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Inside Fentanyl’s Mounting Death Toll: ‘This Is Poison’

The New York Times
By Sarah Maslin Nir

Dark heroin cut with so much white powdered fentanyl that it’s known on the street as “gray.” Cocaine laced so frequently with fentanyl that club DJs stock anti-overdose medication. Fake prescription pain pills that are in fact all fentanyl.

The synthetic opioid fentanyl, a legal prescription pain medication, is now a black market commodity blasting through the street drug marketplace. Cheap and up to 100 times more powerful than naturally derived opioids, it is also lethal.

Behind the trend is a growing body count: In the 12-month period that ended in April, more than 100,000 Americans, a record number, died from overdoses, according to preliminary data from the United States Centers for Disease Control and Prevention. The majority of the deaths were linked to synthetic opioids like fentanyl.

In New York City, the majority of autopsies of overdose deaths now reveal that fentanyl was involved, including that of Michael K. Williams, the actor found dead in his Brooklyn apartment.

It is spliced into party drugs where it can be consumed unwittingly, as it was by six people killed by a single batch of laced cocaine on Long Island this summer.

While the mounting deaths show the devastating consequence of fentanyl’s seep, it is less widely understood why the drug has mushroomed. And why so many illicit products — from fentanyl-laced cocaine and crystal methamphetamines, to marijuana sprayed with fentanyl, to faux prescription pills that are in fact fentanyl, colored and stamped to resemble a brand-name drug — now contain it.

The spread of fentanyl has been stealthy, steady and deadly, according to interviews with nine people involved in the sale of illegal drugs in New York, where much of the country’s fentanyl enters the street market, as well as law enforcement and addiction experts. The identities and backgrounds of the nine people were confirmed by The Times through their criminal records, lawyers and addiction counselors.

People who intermittently use stimulants like cocaine, for example, have low tolerances for such powerful synthetic opioids, said Dr. Chinazo O. Cunningham, the executive deputy commissioner of the New York City Department of Health and Mental Hygiene.

In 2015, just 17 of the city’s overdose deaths involved cocaine and fentanyl, without heroin; that number rose to 183 in 2019, the last year for which data was available, according to the Health Department.

“These are no longer street drugs,” said John Tavolacci, the executive vice president and chief operating officer of Odyssey House, a drug rehabilitation center in New York City. “This is poison.”

John Tavolacci

“This is poison,” said John Tavolacci, the executive vice president and chief operating officer of Odyssey House, a drug rehabilitation center on Manhattan’s Wards Island.

‘With fentanyl, the hair on our necks stood up’

Fentanyl is the third wave of an opioid epidemic that began in the 1990s with prescription pills, followed by exploding heroin use.

Now communities are struggling under an onslaught of fentanyl. The reasons are multilayered: As pharmaceutical companies have tightened the tap on prescription pain pills following a raft of legal losses for their role in causing the opioid epidemic, the pills have become scarce on the black market. Addicts have turned to fentanyl for their fix.

To profit off the situation, cartels and small-time manufacturers have flooded in caches of imitation pills — fentanyl tablets mimicking prescription brands. In September, the United States Drug Enforcement Administration issued a public safety alert: More than 40 percent of black-market prescription pills are actually counterfeits laced with fentanyl.

“Like a wolf in sheep’s clothing, these pills are lethal,” Ray Donovan, then the D.E.A’.s special agent in charge of the New York division, said in a statement.

As borders were closed to thwart the coronavirus, cartels created stockpiles, leading to a spike, said Bridget G. Brennan, New York City’s special narcotics prosecutor.

At the same time, several drug dealers said in interviews, domestic dealers turned to fentanyl as a cheap way to bulk out thin wares.

As lockdowns lifted and border crossings began to normalize, fentanyl flooded in. In just the first six months of 2021, the special prosecutor’s office confiscated more than in any previous year.

Since 2018, fentanyl seizures by the New York D.E.A. have tripled, as confiscated heroin fell by more than half. The drug agency in New York says it has taken 1,099 kilograms of fentanyl off the street so far in 2021, compared with just 434 kilograms of heroin.

Enforcement is on high alert: Whenever fentanyl circulation goes up, Ms. Brennan said, overdose deaths inevitably do too.

“With fentanyl, the hair on our necks stood up,” Ms. Brennan said.

‘Stepping on’ drugs with fentanyl

Client in treatment

“The destruction I caused, I think, how could I have done that?” said Tim, a former drug dealer. “It started off with fentanyl.”

Fentanyl was first synthesized in 1959 as a substitute for morphine. The synthetic opioid is prescribed to treat pain, including for cancer patients. It is often administered in a patch; abusers figured out how to chew or smoke the patches or adhere strips of them to their gums.

When he first began experimenting with fentanyl, Tim, a former dealer from Newburgh, N.Y., said others taught him how to boil the patches to extract the fentanyl, then inject it intravenously. Soon he was adding fentanyl powder to the drugs he sold. Like nearly all dealers interviewed for this story, he requested that his last name be withheld because he was discussing illegal activity.

