NY Times' German Lopez Botches Opioid Coverage — And It's Not The First Time

'German Lopez is one of journalism’s clearest writers on a remarkable array of topics, including the opioid epidemic, crime, gun control, taxes, the economy, Congress and Covid. Now German — a senior correspondent at Vox — will be joining The Times as a reporter and writer for The Morning team. We are very excited to be able to call him a colleague.'

New York Times, 11/23/21:

Well, I hope he knows about crime and taxes because Lopez's writing about opioids has been less than exemplary. For example, he argues that the CDC is partly responsible for the overdose crisis because it waited too long before coming up with its atrocious 2016 opioid prescribing guidelines. I would argue that given the damage it's done, CDC should have waited another century or two. Lopez also blames the pharmaceutical industry (how clever) entirely for today's soaring fentanyl death toll, and bemoans Oklahoma's failure to successfully use a public nuisance law to extort $17 billion from J&J. 

And in his latest piece in the Times morning newsletter, he manages to get things wrong before the article even starts (this is not so easy). In the title.

Good morning. Drugs made in labs now cause most U.S. overdose deaths.

Let's break down the title a bit.

1. "Good Morning"

Seems accurate enough, unless you happen to be having a bad one. 

2. "Drugs made in labs..."

This warrants some discussion since it is misleading at the very least and also scientifically incorrect. As I have written many times before (1), neither the source, location, nor method of preparation have any bearing on the properties of a drug. Like any other chemical, the source of that chemical depends upon only its structure and purity. Let's examine the emphasis on "labs." Here are a couple of questions that illustrate this point.

• Why are methamphetamine and fentanyl made in labs?

Because there is no natural source for them (2). Which is totally irrelevant. Keep reading.

• Why aren't cocaine or morphine made in labs?

They can (and have) been, but the syntheses for both are long, painful, and require the skills of a trained synthetic organic chemist. The first total synthesis of cocaine was reported in 1901. It consisted of 23 steps. While the percent yield of these steps isn't mentioned, we can assume it was 50% per step back then (3). This means that if you start with one ton of the first chemical (called the starting material), by the end of the synthesis (and probably your life too), you'd have a grand total of...

Let's have a multiple-choice test!

(a). 133 pounds

(b) One ton

(c) 0.5 pounds

(d) 0.4 ounces

The answer is (d), meaning that your overall efficiency (yield) is 0.0031% from beginning to end, so you would have thrown away more than 99.99% of the one ton of material you started with. 

So it makes no sense at all to try to make cocaine in the lab; the coca leaves are a much better source. It's the same deal with morphine. It has been made in a lab and is the same morphine that comes from poppies, but you'd have to be out of your mind to use this method to get a supply of the drug for the same reason.

3. "[Drugs made in labs] now cause most U.S. overdose deaths"

This is like saying that "smoking now causes lung cancer." Drugs in labs don't NOW cause most deaths. They have been causing deaths for almost a decade. Fentanyl (the illegal kind from China, not the essential pharmaceutical kind ) first hit the US in 2013 in response to the burgeoning demand for heroin. It wasn't long before it eclipsed heroin in overdose deaths. And as you'll see in a bit, all drugs are "made" someplace. They are either manufactured or isolated and purified in ...labs (or factories). It makes no difference.

Perhaps we can now move past the title...

For much of human history, people got their drugs from nature. Marijuana comes from the cannabis plant, cocaine from coca leaves, heroin from poppies and magic mushrooms really do come from mushrooms.

Uh, no. There is approximately zero heroin in poppies. It is made from morphine. Heroin does not exist in nature. That's just wrong.

But in today’s overdose crisis, the most damaging drugs do not come from plants. They are synthetic — manufactured in a lab, usually requiring no plants at all.

Last year, fentanyl — a "synthetic opioid" — caused more overdose deaths than any other drug has in a single year. The second-deadliest drug was meth, which is also produced in labs (the kind you might have seen in “Breaking Bad”). Does this make any difference?

------> Existential intermission:  Are we so sure that cocaine isn't made in a lab? I suppose that depends on what you mean by "lab." I haven't spent a whole lot of time witnessing cocaine production in Putumayo, Columbia, but I'm willing to wager that the coca leaves don't come flying off the plant, magically turn into a white powder while in the air, and then pack themselves into plastic-covered bricks. Nope.

You've seen scenes on TV or in the movies. The cocaine must be extracted, processed, and purified. Sure, instead of a modern chem lab, it's done in a hut in the middle of the jungle with a bunch of psychos pointing AK-47s at your head. But I would argue that this is simply a "Motel 6 Lab"  Bottom line: It doesn't matter if a drug comes from the jungle, a lab, or an Arby's. The drug is the same.

Together, fentanyl and meth helped make 2021 the worst year for drug overdoses in U.S. history: The full-year death toll topped 100,000 for the first time, the C.D.C. reported last week.

Mr. Lopez, please explain why people who became addicted to opioids all of a sudden become addicted to meth and cocaine as well. Sure, someone who became addicted to OxyContin could easily progress to heroin, it's perfectly logical, but neither meth nor cocaine has any pharmacological similarity to opioids whatsoever. None. You can't blame opioid addiction on methamphetamine, or the other way around. 

Both drugs [fentanyl and methamphetamine] have proliferated so quickly because they are synthetic.

Nonsense. If this is true, please explain the following:

Methamphetamine-related deaths have soared since 2009. It is "synthetic." Cocaine-related deaths have soared since 2009. It is "natural." So much for that theory. Source (Left) CDC Wonder and The Cato Institute. (Right) National Vital Statistics System, Mortality File. https://wonder.cdc.gov/.

No, methamphetamine deaths didn't skyrocket because the drug is "synthetic" and cocaine deaths didn't soar because it's "natural." It is because people decided to take them.

Lest you think that I'm the only one who holds Lopez's take in low regard, patient pain advocate Red Lawhern (who is also an ACSH advisor) was only too happy to send his thoughts:

"As he has many times before, German Lopez misreads the sources of America's 'overdose crisis.' Addiction and overdose deaths are not driven by drug availability or price.  They mostly result from a 'crisis of hopelessness' that has grown steadily worse over the past 50 years of wage stagnation. 

Under-investment in infrastructure repair and other jobs eliminated by automation and technology or outsourced overseas has left millions of US families structurally unemployed in hollowed-out rural or Rust Belt communities. Nothing less than a major change in US labor force priorities will reclaim a generation lost to distractions of drug abuse. "

Richard (Red) Lawhern, Ph.D., Private communication.

NOTES:

(1) See Stop Calling Fentanyl A Synthetic Opioid. It's Confusing.

(2) This is not entirely accurate. Although methamphetamine does not exist naturally, it can be made by extracting ephedrine from the ephedra plant and then chemically removing the hydroxyl group.

(3) In organic chemistry almost no reaction converts one chemical to another without side reactions, which lead to impurities. These impurities must be removed, which means loss of material. The percent yield is the weight of the product divided by the theoretical weight assuming a perfect reaction. For example, two consecutive reactions, each with a 90% yield (this is excellent) will result in an 81% yield over the two steps. If the reaction yields are 50%, the the overall yield is 25%. You can see how quickly the amount of material can drop off in a long linear synthesis.