We hear so much about drugs – their negative effects, how much they cost, all the myriad and bizarre names they have – that sometimes, the most basic questions get lost in the shuffle. What are the origins of drugs? Where do they come from? Who is responsible for the many layers of production and distribution of a highly illegal, highly dangerous and highly productive industry? While the scourge of drugs may never fully go away, the more we know about where drugs come from and how they get here may help minimize the damage they can cause today.
Where Do Drugs Come From?
Some drugs can trace their roots to plants (like cocaine), others are devised purely in laboratories (in the case of methamphetamines), and some are a combination of both (such as heroin). Street drugs carry the added risk of being mixed with other substances in order to deliver a more powerful and unique effect, leading to such hybrids as a “speedball” (cocaine as a stimulant and heroin as a depressant) or marijuana being used with other drugs.
As for the first category, a blog on Scientific American explains that the cultivation of drugs in rainforests goes back thousands of years, with indigenous South Americans chewing coca leaves as part of tribal rituals that gave them stimulation and energy. While they may have attributed this to mystical or religious properties, we – and drug manufacturers – know today that coca leaves contain the alkaloid cocaine, which, even in its natural form, is capable of stimulating the brain (similar to the effect of coffee).
From the jungles of Colombia – where, despite the best combined efforts of the Colombian and United States government, the drug has become a tourist attraction — cocaine makes its way to the US over (and sometimes under) the Mexican border in everything from toys to tennis shoes. To circumvent federal law enforcement on the American side of the border, Mexican drug smugglers (operating under the orders of cartel bosses) resort to transporting their cocaine via boat, for which the U.S. Coast Guard runs interdiction missions.
Nonetheless, as long as there is demand, there is supply; and for the drug consumers and suppliers, the reward seems to be worth the risk. According to figures from the National Institute on Drug Abuse, 1.9 million Americans reported using cocaine in the preceding month in 2008. Pure cocaine costs approximately $120 a gram, while cocaine that is cut with other drugs or diluted in some way, like crack cocaine, is around $60 to $80 per gram. In 2010, five students at Columbia University were arrested for selling cocaine to undercover police officers. At $27.50 a gram, the stash of 40 grams netted a haul of $1,100. And according to Mexico’s public safety secretary, drug cartels make $64 billion a year from users based in the United States, making America the world’s biggest consumer of cocaine.
Amphetamines: No Education Required
Americans also consume 80 percent of the world’s painkillers, in what the BBC called “the fastest growing drug addiction” in the country. For prescription medication and other synthetic drugs (of varying legality), their origin is much less exotic than the lush countryside of South America.Amphetamine, for example, was first produced at the University of Berlin in 1887. One of its most notorious variants is methamphetamine, which was synthesized by a Japanese chemist the following decade. The popularity of the drug as a stimulant has led it to overtake cocaine in a majority of US counties, according to Fox News.
While cocaine and certain other drugs have an old-world quality to their cultivation, methamphetamine’s origins can be traced to clandestine, underground laboratories run by practically anyone – because as Vice magazine puts it, an education in chemistry is not needed to learn how to cook meth. While the television show Breaking Bad featured a well-maintained “super lab” for the large-scale production of crystal meth, the reality is that meth labs are often dirty, filthy places that can be set up in the trunk of a car.
Similarly, while Ecstasy (which is the colloquial term for 3,4-methylenedioxy-methamphetamine, abbreviated to MDMA) is renowned for being a drug distributed in trendy nightclubs and at rave events, the journal Addiction found that 90 percent of people who had attended a rave in the preceding six months had used LSD, 76 percent had used Ecstasy, and 69 percent had used amphetamines. Ecstasy is manufactured in Chinese laboratories. It is sold on the Deep Web (the hidden black market of the Internet) to suppliers in the United States, who then cut the Ecstasy with other substances before selling it to buyers who are blissfully unaware of the ingredients in the chemicals they are ingesting.
The Deep Web
Buying drugs on the Deep Web – the massive unindexed part of the Internet that can’t be accessed by regular web browsers – might be the future of how controlled substances are imported and traded within the United States. The New York Times explains that the Internet we know, literally trillions of web pages, is only the tip of the iceberg. Beneath the surface is a vast wilderness of people buying and selling everything from military-grade weapons to assassination services, from child pornography to, in the words of The Guardian, “cannabis, dissociatives, ecstasy, opioids, prescription [drugs], psychedelics, stimulants” and precursors (a chemical compound that participates in a chemical reaction to produce another chemical compound – in other words, not even a drug, but a tool to make a drug).
In October 2013, the Federal Bureau of Investigation, Immigrations and Customs Enforcement and various European law enforcement agencies shut down “Silk Road,” the largest platform for the sale of illegal drugs on the Deep Web. A month later, “Silk Road 2.0” was brought online, and it was itself taken down by the FBI. Nonetheless, The Daily Dot reports that six months after the FBI’s initial success, there are more drugs sold on the Deep Web than there were before the Silk Road bust. In the same way that Colombian and Mexican cartel members become increasingly ingenious in their attempts to evade U.S. Customs & Border Protection and the Coast Guard, the minds behind the Deep Web have used “increasingly advanced technology” to make the Deep Web even deeper, and continue their “movement” of the unregulated distribution of drugs to anyone looking to buy.
