The Moscow mule, a mix of ginger beer, an ounce of vodka, and a squeeze of lemon, has become one of the favorites among cocktail aficionados across the United States. It delivers on all that it promises, namely, an easy-to-make tasty drink, except it has nothing to do with the Russian capital whose name it bears. The birthplace was New York’s Chatham Hotel in Lower Manhattan, and the year was 1941. Its origin is an interesting case of pure serendipity.

Perhaps you should be aware that any mixologist worth their salt definitely knows the legend of the Moscow mule, and that tradition isn’t the only reason the drink is served in a copper mug. Besides keeping the cocktail silky and fresh, the cold metal insulates the temperature of the ginger beer and keeps everything perfectly chilled and deliciously smooth.

Prosecutors believe that Kouri Darden Richins, the Utah woman accused of killing her husband with a lethal dose of fentanyl by spiking his Moscow mule, has sinister knowledge of the drink’s lore. The 33-year-old mother of three allegedly told police that they were celebrating her closing on a house that fateful night when she made Eric a Moscow Mule in the kitchen and brought it to him in their bedroom. Eric Richins died at their home in Kamas, Utah, on March 4, 2022.

Autopsy reports later revealed the cause of death as poisoning from a lethal dose of illicit fentanyl. According to the charging document, detectives found that Eric’s wife, Kouri, procured 30 fentanyl pills from a vendor whom she also asked for “some of the Michael Jackson stuff” in exchange for $900 a month prior to her husband’s death.

The unfortunate story of Eric and Kouri Richins is not the only sad story I have had to grapple with this week. Even closer to home is a patient I took care of, a handsome blond man in his early thirties. On the night preceding his arrival at our hospital’s Intensive Care Unit (ICU) following a cardiac arrest at home, the young man decided to treat himself by binging on alcohol laced with fentanyl, causing him to stop breathing. Fentanyl, a synthetic opioid 50 times stronger than heroin and 100 times stronger than morphine, has become an ubiquitous drug causing a major health crisis in the United States and beyond.

But where are all the supplies coming from? Most fentanyl in the United States is smuggled across the southern border by Mexican drug cartels. China’s vast chemicals market, which supplies the world with raw materials for everything from perfume to explosives, is also a major pipeline for the building blocks of fentanyl, known as fentanyl precursors, according to US officials.

Illegally manufactured fentanyl has turbocharged the US opioid crisis. With 80,411 US overdose deaths in 2021 alone, this is more than ten times the number of US military service members killed in the post-9/11 wars in Iraq and Afghanistan. It is the leading cause of death for Americans aged 18-45. Last year, the Drug Enforcement Administration (DEA) seized over 379 million deadly doses of fentanyl, enough to supply a lethal dose to every American citizen.

There is also another dimension to it. Many who struggle with opioid addiction also suffer from mental health issues, and these individuals may be more likely to engage in violent behavior, including using firearms. Furthermore, the illegal drug trade is often associated with firearms, as dealers and users may carry guns for protection or to intimidate others. Drug addicts are often victims of gun violence, such as those who are shot during drug deals or in drug-related disputes.

In March 2023, Alejandro Mayorkas, Secretary of the Department of Homeland Security, called fentanyl overdoses “the single greatest challenge we face as a country,” and he was not wrong. Addressing the opioid crisis will require a comprehensive approach that tackles the broader social and economic factors, including poverty and unemployment. Both issues also disproportionately affect low-income and minority communities in the United States.

Overall, the Moscow Mule, a seemingly harmless and enjoyable cocktail, has unfortunately become entangled in a tragic narrative due to its association with fentanyl-related deaths. The toxic legacy of the opioid crisis highlights the urgent need for awareness, prevention, and intervention to combat this devastating public health issue. By addressing the root causes and implementing comprehensive strategies, we can strive towards a future where cocktails and beverages are enjoyed responsibly and without the threat of addiction or harm.

Osmund Agbo is a pulmonary physician.