Fentanyl is fueling new overdose crisis

Fentanyl, a super potent synthetic opioid at the center of a new overdose epidemic, is presenting uniquely vexing challenges for law enforcement officials because it’s so deadly, so versatile and so profitable.

It’s flowing into the U.S. across the southern border and via the mail system. It’s being trafficked by Mexican cartels with vast dealer networks and by small-time operators ordering the drugs online. It’s being purchased by desperate opioid addicts looking for the most potent dose on the street and by unsuspecting consumers looking for cheap pain pills from shady Internet retailers.

“It truly is everywhere,” said Barbara Carreno, a spokeswoman for the federal Drug Enforcement Agency.

Here are the key things to know about the drug fueling this deadly crisis:

Where is the fentanyl coming from?

The primary source of this synthetic opioid is China, where thousands of illicit labs led by rogue chemists manufacture fentanyl and a raft of copycat substances.

Experts say the primary buyers are Mexican drug cartels, who mix the fentanyl with heroin and other substances and then smuggle those diluted mixtures across the U.S.-Mexico border. But the amount of fentanyl coming into the U.S. via the mail system is on the rise — in smaller packages and at much greater potency.

“I expect that in fiscal year 2017, the numbers of seizures in the mail and express consignment environment (such as FedEx and UPS) will be much higher than they were last year,” said Robert Perez, an acting commissioner with the U.S. Customs and Border Protection agency.

Perez said the CBP seized more than 400 pounds of fentanyl in fiscal year 2016 — up from eight pounds in 2014. A few granules of the drug can be deadly, and many customs agents are now equipped with Narcan, the anti-overdose medication, in case they come into contact with the substance.

What role is China playing?

Chinese officials were initially slow to respond to pleas from American officials to crack down on fentanyl, which is a Schedule II narcotic in the U.S.

China has a booming pharmaceutical industry, and fentanyl was not causing a deadly overdose epidemic in China, so the government there wasn’t focused on controlling it.

“It’s hard to get cooperation from another country on a substance that’s not illegal in their country,” said Richard Baum, acting director of the Office of National Drug Control Policy.

But China has become more aggressive, Baum and others say. Earlier this year, for example, China’s National Narcotics Control Commission banned four fentanyl-class substances, including carfentanil — which is normally used as a large-animal tranquilizer and is 10,000 times more potent than morphine, according to the DEA.

That should cause a drop in the amount of carfentanil flowing into the U.S. But every time the Chinese ban one synthetic opioid, drugmakers in that country tweak their recipes to get around the new restrictions.

“These rogue chemists in China can just tweak a molecule and then you have a new substance,” said Carreno. That often leaves American law enforcement officials “three or four generations behind” the chemists, she said.

Why is fentanyl supplanting heroin as a key driver of the overdose epidemic?

It’s easier and cheaper to produce than heroin, which is derived from poppy plants. With fentanyl, there are no crops, just chemicals.

“You can make it as strong as you want, and in bulk and fast,” said Tim Reagan, a Cincinnati-based DEA agent. And because it’s so potent, a little bit goes a long way, making it extremely profitable.

How difficult is it for local law enforcement officers to prosecute cases?

Very.

“With it coming through the mail, it just adds a whole different dynamic that we’ve never dealt with with any other drug,” said Tom Synan, police chief in Newtown, Ohio, which has been particularly hard hit by the influx of fentanyl.

Synan said it’s dangerous to collect evidence at an overdose scene because fentanyl is so toxic. In May, a police officer in northeast Ohio overdosed after he brushed a bit of the white powder off his uniform. He had just returned to the station from making a drug arrest, where he had used gloves and a mask to search a suspect’s car. Without the protective gear, it took four doses of Narcan to bring him back.

Synan said his officers focus on reviving overdose victims and keeping themselves safe, and they worry about making arrests and building cases later. Even when officers are able to ensnare dealers, Synan and others said, it can be hard to connect them to a broader drug ring.

