Doctors created its demand. Legal weed boosted its supply …

Doctors created its demand. Legal weed boosted its supply. Fentanyl, the deadliest drug to hit the streets in decades, is here. And won’t be leaving anytime soon.

Until I became an EMT and saw the track marks for myself, I had no idea how far heroin had gotten inside of our communities. It’s everywhere.

In an overdose case, it’s the temperature of the bodies that I’ll always remember. They’ll be lying there, breathing weakly — barely — with a dull chill in the hands, feet and head. The cold limbs tell the emergency crew that blood isn’t flowing properly. The machinery of that person’s life is shutting down.

We then scramble to find a vein, but they’re too often so chewed up that sticking lines in strange places is our only option: the jugular vein, the feet, even the forehead. Whatever works. The IVs allow us to push naloxone, an antidote to overdosing. It’s life or death.

Then it’s the line of questioning to whoever found them: “What are they on?”

If they say “heroin,” we ask, “Just heroin?”

We’re hoping it’s just heroin. Heroin we sort of understand.

But it’s not all heroin out there. Not anymore. There’s something else destroying our communities that’s up to 50 times more powerful than that. It’s called fentanyl. In many parts of the country, especially the areas hardest hit by the heroin crisis, like Ohio and Kentucky, there are more fentanyl overdoses than that of heroin, reports the Cincinnati Enquirer. An overdose of fentanyl is worse because it’s much harder for naloxone to reverse. That’s why first responders always want to know what they took. If it’s fentanyl, there’s sometimes not much we can do.

Fentanyl is a synthetic opioid. Health care providers — including us on the ambulance — use it for pain and sedation. It’s sold legally, and it comes in a pill, a patch, a lollipop, liquid and white powder.

But in the wrong hands, it’s not just a villainous drug, it’s a crime against humanity. It’s what killed Prince.

But for the drug cartels — Mexican, Chinese and American — fentanyl isn’t a problem, it’s a profit center. Compared to heroin, it’s cheaper to make, easier to move, and street dealers face fewer legal penalties when caught.

And yet, most of the time, users don’t even know they’re doing it.


Brett, an admitted addict from New Hampshire, says he used to “jones like crazy” for his opioid fix. He needed needles in his arms so bad he pawned everything from a kitchen mixer to his wedding ring — even stole money from his in-laws. Heroin was killing him, he thought, so a year ago he decided to get ahead of it and kill himself. He bought $50 worth of a white powder he thought was heroin, slammed home 10 shots at once and expected never to wake up.

Instead, he woke up in the hospital. The doctors asked him, “What did you take?”

“Heroin,” he said.

“No,” they hastily replied. “No opiates were found in your system.”

Fentanyl doesn’t show up on a lot of drug tests. So, all that heroin he thought he was doing? “I now realize it was almost all fent,” he says.

Because of its low cost and high potency, shady dealers are dumping fentanyl into everything to juice it up. They’re going so far as to press fentanyl with oxy pills, into Xanax and into hydrocodone to pass them off as more expensive drugs. But mostly, they’re pressing it into heroin, since it feels so much the same.

In general, in the southwest part of the United States and the Mountain West, heroin is usually a black tar or a brown powder, sourced from Sinaloa or Nayarit, moved almost exclusively by Mexican cartels and sold on the street largely by Hondurans.

Parts of North America that are farther from Mexico — the East Coast, the Pacific Northwest, Canada, and New Hampshire, where Brett lives — tend to do less black or brown tar and more white powder heroin, which comes from Asia, often called China White. And so fentanyl, which is usually also a white powder, is easier to mix with heroin batches. It’s why the fentanyl crisis has hit hardest in states that are farther from Mexico.

Since his suicide attempt, Brett says he’s been clean and lives in a “sober house” — a place ironically named, since he says seven body bags have been dragged out of the front door in just the last year. A lot of those were from the “China White,” which, he says, is basically all fentanyl at this point.

“It’s really fucking crazy, fent. It’s fucking killing people,” he says. “If it spreads out there [in Colorado] like it did out here, you’re looking at a massive amount of deaths. I’m not lying. It’s like a death a day up here.”

Even fentanyl, bad as it is, might not be the worst of it. This summer, an even more deadly drug poisoned addicts in Ohio. Carfentanil, an elephant tranquilizer related to fentanyl, kills in doses smaller than a snowflake. Even touching it can make someone sick. If that spreads, there’s not enough naloxone in the world to save people.


Today, more Americans take pain pills than smoke cigarettes. Because of that, America averages about five drug overdoses per hour, mostly on the legal stuff — or so claims the Centers for Disease Control. That’s around 50,000 overdose deaths per year. It’s like a Vietnam War every calendar cycle.

