Inside fentanyl’s mounting death toll

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 Centers for Disease Control and Prevention. The majority of the deaths were linked to synthetic opioids such as fentanyl.

In New York City, the majority of autopsies of overdose deaths now reveal that fentanyl was involved, including that of actor Michael K. Williams.

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 in the 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 methamphetamine, 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.

People who intermittently use stimulants such as cocaine, for example, have low tolerances for such powerful synthetic opioids, said Dr. Chinazo O. Cunningham, 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, executive vice president and chief operating officer of Odyssey House, a drug rehabilitation center in New York City. “This is poison.”

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 after 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 Drug Enforcement Administration issued a public safety alert: More than 40% of black-market prescription pills contain lethal amounts of fentanyl.

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 domestic dealers turned to fentanyl as a cheap way to bulk up 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 DEA have tripled, as confiscated heroin fell by more than half.

Whenever fentanyl circulation goes up, Brennan said, overdose deaths inevitably do too. “With fentanyl, the hair on our necks stood up,” Brennan said.

Fentanyl was first synthesized in 1959 as a substitute for morphine.

Today fentanyl primarily is 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 such as 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 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.