“When you had crack cocaine, you had a lot of organized gangs that were really the primary pushers,” said Synan. With fentanyl, some dealers are connected to Mexican cartels, but many others are independent operators.

The dealer may lead to just “one string, instead of a tree,” Synan said. “Right now, we’re just kind of surviving and just trying to save lives.”

Reagan said the DEA has had “a ton of success identifying street dealers” whose transactions have resulted in overdose deaths. But those dealers are often unwilling to cooperate, stymieing efforts to target operators further up in the supply chain.

As for tracing sources in China, Reagan said, the DEA can turn over incriminating information to Chinese authorities to see whether they will prosecute. Or try to bring charges in the U.S. and ask for extradition.

“There’s definitely more cooperation than ever,” he said. But “this is all kind of new.”

Why do addicts take fentanyl-laced drugs when they are so likely to result in an overdose?

First, medical experts note that addiction is a brain disease that can impair self-control and judgment. Addicts are not making rational decisions.

Second, some addicts don’t realize fentanyl has been mixed into the drugs they’re buying. Take this user, who posted a message in a fentanyl chat room on Reddit asking about what might be in his opioid pills.

“With real oxy, I usually have at least a day after my last dose before the withdrawls (sic) kick in, but now it’s literally like 3-4 hours after my last dose,” this person wrote. “Is this normal for fent or are my pills laced with something else?”

Finally, addicts want the most intense high, and some seek out fentanyl-laced drugs even if they realize it could kill them. “If a user dies … (others) are going to try to find that dealer, because they’re looking for the best stuff,” Reagan said.

Another addict on Reddit explained the decision to use fentanyl this way:

“So because oxycodone is so gosh darn expensive I’ve decided to start using fentanyl but have no idea how to use it,” this person wrote. “How much am I supposed to use without killing myself thanks for your help.”

What role is the Internet playing in fentanyl sales and distribution?

A big one. Dealers and addicts can buy fentanyl directly from Chinese manufacturers with just a Google search and a few clicks.

More sophisticated operators use the so-called dark web, which hides the servers and identities of a websites administrators and users. These clandestine sites often use digital currencies, such as Bitcoin, to further disguise financial transactions.

“These dark web markets are like eBay” for illegal products, said Isak Ladegaard, a researcher at Boston College who has studied digital drug markets. “If you order something through the dark web and it’s delivered to your address, there is no evidence you were the person making the order.”

The Department of Justice announced on July 20 that it had shuttered one the largest online criminal marketplaces, AlphaBay, and Dutch authorities also recently closed a similar site called Hansa Market. At the time of the AlphaBay bust, there were more than 250,000 listings for illegal drugs and toxic chemicals on the site, the Department of Justice said, along with thousands of listings for other illicit goods.

But Ladegaard said the DOJ crackdown would not dampen the illegal fentanyl trade.

“All research thus far suggests that when a market is closed down, there is a period when there is some instability and people are not entirely sure what to do,” he said. “But fairly soon, traffic moves on to other (dark web) marketplaces.”

How do Customs officials stop fentanyl shipments from getting into the U.S.?

In June, Border Patrol agents seized 34 pounds of fentanyl during a vehicle stop at a California checkpoint — discovering 10 plastic-wrapped bundles of fentanyl in the car’s trunk, with an estimated street value of more than $1 million, according to a CBP news release.

But the dangers at the border are the same as on the street. Even drug-sniffing dogs are at risk of death if they accidentally ingest fentanyl during searches, and the agency is now engaged in a pilot project to specially train dogs for these synthetic opioids.

Finding fentanyl in the mail can be even more difficult, because of the sheer volume of packages and the lack of electronic data detailing shipments sent via the U.S. postal service.

“How we inspect and how we select packages in the mail is still a very manual process,” said Perez, the CPB commissioner.

Deirdre Shesgreen

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