Today the drug is far simpler to obtain. Fentanyl is primarily manufactured in China, which sends it or the raw ingredients, called precursors, on cargo ships to Mexico, where it is finished by cartels, according to Ben Westhoff, the author of “Fentanyl, Inc. How Rogue Chemists Created the Deadliest Wave of the Opioid Epidemic.” It is widely available on the “dark web,” an untraceable online network, and shipped in the mail.

Fentanyl’s spread has been pushed by the profit imperative, according to interviews with dealers: On each leg of the journey of a drug like heroin or cocaine, from cartel to end user, sellers often cut the pure product with cheap powders that are similar in appearance, a process known as “stepping on” the drug. Once it was things like baby formula; today, it is likely to be fentanyl.

There is no quality control: A street dealer might cut fentanyl into cocaine that already contains it, creating a lethal dose.

In interviews, dealers described lacing as completely ad hoc. One said she measured out fentanyl with a McDonald’s ice cream spoon, leveled with a playing card. More than one dealer did not measure at all, spritzing liquid fentanyl onto baking sheets of marijuana, creating a once-rare concoction that some dealers say is increasingly requested.

Tim, the dealer from Newburgh, said overdoses were almost a perk. Once word got out, he said, his phone would light up with users seeking extra-strong fentanyl, an experience several other dealers said they shared.

“That means it was so good, this person dropped on it,” said Tim, 32. “So trust me, you want to come and get what I have.” In addiction recovery at Odyssey House, he said he is now filled with shame.

“The destruction I caused, I think, how could I have done that?” Tim said. “It started off with fentanyl.”

While in prison for crimes related to dealing drugs, Corey F. Russell, 50, saw so many overdoses on contraband fentanyl that he emerged as an anti-fentanyl activist.

Mr. Russell, known as Ja’Corey, now warns old customers and pleads with former associates not to lace their drugs.

“That fentanyl is a beast,” said Mr. Russell. “That is something they should have never tampered with.”

‘He did not want to die’

Female client in treatment

“I knew it was so dangerous,” said Anna, a recovering addict who is proud of her drug-free pregnancy. “But I didn’t care. It was so cheap.”

Anna, a 31-year-old from Brooklyn, was first introduced to fentanyl three years ago while working in a drug mill in Crown Heights, scooping the chemical mixture into glassine envelopes of heroin.

Soon, straight fentanyl became her drug of choice.

It was powerful — just three baggies replaced her nine daily of heroin — but above all, lab-made fentanyl costs a fraction of the price of natural opiates, which are derived from poppies.

“I knew it was so dangerous,” said Anna, who said she overdosed twice and was revived with Narcan, an anti-overdose medication. She is now in inpatient addiction recovery. “But I didn’t care. It was so cheap.”

When Swainson Brown, 40, a beloved chef at a restaurant on Shelter Island, at the eastern end of Long Island, consumed cocaine on an evening in August, authorities said he had no idea it was laced with fentanyl.

Mr. Brown was among six people in the community killed in a three-day span by the drug.

“He did not want to die,” said Glenn Petry, Mr. Brown’s friend and employer. “That was without question the farthest thing that he imagined would happen to him that night after using cocaine.”

Scrambling to keep up

Fentanyl’s rapid spread has caught law enforcement on the back foot.

“Fentanyl had been in the drug supply, but it just wasn’t being detected,” said Major Juan Colón, the former commanding officer of the New Jersey State Police’s Drug Monitoring Initiative. “Once the lab technicians detected heroin, they’d stop there.”

In January 2014, after a seized heroin sample was found to be all fentanyl, Major Colón launched a statewide retrospective look at specimens thought to have been heroin and found that they contained fentanyl.

But years later, crime labs still often lack advanced equipment to test for fentanyl. Three years ago, Suffolk County, where 3,000 people died from overdoses in the last decade, spent $400,0000 on a new mass spectrometer to untangle the crisis.

Complicating factors are fentanyl analogues, the over 1,000 similar chemicals that mimic fentanyl’s behavior, often substituted to avoid detection. The autopsy on Mr. Williams, for example, showed that his body also contained p-fluorofentanyl, one such analogue.

In 2019, under pressure from the Trump administration, China banned all analogues. But the move drove up the volume of raw ingredients — many of which are legal — being shipped in, said Mr. Westhoff, the author of “Fentanyl Inc.”

In September, the Biden administration extended a temporary order to include all fentanyl analogues in the highest classification of illegal drugs, called Schedule 1.

In Suffolk County, Odette R. Hall, the chief medical examiner, is using the new mass spectrometer to dig through deaths, to figure out whether fentanyl or its analogues were to blame — or, she fears, whatever novel drug is coming next.

“Whatever is happening on the street,” Dr. Hall said, “is always going to be a step ahead.”

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