The Prescription Predicament
Many of the drugs sold on the Deep Web are prescription drugs, which can be seen as a response to the overwhelming need of millions of Americans who use such drugs recreationally, or who don’t want to wait for their next prescription to alleviate their chronic pain.
Most prescription drugs – 40 percent, according to CNN – sold in the United States are developed overseas. According to South Florida Hospital News, China and India lead the rest of the world in the production of active pharmaceutical ingredients (API). The Pharma Letter reports that 30 percent ($4 billion) of India’s prescription medication exports are to the United States, that India is home to the largest number of FDA-approved drug manufacturing plants in the world (150), and that over 800 applications for generic drug approval in the United States originate from the top 10 Indian pharmaceutical companies.
Duly, the U.S. Food & Drug Administration is responsible for regulating foreign manufacturers (going so far as to ban the importation of products from a plant in Toansa, India for “significant […] manufacturing practice violations” in 2014), as well as the American drug companies that import the API, which are then released to pharmacies for purchase. Individual states can opt to follow FDA regulations, devise their own compliance policies, or employ both methods.
FDA regulation extends far beyond Asia – the administration has sent warning letters regarding violations to drug companies in Spain, Germany, Australia, Canada (which is one of the biggest drug suppliers to the United States by volume of generic drugs), Austria, the Netherlands, and Ireland. The FDA has also reprimanded 114 US manufacturers from 2008 to 2013 for everything from “marketing related offenses” to “faulty manufacturing claims.”
‘A Global Agency with a Global Mission’
However, despite the vigilance and authority of the FDA, it is still possible for a link in the chain to be compromised: “the safety of the prescriptions,” writes Rep. John Dingell in the special report for CNN, “can be broken at any time by a supplier in China, a counterfeiter in India or an importer from Thailand.” The FDA does not have the necessary resources to inspect the process at every foreign – or even domestic – pharmaceutical manufacturing facility, raising questions about the safety of the millions of prescription drugs currently being imported to, and distributed in, the United States.
In an interview on The Diane Rehm Show, the South Asia correspondent for The New York Times explained that despite India’s significant contributions to the US pharmaceutical industry, the Indian government has no regulatory presence in its factories, which prompted Dr. Margaret Hamburg, the FDA Commissioner, to visit the country in early 2014. Speaking on The Diane Rehm Show, Dr. Hamburg called for the FDA “to behave like a global agency with a global mission,” citing the presence of FDA offices in New Delhi and Mumbai, as well as in Latin America, South Africa, and China, in order to standardize regulation and “achieve the same levels of inspection and enforcement and compliance” across the board.
Part of the problem appears to be cultural dissonance between the hands-on approach employed by, and required of, the American FDA and local drug production organizations. The Pharma Letter quoted the senior director of CRISIL, a ratings agency owned by Standard & Poor’s, as saying that while the US enforces regulation on the manufacturing side of the process, Indian authorities monitor the safety of their drugs by collecting and testing samples. Similarly, Dr. Hamburg pointed out that Chinese and Indian entities are simply not used to the level of involvement the FDA takes in the production of drugs, and they do not comprehend the FDA expectation that they adopt a similar approach.
The Counterfeit Conundrum
But significant problems can be found much closer to home too. 60 Minutes explains that there may be as many as 10 stops from drug manufacturers to the wholesalers. Along the way, the drugs can be improperly stored, improperly transported, or deliberately tampered with in order to artificially increase profits (in the case of high-demand, expensive medications). Worryingly, if a drug manufacturer is made aware that the integrity of their product has been compromised, they are not legally required to inform the FDA, wholesalers or patients. For reasons of industrial competition, they may opt to remain quiet on the issue for fear of losing customers and clients to other manufacturers.
The former commissioner of the FDA explains that while the FDA is responsible for the safe manufacture of a drug, the safe distribution of drugs is up to individual states, not the FDA – and as 60 Minutes reports, the pharmaceutical distribution system in the United States is “largely unregulated and vulnerable.”
The laborious, bloated, and exorbitant nature of prescription drug delivery in the United States is why as many as five million Americans purchase their drugs online from foreign countries, much to the consternation of the FDA, who considers these drugs unapproved and illegal. A deputy commissioner at the FDA testified in February 2014 before a House subcommittee that “foreign unapproved drugs” were as dangerous as counterfeit drugs (which the FDA defines as contaminated medicine, medicine containing incorrect or no active ingredient, or the right ingredient at the wrong dosage). Writing in The New York Times, the vice president of PharmacyChecker.com strongly rejected the comparison, calling it a “scare tactic,” saying that the unapproved drugs purchased internationally over the Internet and brought into the United States are identical to generic drugs already being sold in America.
Established online pharmacies sell brand name medications for 80 percent less than the same drugs sold in America. Without online access to these foreign drugs, says the VP, more and more Americans will not be able to afford the medication they desperately need. That should be the primary concern of the FDA, he writes, not lobbying Congress to authorize US customs to seize and destroy legitimate medications mailed to American patients from Canadian pharmaceutical manufacturers because of unfounded public safety fears, or because it cuts into their profits.
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Further Reading About The Origins of Drugs
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.