Heroin vanishing, fentanyl deaths rise
BALTIMORE — Heroin has ravaged this city since the early 1960s, fueling desperation and crime that remain endemic in many neighborhoods. But lately, despite heroin’s long, deep history here, users say it has become nearly impossible to find.
Heroin’s presence is fading up and down the Eastern Seaboard, from New England mill towns to rural Appalachia, and in parts of the Midwest that were overwhelmed by it a few years back. It remains prevalent in many Western states, but even New York City, the nation’s biggest distribution hub for the drug, has seen less of it this year.
The diminishing supply should be a victory for public health and law enforcement alike. Instead, in cities like Baltimore, longtime users who managed to survive decades injecting heroin are now at far higher risk of dying from an overdose. That is because synthetic fentanyl, a deadlier drug that is much cheaper to produce and distribute than heroin, has all but replaced it.
The dramatic rise of fentanyl, which can be 50 times stronger than heroin, has been well documented. But its effect on many older, urban users of heroin, who had been able to manage their addiction for years, has been less noticed. The shift from heroin to fentanyl in cities has contributed to surging overdose deaths among older people and African Americans and deeply unnerved many like William Glen Miller Sr., who first tried heroin as a 13-year-old in West Baltimore.
“It doesn’t take a second for it to hit you,” said Miller, 64, describing the unfamiliar punch of fentanyl. “All I remember is pushing in the needle, and three hours later I am getting up off the ground.”
He was speaking from a nursing home bed in northern Baltimore, where he spent several recent months recovering from pneumonia and contemplating addiction treatment in another state. Heroin had a lulling effect, he and others said, but fentanyl is killing many of their peers. The claim is backed by federal data showing that the rate of overdose deaths involving fentanyl increased by nearly 54 percent in 2017 for people 55-64 — more than for any other age group.
“Clients we’ve known for years are dying,” said Derrick Hunt, director of the Baltimore City Needle Exchange Program, which has two vans that serve 17 locations around the city. “Everywhere I go, this person passed, that person passed.”
The reason fentanyl is everywhere is economic: Dealers and traffickers can make far more money from it than from heroin. Instead of waiting months for poppy fields to grow in Mexico and farmers to harvest the brownish-black gum, which then gets refined into powder and shipped north, traffickers here and in Mexico can order fentanyl from China, or precursor chemicals to make it in clandestine labs, generating far more doses with far less labor.
This is not an elegy for heroin, a dangerous drug in its own right that spread from cities into suburbs and rural areas about a decade ago, when addictive prescription painkillers became harder to get. But for longtime urban users like Miller, many of them African American, its disappearance is taking a particular toll. From 2016-17, the fatal overdose rate from fentanyl and other synthetic opioids increased by 61 percent among black Americans, compared with a 45 percent increase for whites.
The number of overdose deaths involving heroin has been dropping, even as overdose deaths overall have kept climbing because of fentanyl.
On a street corner in East Baltimore one recent morning, a van distributed clean needles to about 25 clients, most of them older black men. Some leaned on canes or walkers; all said they missed heroin and its relative predictability.
Each person took a paper bag full of needles and Narcan, the overdose reversal drug. The vans now also offer test strips, which people can use to check their drugs, including cocaine, for fentanyl. But some clients don’t see the point.
“Most people, they’re not using no test strips,” said Miller, who helped start a local group that hands out fentanyl strips and naloxone. “Because fentanyl is in daggone everything now.”