THE EFFECTIVE PROBLEMSOLVER #092
Welcome back to the hands-on problem-solving series within The Effective Problemsolver.
First, a big thank you to everyone who responded to last week’s newsletter on first-order causes!
Multiple readers chimed in on the importance of challenging AI’s answers with critical thinking.
One former colleague of mine aptly pointed out that only one causal factor—Substitution from Prescription Opioids to Illicit Fentanyl—explained why people use fentanyl, and she provided me with 10 more causal factors related to individual behavior (thanks Cristine!).
Keep those reader comments coming by replying to this email!
In Part 1, we started applying systems thinking to the fentanyl epidemic by identifying first-order causes—the direct drivers of the crisis.
But stopping there would be like treating symptoms without understanding the disease.
To really understand what’s happening, we need to go one level deeper:
What’s causing these causes?
This is where most conversations about fentanyl go off the rails.
Instead of digging into real causal mechanisms, the debate often shifts to politics and ideology—strong opinions about homelessness, border security, drug cartels, immigration, tensions with China.
But if we want to actually solve the problem, we need to move past partisan talking points and get rigorous about what’s really driving these first-order causes.
Why This Matters
Fentanyl overdoses are now the leading cause of death for Americans aged 18-45—more than car accidents, suicide, or COVID-19.
This isn’t just a crisis. It’s a generational catastrophe.
We already identified five first-order causes with ChatGPT in the last newsletter:
- Illicit fentanyl production & trafficking
- Substitution from prescription opioids to illicit fentanyl
- Extreme potency & market incentives
- Supply chain resilience & evasion tactics
- Delayed public health & harm reduction responses
But each of these has its own causes.
And that’s what we’re going to investigate today.
Step 1: What Makes First-Order Causes Possible?
To think in second-order causes, we ask:
- Why does fentanyl production thrive despite enforcement?
- Why did prescription opioid restrictions backfire?
- What forces sustain extreme potency in the drug market?
- Why is harm reduction lagging behind the crisis?
To answer these, we have to dig into deeper structural forces that shape the crisis.
Step 2: Using ChatGPT to Identify Second-Order Causes
Here’s the prompt you can try:
Prompt:
"What are the second-order causes driving the fentanyl crisis? Focus on the top 2-3 causes of each of the first-order causes, not correlations or vague systemic critiques."
ChatGPT’s Response:
1. Illicit Fentanyl Production & Trafficking
Fentanyl is cheap, easy to manufacture, and massively profitable. But why has its production exploded in recent years?
- 1a. Chemical Manufacturing Loopholes in Global Trade – Many fentanyl precursors (key ingredients) are legally produced in China and India with minimal oversight. These chemicals are then shipped to Mexican cartels, who synthesize and distribute the final product.
- 1b. Cartel-Led Innovation – Mexican drug cartels have shifted from heroin production (which requires farming and labor) to synthetic fentanyl, which is easier to produce, store, and smuggle.
- 1c. Decentralized Dark Web & Crypto Transactions – Online marketplaces and encrypted messaging apps (e.g., Telegram, WhatsApp) facilitate direct-to-consumer sales, making fentanyl distribution more widespread and harder to trace.
2. Substitution from Prescription Opioids to Illicit Fentanyl
Many users turned to fentanyl only after prescription opioids became harder to access. What led to this shift?
- 2a. OxyContin Reformulation (2010) – Purdue Pharma reformulated OxyContin to make it abuse-deterrent, leading many dependent users to seek illicit opioids like heroin, which later became contaminated with fentanyl.
- 2b. DEA Quotas & Prescriber Crackdowns – Government-imposed limits on opioid production and aggressive law enforcement against overprescribing led to abrupt cutoffs for chronic pain patients, fueling demand for illicit opioids.
- 2c. Street Market Adaptation – As heroin demand surged due to prescription cutbacks, drug suppliers began lacing heroin with fentanyl to increase potency and maintain customer dependence.
3. Extreme Potency & Market Incentives
Why has fentanyl become the dominant opioid, replacing heroin?
- 3a. Lower Production Costs – Fentanyl is exponentially cheaper to manufacture than heroin (grams vs. kilos), leading traffickers to prefer fentanyl for higher profits with lower logistical risks.
- 3b. High Tolerance & Addiction Acceleration – Users who develop opioid tolerance require stronger doses, increasing demand for fentanyl’s extreme potency. Dealers respond by cutting heroin or producing fentanyl-laced counterfeit pills.
- 3c. Weak Drug Checking Infrastructure – Most users lack access to fentanyl test strips or drug-checking services, making it nearly impossible to detect fentanyl in street drugs before consumption.
4. Supply Chain Resilience & Evasion Tactics
Despite repeated crackdowns, fentanyl supply remains strong. How do traffickers stay ahead?
- 4a. Shifting Precursor Regulations – When one fentanyl precursor is banned or restricted, suppliers quickly switch to new, unregulated chemicals, maintaining the production pipeline.
- 4b. Cryptocurrency & Money Laundering Networks – Cartels and distributors use cryptocurrency, Chinese underground banking networks, and shell companies to move money undetected, keeping operations running.
- 4c. Law Enforcement Whack-a-Mole Effect – Crackdowns on specific routes (e.g., direct shipments from China) led to the rise of alternative trafficking methods, such as cartel-controlled labs in Mexico.
5. Delayed Public Health & Harm Reduction Responses
Why hasn’t public health kept pace with the crisis?
- 5a. Political & Cultural Resistance to Harm Reduction – Many U.S. states and local governments delayed harm reduction policies (e.g., safe consumption sites, fentanyl test strips) due to stigma and legal barriers.
- 5b. Naloxone (Narcan) Distribution Gaps – While naloxone reverses fentanyl overdoses, limited distribution, high costs, and lack of awareness have kept it from reaching the most vulnerable users.
- 5c. Inconsistent Public Messaging on Overdose Risks – Initial public health campaigns focused on prescription opioids, failing to adapt messaging to the fentanyl crisis early on, leaving many unaware of the dangers.
Step 3: What This Tells Us
Now we can see how the fentanyl crisis is entangled with global trade, drug policy, law enforcement, corporate influence, and public health failures.
But just like last time, we can’t take these answers at face value.
To push our thinking further, we need to ask:
- Are these second-order causes truly driving the first-order causes? – What evidence supports these claims? What contradicts them?
- Are there even deeper third-order causes? – For example, what caused the rise of opioid overprescription in the first place? Why do some countries handle drug crises differently?
- What’s missing? – Did ChatGPT overlook anything? Are there hidden forces shaping the crisis that we haven’t considered?
This process isn’t about memorizing causes—it’s about building the mental habits to question, validate, and refine our understanding.
Next: The Crisis as a Self-Reinforcing System
Now we have a list of first- and second-order causes. But understanding the causes behind the causes is still only part of the picture.
In Part 3, we’ll take this one step further:
- How do these factors interact?
- Which ones reinforce each other in dangerous feedback loops?
- Why does the crisis keep escalating despite intervention?
Because in the end, it’s not just about the individual causes—it’s about how they fuel each other in a system that resists change.
See you in two weeks.
