As more heroin is mixed with fentanyl, opioid crisis turns even deadlier
Nicole Clark’s first encounter with fentanyl-laced heroin came a decade ago, when it was a novelty in Chicago’s drug scene. What she remembers still haunts her.
She snorted a small line of the drug soon after she bought it on a street corner, but before she and her friend could reach the nearby expressway for the ride back to Huntley, she fell unconscious. When she awoke, she was in a hospital bed, her body bristling with tubes.
That was enough to scare Clark, now 41, away from fentanyl, a synthetic opioid 40 times more potent than heroin. But her friend, 42-year-old Keith Glissendorf, said the drug’s dangerous power wasn’t a red flag — it was exactly why he wanted it.
“I was (patronizing a particular dealer) because he had the fentanyl dope,” said Glissendorf, who, like Clark, is now in a methadone treatment program. “I crashed three vehicles in a week. I went to jail. But I liked it. I loved it — the rush, the euphoria, everything that came along with it. I was getting ripped.”
Whether feared or desired, fentanyl, carfentanil and other man-made opioids have become a mainstay in the city’s drug trade, found in about 40 percent of the heroin sold here, according to a Chicago Police Department estimate.
Experts say these powerful synthetics are responsible for a spike in fatal overdoses in the Chicago area and nationwide: Users are consuming drugs stronger than they can handle, often without knowing what they’re putting into their bodies.
“I believe that’s contributing to the increase in deaths,” said DuPage County Coroner Richard Jorgensen, whose jurisdiction has seen 23 fentanyl-related fatalities this year, compared to 13 involving heroin alone. “How do you as a dealer or user know the strength of your drug?”
‘Drop Dead’
Fentanyl patches have long been used as a treatment for chronic pain, but starting around 1980, dealers began mixing the drug and its close cousins into the heroin supply, causing irregular outbreaks of overdose deaths.
The synthetics hit Chicago hard in the mid-2000s, when the Mickey Cobra gang obtained a supply from a clandestine lab in Mexico and passed it off as heroin that became known as “Drop Dead.” About 350 people died within 20 months, according to a study by pathologist Dr. Scott Denton, former interim chief of the Cook County medical examiner’s office.
“It didn’t stop until the (U.S. Drug Enforcement Administration) busted the lab in Mexico,” Denton said. “The demand wasn’t going away.”
Synthetics flared again about four years ago, but this time the supply hasn’t stopped. Chief Anthony Riccio of the Chicago Police Department’s organized crime bureau said local gangs are mixing heroin from Mexico with fentanyl from China to create super-potent hybrids.
Death often follows when those drugs circulate, but in the perverse world of heroin sales, that’s like putting up a Times Square billboard.
“It’s the best advertising they can have,” Riccio said. “The true addicts want that (powerful) high. When word gets around, business booms.”
Fatal opioid overdoses in Illinois had been rising for years even before the rise of synthetics, reaching more than 1,000 in 2013. Just 8 percent of those deaths involved fentanyl and its analogs, according to the Illinois Department of Public Health.
Three years later, overdose deaths rose to nearly 1,900 — and about half were fentanyl-related.
Kane County Coroner Rob Russell saw synthetic-related overdoses jump sixfold between 2015 and 2016. He expects that to continue, given the ease of smuggling fentanyl; one study estimates that while a mere 300 pounds entered the country last year, it was enough to supply 1 million doses a day.
“There’s quite a bit of enforcement out there to try to thwart this, but it’s hard,” Russell said. “It’s like trying to shoot a fly from outer space.”
The same acceleration is happening elsewhere in the country, leading federal officials at a congressional hearing earlier this year to label fentanyl “an even more dangerous threat” than heroin.
Matthew Allen of the Department of Homeland Security told the panel that drug cartels have learned that lab-crafted opioids like fentanyl are more cost-effective and easier to manufacture than heroin, which requires fields of opium poppies for its raw material.
Leo Beletsky, a drug policy researcher at Northeastern University in Boston, said that evolution is a predictable outcome of the “iron law of prohibition,” which holds that any banned substance will become more concentrated to maximize its financial return.
“It takes a lot of effort to produce heroin,” he said. “It takes much less effort to synthesize fentanyl in a lab, so I imagine the market will continue to turn in that direction. … I think we’ve not seen the peak of the overdose crisis.”
Cops endangered
As fentanyl proliferates, its effects are rippling outward. The DEA this summer warned first responders that exposure to even small quantities can cause “serious negative health effects, respiratory depression and even death,” leading some departments to change how they handle suspected narcotics.
Riccio said fentanyl-laced drugs once looked different than pure heroin, prompting officers to exercise greater caution, but that’s no longer the case. Chicago police now send all suspected narcotics to a crime lab instead of performing field tests.
“The more the product is handled, the greater the potential to go airborne,” Riccio said.
Even drug-sniffing police dogs are endangered by synthetics; some have reportedly died after inhaling the drugs. The University of Illinois College of Veterinary Medicine recently released a video advising veterinarians on how to treat dogs that accidentally overdose (naloxone, the overdose-reversing medication, works on canines, too).
Many people who overdose end up at Loretto Hospital on Chicago’s West Side, in the midst of one of the city’s most active drug markets. Dr. Lois Clarke, head of Loretto’s emergency department, said the effects of the surge have been obvious.
“A few years ago, we maybe saw one or two overdoses in a week,” she said. “Now we’re seeing multiple people in a day.”
Chris Pinkard, a clinical supervisor with the hospital’s addiction center, said he and his colleagues are rethinking how to treat people who get hooked on fentanyl. They are considering using larger doses of Suboxone, a medication that staves off withdrawal symptoms, and introducing Vivitrol, a one-shot opioid blocker.
Dr. Sonia Mehta, Loretto’s CEO, said that for all the work done in the hospital, resources to help people struggling with opioids are still far too limited. A lack of psychiatrists, counselors and job opportunities — not to mention the funding to pay for it all — makes addiction even harder to kick, she said.
“This is definitely a crisis, almost an epidemic right now,” she said. “We can treat them, we can send them out with naloxone kits, but where do they go from there?”
Street-level view
Standing on a street corner in North Lawndale, a longtime heroin user named Jose wondered where he was going to go. He had just gotten out of Cook County Jail, he said, and wanted to see if there was room in a treatment program.
He wasn’t counting on it. That’s why he was picking up clean needles from a van operated by the Chicago Recovery Alliance, a group that provides health services to drug users.
People leaving incarceration are among the most at-risk for an overdose, their tolerance lowered from months of abstinence. Potent synthetics heighten the danger even more, but Jose, 47, said he wasn’t worried: His dealer had always been straight with him.
“I’ve known him a long time,” he said. “Whatever he puts in, he tells me.”
A woman named Angel, 51, wasn’t so nonchalant. She said she recently overdosed on fentanyl, having received no warning from her dealer.
“We don’t know what we’re putting in our systems,” she said. “For all we know, they’re opening up the kitchen sink and just putting in anything. … It’s a losing battle out here.”
Daniel Ciccarone, a professor of family and community medicine at the University of California at San Francisco, said highly dangerous drugs tend to have a short run — the cannabinoid K2, which in 2015 caused a spate of “zombie-like” overdoses in New York, is one example — as users and dealers alike grow leery of the carnage.
Synthetic opioids are lethal mainly because of erratic doses, he said, and could become more predictable over time. But he fears that with cartel hierarchies in flux and China rising as a new supplier, it might be too late for anyone to gain control.
“What happens next is unknown,” Ciccarone said. “It’s more unknown than we’ve ever had in any drug epidemic.”