On April 21, 2016, Prince Rogers Nelson — adorned in a black hat, shirt, and pants — was found unresponsive in an elevator at his home and recording studio, Paisley Park. The cause of death was found to be an overdose of Fentanyl, an opioid 50 times stronger than heroin. Questions still abound. Did he get these drugs legally? Illegally? What kind of pain was he numbing?
Some information has trickled out. Prince had battled an addiction to Percocet decades before his death, with one family member stating that he’d started using the painkiller legally. On April 15, after a performance in Atlanta, Prince’s plane had to be grounded when the musician became unresponsive, the cause of which has been attributed to an overdose of pain medication. In the 24 hours before being found at Paisley Park, an addiction specialist, Dr. Howard Kornfeld, was called to come to the singer’s aid. Dr. Kornfeld wasn’t available, so he sent his son, Andrew Kornfeld in his place. It was Andrew Kornfeld who, along with two Prince associates, found the legend unconscious in an elevator. By that time, it was too late.
Opioids have been linked to almost half-a-million overdose deaths since 1999, with Prince being the most dramatic recent reminder of this epidemic. It’s a fact that 78 people die every day from an opioid overdose. Addiction to fentanyl mirrors other painkiller addictions: it starts with a prescription, then users increase their dosages and/or change their ingestion methods. Prince’s death offers us a harbinger of the rising fentanyl plague, which is inherently tied to the heroin epidemic.
To understand the dangers of fentanyl and fentanyl-laced heroin, we spoke to a DEA agent, two undercover narcotics officers (who spoke on the condition of anonymity), and one user. Their stories paint a picture of a dangerous substance that’s wrapping its claws around communities across the nation.
An Insidious Drug
“You are dealing with something that is incredibly hard to dose, and is potentially fatal at a microgram level. Not a milligram level. A microgram level.”
— DEA Special Agent Joe Moses
Fentanyl is a schedule two narcotic controlled substance, and is the most potent opiate available for medical or veterinary use. It’s an analgesic and an anesthetic, 50 to 100 times stronger than morphine, and 30 to 50 times stronger than heroin.
“So, when you think about it, it’s just an incredibly potent opioid,” DEA Special Agent Joe Moses explains. “It’s incredibly dangerous, because it’s potentially lethal at very low levels. Ingestion of doses as small as .25 micrograms can be fatal.”
There are two kinds of fentanyl that reach the hands of users. There’s the clandestine variety, in which the precursor chemicals are used to manufacture the drug illegally. And then there is pharmaceutical fentanyl, which is medical grade pain medication used for people in the advanced stages of cancer. That fentanyl is very hard to get a hold of — only seen on the streets due to someone smuggling it out of a medical facility. Most of the fentanyl in circulation is of the clandestine variety, and it’s almost always mixed with heroin to increase the potency of the heroin.
“Fentanyl is just another cut — it’s a cutting agent that they use with the heroin,” says Undercover Officer Eric Smith (name changed), who works in Southern New Jersey. “It’s just another thing they can add to it that’s cheap and that brings the high up real fast. Sometimes the fentanyl can be too much, because these aren’t pharmacists mixing it up. When the mix isn’t right, that’s when people go down.”
In March of 2015, the DEA sent out a nationwide alert, specifying fentanyl as a dangerous threat to not only the user, but to law enforcement officials as well.
“Fentanyl itself — when conducting a search warrant or even a traffic stop — the police officers on the street may not even know what they’re handling,” Agent Moses says. “They may think it’s heroin. They may even think it’s cocaine. If it’s ingested or if it even gets on the skin, it’s a real cause for officer safety.”
That’s because fentanyl can absorb into the skin and can go airborne as well. If law enforcement comes across a domestic fentanyl laboratory, DEA’s clandestine laboratory enforcement team is called to the scene, where they employ breathing apparatuses and full body suits.
Seizures of these labs and of pure fentanyl caches have increased dramatically in recent years. According to the DEA’s Annual Threat Assessment Report, there were 618 fentanyl seizures in 2012. In 2014, the number rose to 4,585.
“It’s a huge concern for the DEA. It goes without saying,” notes Agent Moses.
In October of 2015, the Center for Disease Control (CDC) released an advisory on fentanyl-related overdose fatalities. Of chief concern were the 700 deaths attributed to the drug over a period spanning from late 2013 through 2014. That may seem like a relatively small number to trigger a major health panic, but the statistic comes with an asterisk: coroners don’t test for the drug unless they are specifically instructed to. So, in cases in which heroin is found in the system of a deceased user, medical examiners will stop testing for substances and will attribute the cause of death to heroin.
“Obviously, one concern is that fentanyl deaths may be underreported,” Agent Moses explains. “And again, given that fentanyl is often mixed with heroin, there could be an undetermined number of overdose deaths reported as heroin when in fact they’re possibly caused by fentanyl.”
Of the 4,585 fentanyl stashes that the DEA reported seizing in 2014, 10 states made up 80% of the haul — with Ohio, Massachusetts, and Pennsylvania in the top three spots. Ohio’s 1,245 seizures almost doubles the amount in Massachusetts (630), making it ground zero for the drug. In 2014, Ohio recorded 514 fentanyl-related overdose deaths, dramatically outpacing the 92 they saw in 2013.
“They (Ohio) don’t get good heroin,” says Officer Smith. “They have to cut it with stuff. Here, [in New Jersey] we get high potency heroin.”
Outside of Ohio, most of the fentanyl-related overdoses seem to be concentrated along the Eastern seaboard — but confusion over the actual numbers is rampant. The undercover officers we spoke with are stationed in New Jersey, the fifth highest state on the reported fentanyl seizure list. Still, everyone seems distrustful of any statistics on the drug.
“Even if they did keep stats, there’s no one keeping track of it,” Officer Smith says. “You have to contact every coroner in the U.S. to determine what everyone’s individual toxicology was and whether or not it was related to fentanyl. And even if they did that, you would never even know if it was the fentanyl that killed them, or it was the heroin that killed them. You’re never going to get a true number, and even if you tried to, you’d be guessing.”
Furthermore, the undercover officers maintain that the DEA numbers come via surveys, many of which don’t get filled out by certain police districts. Compounding the issue is that there are no field-test kits for fentanyl available to law enforcement.
“You can probably quadruple that [death estimate],” Officer Smith says. “Seven-hundred deaths is probably just in [New Jersey’s] Camden County.”
This isn’t the first time the U.S. has seen a surge of fentanyl deaths. From 2005 to 2007, fentanyl-laced heroin had another dramatic upswing. Many of the deaths related to that outbreak were centralized in the northern part of the country, specifically Detroit. The rise in fentanyl during those two years were linked to a laboratory in Mexico. Compared to that outbreak, the “geographical dispersion” is much more expansive this time.
“This hasn’t slowed down,” says Undercover Officer Percy Jacobs (name changed).
“This doesn’t even compare (to the previous outbreak),” agrees Officer Smith. “When I tell you it’s non-stop, it’s non-stop. Your overdoses are pretty much all fentanyl based.”
With heroin use surging across the nation, and with more and more fentanyl hitting the streets, the toxic mix of the two substances is turning an already grim situation into an absolute nightmare.