that the Sinophobia present in the Canadian newspapers is subtler, while the US newspapers reify the link between racialized outsider groups—namely Chinese producers—and crime.

In both contexts, China is depicted as lawless, corrupt, and dishonest. Several examples are demonstrative. First, Howlett and colleagues (2016: F1) suggest that China is “at the centre of the vast underground world of synthetic-drug manufacturers”, where “enforcement is fragmented, and companies operate with impunity”. Second, Burton (2016) cautions against depending on China to stop fentanyl exports, claiming, “undoubtedly China’s fentanyl manufacturers are already issuing the necessary bribes to keep their operations free from government harassment”. Third, Wee and Hernandez (2017), writing for the New York Times, suggest that cutting off the supply of fentanyl from China will be difficult because of the “lax regulation of chemical companies, a sprawling industry of more than 30,000 businesses that face few requirements for transparency”. This chemical industry is characterized as “vast” and “freewheeling” (Kinetz and Butler, 2016: A19), while the Chinese government is framed as negligent, permissive, and willing to accept bribes. Meanwhile, Chinese suppliers are portrayed as intelligent and deceptive, consistently uncovering ways to hide fentanyl and get around inspection rules (Howlett, 2016b; see also Wee and Hernandez, 2017). With China framed this way, its antithesis, the West (i.e. Canada and the United States), is thereby positioned as orderly, honest, and governed by the rule of law.

In this “vast underground world”, “clandestine” Chinese laboratories are producing fentanyl, a synthetic opioid (n = 212). According to Jenkins (1999: 7), synthetic drug scares exploit concerns about the ability of unrestrained science to “corrupt humanity”. Furthermore, Jenkins (1999: 9) observes those chemists who create these unnatural substances are represented as “mysterious, evil geniuses”. Similar concerns are evident in the news coverage we analyzed, as former US Attorney General Jeff Sessions warns synthetic drugs are more dangerous, powerful, and addictive than before (Miroff, 2017). Those producing fentanyl in clandestine laboratories are described as so sophisticated that they are able to “custom-design variants of pharmaceutical-grade fentanyl by tweaking a molecule ever so slightly” and are “technologically skilled enough” to run their own shops on the dark web, where individuals purchase drugs and other goods anonymously using virtual currencies (Howlett et al., 2016: F1; Popper, 2017). We contend that, in the case of fentanyl, news media coverage stokes fears regarding the unrestricted nature of Chinese industry and the nation’s technological and intellectual sophistication. As such, this news coverage draws on and reproduces anxieties relating to the inevitable rise of China (see also Alexandrescu, 2014) and concomitant white (i.e. Canada and the United States) status decline (see Murakawa, 2011).

In the US context, we find that Chinese producers and Mexican cartels are blamed for smuggling fentanyl (e.g. Cunningham, 2017; Deutsch, 2016; Miroff, 2017; Zezima, 2016). A total of 40 articles—37 of which were in the New York Times and Washington Post—mention Mexico as a major source of the drug. Much of this rhetoric was inflammatory and explicitly racist as it associated Mexico with poverty, crime, and violence. During the 2016 US presidential campaign, for instance, Donald Trump claimed that immigrants from Mexico are “bringing drugs. They’re bringing crime. They’re rapists” (Phillips, 2017). After being elected President, Trump remarked that “drug lords in Mexico are knocking the hell out of our country” (Phillips, 2017). These drug lords are purportedly concerned only with their own self-interest, “operate with quasi-corporate sophistication”, and employ violence strategically, killing “easily and with near-total impunity” in Mexico (Miroff, 2017: A01). For their part, Chuck Rosenberg, former head of the Drug Enforcement Agency, notes that this cartel violence is “horrific” (Baker, 2017). Along similar lines, Berlanga (2016) suggests that the violence associated with the drug trade in Mexico necessitates businesses close their doors and fire their employees and means that “kids aren’t allowed to play outside”. In other words, Mexican drug cartels trafficking fentanyl are framed as ruthless and amoral, with their violent behavior threatening capitalism and curtailing freedoms “regular” Americans take for granted. Similarly, Rebecca Bill Chavez (2017), former Deputy Assistant Secretary of Defense for Western Hemisphere Affairs and writing for the New York Times, observes that those individuals crossing the US/Mexico border and entering the United States are fleeing violence, lack of opportunity, and “fragile” state institutions. While this provides some context for transnational migration, the places these migrants come from—and consequently the individuals who live there—are represented as lawless, undemocratic, and “troubled” (Chavez, 2017).

This case study illustrates the racism inherent in drug scares is context-specific, “not monolithic” (Omi and Winant, 2009: 123), and that globalization requires scholars to urgently (re)consider the various ways racism and criminalization intersect (see also Bosworth et al., 2008). Our initial reaction to the Sinophobia particularly evident in The Globe and Mail coverage was that it was subtle (see Bonilla-Silva, 2015). That is, we suggest that blaming “clandestine” Chinese labs is an acceptable way of expressing Sinophobia in a supposedly post-racial age of colorblindness (see Bonilla-Silva, 2015). In our view, this phrase is designed to elicit fears regarding unchecked Chinese science and technology and the great risk the fentanyl produced in these labs poses to Canadians from “all walks of life” (Picard, 2016b). While this phrase is not overtly racist like the ones—think “‘cocaine crazed’ Negro” (see Reinarman and Levine, 1989: 558) and “Mexican menace” (see Murakawa, 2011: 221)—uttered during previous drug scares, this is not reflective of progress. Despite Canadian Prime Minister Justin Trudeau’s claims that Canada is committed to “diversity and inclusion” and that Canadians are “polite” and “reasonable” people who also “rise up to reject” intolerance (see Dale and Ballingall, 2018; Prime Minister of Canada, 2015), we should heed Omi and Winant’s (2009) warning that the institutionalization of multiculturalism and diversity can neutralize challenges to institutional or structural racism. This helps legitimate social structures that (re)produce racial inequality and obscure instances of state-perpetrated racial violence (see also Ward, 2015). In the United States, it appears that “old-fashioned racism” is alive and well (see Tesler, 2013) as some journalists and officials perpetuate the “myth of the criminal immigrant” (Flagg, 2018).