Fentanyl deaths increasing, but many users remain unaware of dangers
Joseph Fernino, a 20-year-old from Staten Island, overdosed on heroin this past February. Paramedics who rushed to his aid had to administer two shots of naloxone, a drug that usually can revive a patient in the grips of an overdose with only one shot.
Fernino had been using heroin since he was 15 years old, but this heroin was more powerful and more dangerous than the kind he used when his addiction began
This heroin was laced with fentanyl, a powerful painkiller that can be 50 to 100 times more potent than morphine.
Fernino hadn’t sought out fentanyl, which is responsible for a growing percentage of deaths across the country.
Few users do. Like many, Fernino learned after the fact that he was using spiked heroin.
His dealer mentioned it casually, warning Fernino to be careful.
“The state of mind that I was in, I just didn’t care,” Fernino said. Instead, he rationalized, deciding to use one bag instead of his regular five.
“I’ll do my regular dose if I don’t die,” Fernino remembers telling himself. “I was playing my cards and I was getting a shorter deck each time.”
Fentanyl is mixed with heroin because it is cheap and easy to produce, and incredibly potent. Drug users fortunate enough to know what is in their heroin have to trust that their dealers — who are often trusting their suppliers — are being prudent. Otherwise the next hit might be the last.
Most users aren’t even aware that their heroin is laced with a significantly more powerful and dangerous opioid, according to addiction care providers.
“It’s folks who were using heroin and didn’t realize there was fentanyl,” said Samantha Paz, assistant vice president of public policy and communications at BOOM!Health, a nonprofit that works with addicts. “With overdoses specifically, most people in New York City who are using fentanyl don’t do it on purpose.”
The increased demand for heroin has led to the increased supply in fentanyl and because a milligram’s worth of fentanyl can kill, the body count is multiplying.
In 2015, 146 overdose deaths in New York City involved fentanyl, 16 percent of all overdose deaths, according to the city health department. Never before had fentanyl accounted for more than 3 percent of overdose deaths in the city.
On Monday, the city’s health department reported that since July 1, 47 percent of confirmed drug overdose deaths involved fentanyl. That's up from 39 percent through the first six months of the year, according to provisional data. That data also shows there have been 725 confirmed overdose deaths to date in New York City and that 581 of these deaths occurred during the first six months of 2016.
The problem is not confined to the city. In 2014, Ohio reported 514 fentanyl-related overdoses, up from 92 in 2013. Other states saw similar jumps. Maryland had 185 fentanyl-related overdoses in 2014, up from 58 in 2013, and Florida had 397, up from 185.
The glut of fentanyl, a synthetic opioid, in New York City is a result of Mexican cartels that bring the drug across the southern border, according to New York City special narcotics prosecutor Bridget Brennan.
“Historically, we’ve never seen fentanyl come in in bulk,” she said. That has changed in the last 18 months to two years as dealers work to keep up with the growing demand of new opioid addicts.
While it’s unclear where exactly the fentanyl is coming from, Brennan said she thinks it is either being produced by the cartels in labs in Mexico or in China.
Making a synthetic opioid in a lab is a far simpler process than organically making heroin, which takes time to grow and extract.
“The benefit of that to the cartels is that they have complete control [over the product],” Brennan said. “[And] you can reap more profit out of the same volume… You can stretch a kilo further.”
While users often may not know what is in the heroin they’re using, Brennan thinks the lack of knowledge about the drug cocktails might extend back even further.
“I don’t have the sense that dealers know what they’re selling,” she said, though she doesn’t think it’s a smart business practice.
“You don’t want to kill every one of your users,” Brennan said. “You know these are businessmen. Ruthless cruel businessmen, but they’re businessmen.”
On the other hand, a drug that produces a more powerful high can earn a dealer better reviews, according to John Coppola of the New York Association of Alcoholism and Substance Abuse Providers.
“It’s the cherry on the top of the sundae,” Coppola said. “Users are aware that it produces an effect more profound,” although they often may not know why.
But it can also be deadly. Paz and other providers say they know of individuals who have fatally overdosed the first time they used heroin cut with fentanyl.
Some care providers expressed particular concern about the danger fentanyl could pose for users who have been away from heroin for a time, lowering their tolerance.
“You build up a tolerance, you have a physical dependence,” Coppola said. “If you purchase heroin with fentanyl, it gives an effect that counters that tolerance.”
When users are away from the drug, their tolerance decreases, and as fentanyl becomes more prevalent, the increased potency of some street-level heroin and lower tolerance can be a deadly cocktail for users who come back to the drug.
U.S. Rep. Dan Donovan, a Republican from Staten Island, proposed a bill last month that would increase penalties for individuals manufacturing and distributing substances laced with fentanyl.
“Overdose deaths [have] soared,” Donovan said. “Something the size of a couple [grains] of salt could kill you.”
Donovan’s bill, which is co-sponsored in the House by Rep. Thomas Rooney, a Republican from Florida, would also give the U.S. attorney general the power to temporarily reclassify synthetic opioids such as fentanyl in order to consider such a substance as a more serious drug even if the chemical makeup doesn’t specifically match a scheduled opioid, similar to a recent move made by New Jersey’s attorney general.
“There’s people dying who shouldn’t be dying,” Donovan said. “We think this will help. It’s not an end-all, but for the time this will save some lives.”