Cheap fentanyl posing as heroin, Oxy, other drugs

LOS ANGELES — Earlier this month, in a house on a Venice canal, three people who reportedly thought they were using cocaine died after apparently ingesting the powerful synthetic opioid fentanyl. A fourth person was hospitalized and survived.

Stories about accidental overdose deaths involving fentanyl are becoming increasingly common.

There is no way of knowing, of course, but it is possible they might have lived if they’d had access to an easily obtainable nasal spray called Narcan, which reverses an opioid overdose.

Or they might have refrained from using it altogether had they first tested the substance with an easy-to-use kit that can detect fentanyl, which kills thousands of Americans a year — and many of them don’t even know they are putting themselves in danger.

“I doubt it occurred to cocaine users to test it,” said Dr. Gilmore Chung, director of addiction services for the Venice Family Clinic. “But we see fentanyl in all drugs.”

Fentanyl, which is cheap to produce and far more powerful than heroin, can be made to look like black tar or China white heroin, cocaine or crystal meth. It can be pressed into pills and appear to be OxyContin, Xanax or Valium. The musician Prince died of a fentanyl overdose; he believed he was taking Vicodin.

“If someone tells me they are on heroin,” Chung told me, “I assume until proven otherwise that they are on fentanyl. After years of using, people become confident — ‘Hey, I know what black tar heroin looks like’ — and you test it and it’s not.”

Chung is among many specialists who take an enlightened approach to treating addiction. He practices harm reduction, a public health strategy that aims to reduce the negative consequences associated with drug and alcohol use.

“We meet people where they are,” he said, “as opposed to where we might like them to be.”

I had a long conversation with one of his patients, Zachary, 31, who asked to be identified only by his first name, to protect his career.

Zachary’s addiction trajectory is pretty typical. In his late teens, he began using prescription opioids like Vicodin and anti-anxiety drugs like Xanax.

As public health experts became alarmed at the increasing number of opioid overdose deaths, and the enormity of the crisis was becoming clear, prescription opioids became harder to find.

“All of a sudden, everyone had switched from prescription stuff to heroin,” Zachary said. “It was so much cheaper.”

But as drug cartels realized it was easier and cheaper to produce fentanyl, heroin became scarce.

Zachary told me he has lost count of how many times he has overdosed and been revived with Narcan; he has used it to revive friends many times.

In his mid-20s, he had already spent four years on probation ordered by drug court, though he’d never really stopped shooting heroin and cocaine. One day, he and his girlfriend scored what they thought was heroin.

He dozed off, and when he woke up, his girlfriend, who was seven months pregnant, was sitting on the floor cross-legged, her arms propped on the coffee table. When he asked if she wanted some ice cream and she didn’t respond, he touched her shoulder. “She just dropped,” he said. He revived her briefly with Narcan and called 911. She died at the hospital. The baby could not be saved.

“Turned out, it was straight fentanyl,” Zachary said.