Last week, prosecutors in Brooklyn charged 34 people for selling a potent designer opioid known as china white across New York City. According to the New York Times, officials said the substance seized in the massive drug bust – a compound similar to the painkiller fentanyl known as furanyl fentanyl – was produced in China and distributed in the city for $7 to $10 a dose.
As the country deals with a worsening opioid crisis, China White use has seen a surge in certain states, such as Rhode Island and Pennsylvania. In some areas, the designer synthetic drug has been blamed for a rash of overdose deaths, outpacing that of heroin. In response, the U.S. Drug Enforcement Administration made China White illegal in November when the agency labeled furanyl fentanyl a Schedule I drug. But furanyl fentanyl is only one version of China White that's sold underground; other derivatives of the painkiller have made their way on the street.
For those unfamiliar with China White, here's what you should know about the designer opioid, its effects on a person, and what research is available so far.
What is China White?
China White has meant many things throughout the years. In the 1970s and 1980s, it was slang for heroin. Right now, China White is the street name for furanyl fentanyl and a few other known derivatives of fentanyl, a synthetic opioid painkiller found in most emergency rooms. According to a 2015 research paper published in the Universal Journal of Clinical Medicine, these chemical adulterations seem to be result from contamination during key processes of fentanyl synthesis. (Basically, dealers who try to replicate fentanyl at home often fail to do so correctly, introducing toxins into the mix.) China white is similar to heroin and morphine, but is a hundred times more potent, if not more so; the high lasts longer and is more difficult to treat if a person overdoses.
Why is the designer drug called "China White"?
For its alleged purity. People assume what the substance they are buying off the street is straight-up fentanyl, when the drug is actually anything but. So the name "China White" is actually a misnomer, said Dr. Wilfredo Lopez-Ojeda, a biomedical sciences professor at the University of Central Florida who co-authored the Universal Journal of Clinical Medicine editorial with Dr. Carlos Ramos-Matos.
"What gave rise to China White is a mixture of the original fentanyl with perhaps some residues of heroin and maybe some cocaine, then they started referring to it as a more pure product," Lopez-Ojeda says. "But the truth is such a thing doesn't exist."
What do we know about China White so far?
Very little. Research on the drug has been scarce because of the clandestine nature of the drug, Lopez-Ojeda says. He and Ramos-Matos studied acetyl fentanyl and were able to gather information based on anecdotes and limited available studies. Both agree that deeper research and training is needed on this iteration of China White so that doctors can better recognize the symptoms and treat accordingly.
On the other hand, instructions on how to make the drug are fairly easy to find online, though it's complicated to produce, says Ramos-Matos. "Somebody who's been to an organic chemistry class, they can run the experiment of trying to synthesize fentanyl," he says.
What does China white do to a person?
China White is a fat-soluble painkiller that's much stronger and lasts far longer than morphine, heroin or fentanyl itself. The designer drug has led to a rash of overdose-related deaths over the last five years; the U.S. Centers for Disease Control and Prevention attributed 14 deaths in Rhode Island and 50 deaths in Pennsylvania to acetyl-fentanyl. And what's killing China White users is the designer drug's side effects, Ramos-Matos sys. People high on the drug who enter emergency room may seem like they're overdosing on heroin or another opioid, but the symptoms are more complicated because fentanyl derivatives are far more powerful. "When they enter the emergency room, the symptoms are very confusing," Lopez-Ojeda says. "If treatment is not followed through accordingly, people can end up dying."
How do you treat a China White overdose?
The protocol to treat an opioid overdose is "really cut and paste," according to Ramos-Matos. Doctors use the drug naloxone to lift a patient out of opioid intoxication. But, with China White, the traditional naloxone treatment is not enough. It may require "days worth of being on a drip of naloxone," he says, because the effects are far more severe. And China White can cause significant respiratory depression, which may require artificial ventilation to get a patient to breath. More so, what's sold as china white on the street may be cut with lemon juice or other agents like dry feces, according to Ramos-Matos, that can lead to a whole host of other conditions (think fungal sepsis) that need to be treated in different ways. That's why it's important to train doctors in areas ravaged by china white use on how to identify and treat side effects of fentanyl derivatives, he said. "Knowing where the high risks areas are is important because you can target those physicians," Ramos-Matos says. Though media reports may indicate otherwise, China White is actually not a new or popular street drug , Ramos-Matos says. Instead, the effects are just "very loud." Still, the pair argue in their paper that more research is needed because, as synthetic heroin supplies run out, addicts may begin to seek out designer opioids at alarming rates.