In the last half-decade, experts began noticing the patterns of drug use shifting significantly from legal pills to illegal heroin — now fentanyl. That’s because, around 2012, a perfect storm brewed in order for it to thrive.

First, doctors noticing the crisis began to write fewer pain pill prescriptions. And the most-abused pain pill, OxyContin, changed its formulation, making it harder to abuse. So when an addict’s prescription ran out, they flocked to the easier street markets to find heroin and satiate cravings.

The restrictions on pain pills accelerated the heroin crisis and its demand. At the same time, the necessity for cartels to outsource another drug changed drastically.

After Colorado and Washington passed legislation to allow recreational weed to adults in 2012, the cartels lost market share (Esquire reports the Sinaloa Cartel saw marijuana sales drop some 40 percent).

The loss of profits had to be made up somehow, so the cartels increased production of heroin by 70 percent and dropped the price to build demand. One standard hit of heroin — called a bag or bindel — dropped to around $4, from $10 around 2010. Suddenly, the cartels were supplying opioids cheaper than the doctors could.


Kerry Broderick, a doctor at the Denver Health emergency department, says that since about 2000, the opioid overdose rate in the ER is “100 fold worse. And in the last 18 months — or even 6 months — it’s really skyrocketing.”

Fentanyl has also been a gold mine for street-level dealers — if a short-sighted one. The dealers are often addicted to opioids themselves. A bag they’ve been dipping in can suddenly become a hot bag, just by dumping in some fentanyl.

This makes life dangerous for users.

Vernon Lewis, of Denver, is funny and smart and kind of a superhero in his circle. He carries naloxone for his friends; he’s saved many. But his knowledge of the dangers of opioids isn’t enough to make him stop. Lewis needs to “get well” every day, before the afternoon, or else he gets dopesick.

Lewis doesn’t love fentanyl. But if he can’t find heroin, he’ll do it. Once he says he was marooned out in another city and couldn’t reach his connect; his buddy swooped in with some fentanyl he’d stolen from a doctor. They muscled it in. It’s good and strong, fent, although too short-acting.

“The front door is, like, slamming, but the back door is like falling off a cliff,” Lewis said. 

He says the worst part about the heroin scene lately for guys like him is doing fentanyl without knowing they’re doing it. Dealers have all kinds of tricks, he says, to disguise it like heroin. They’ll “steal fentanyl patches from a doctor’s office, cut them open, pour the gel on top of a pile of B12 vitamin powder to let it sink in, and tell people that the mix is China White.” Or they’ll “take a bottle of Coca-Cola, boil off all the water until it’s a brown sludge, then add fent to it, and tell people it’s pure Mexican Brown.”

“This stuff tastes like heroin, it looks like heroin, it feels like a heroin shot — you get well, you nod off — but if it’s wrong, you might fall out,” he told me.

Because fentanyl is so compact, if the dealers get the volumetrics wrong, it’s like loading a gun and telling people it’s a pixie stick. Fent is so powerful a few grains of it can kill you.

Some don’t take fentanyl by accident. Many like the high better. Others have even built up such a tolerance to heroin that they need an even more powerful dragon to chase.


Surprisingly, some illegal dealers are acting in more ethical ways than the nation’s trusted drug companies. The darknet site Apple Market, for example — where you can buy Afghan heroin and counterfeit Euros as easily as you’d buy a new juicer on Amazon — refuses to sell “poisons like ricin and arsenic oxide,” both tools for assassination. It also refuses to sell fentanyl.

Another user named David says he once knew a woman who put fentanyl in a chocolate bar to poison his friend. “Fentanyl is my least favorite molecule,” he adds. He carries naloxone around with him, now.

“We don’t see too much fentanyl [overdoses],” explains Kerry Broderick, the ER doctor. “By the time they get on to fentanyl, they don’t usually get to us.”

Riding around on the ambulance, picking up sufferers who have nodded off, EMTs and paramedics are always now pondering whether the needle used was filled with heroin or fentanyl. Or if it was unknowingly cut with fentanyl, because that’s when the mega-doses of naloxone need to come out. If it’s pure fentanyl, the ambulance might not make it back to the hospital with lights and sirens. It’ll be their relatives’ turn to drive them, doing the slow parade in the hearse.

So when I plead with the witnesses: “Was it just heroin?” I now have to add the word “fentanyl” in there somewhere too. Most of them have no idea what I’m talking about. They don’t know it’s out there.

I’d ask the users themselves — but through their weak moans and shallow breaths, many can’t recall what it is they took, either. I still don’t know how completely some of them wake up.