More than a decade into the opioid epidemic, illicit fentanyl and related synthetic drugs are now driving the nation’s spiraling overdose death toll. Involved in nearly half of the roughly 200 U.S. drug overdose deaths every day, fentanyl appears to be here to stay.
“Even if we do a really good job at the border and start making a serious dent in shipments from China and Mexico, we need to anticipate that people will simply start cooking it here. It’s already happening,” U.S. Customs and Border Protection operations manager Stephen McConachie said in an interview.
As governors in the hardest-hit New England, Mid-Atlantic and Midwestern states call for intensified law enforcement efforts and stiffer penalties for fentanyl dealers, public health officials are saying this latest drug scourge underscores the urgent need to get more people into treatment, particularly those who use heroin.
With lethal amounts of fentanyl showing up in heroin and other drug supplies throughout the country, active drug users are at a greater risk of dying than ever before, said Jay Butler, director of public health at the Alaska health department and past president of the Association of State and Territorial Health Officials.
Even as the number of new heroin users declined last year, according to a recent survey by the federal Substance Abuse and Mental Health Services Administration, the number of current drug users exposed to fentanyl appears to be growing, Butler said.
One hundred times more potent than morphine, the synthetic drug fentanyl has been contaminating illicit drug markets for decades. A 1988 New York Times article reported a spate of overdose deaths in western Pennsylvania from “China White, a powerful synthetic heroin” that the article said had “plagued California in the early 1980’s.”
But, according to the Centers for Disease Control and Prevention, fentanyl’s popularity didn’t take off until 2013, propelling what the agency now calls the third wave of the opioid epidemic, after painkillers and heroin.
Fentanyl is cheap and easy to manufacture and smuggle, and it was involved in almost half of the more than 72,000 U.S. drug overdoses in 2017, according to the Centers for Disease Control and Prevention. The latest numbers show a sharp increase over 2012, when fentanyl was involved in only 6 percent of the more than 41,000 U.S. drug overdoses.
Fentanyl can be purchased online and shipped directly to a user’s home, prompting some to call it the Amazon of illicit drugs. Many dealers, primarily in Mexico, routinely ship via the U.S. Postal Service, FedEx and other private carriers.
Unlike pharmaceutical-grade fentanyl, which is used in hospitals for severe pain and anesthesia, the precise chemical formula for illicitly made fentanyl has been shifting, making it increasingly difficult to detect in autopsies, hospitals, drug treatment centers and crime labs.
At international mail terminals in New York, Chicago, Los Angeles, San Francisco and a handful of other locations, customs officials scan millions of parcels using X-ray devices to identify those that might contain fentanyl and other illicit drugs. And the force began last year to deploy dogs trained to sniff packages and alert agents when they detect fentanyl.
Even when agents find an envelope or parcel containing a white powder they think is fentanyl, it can take days to confirm because dealers continuously change the chemical formulas to elude law enforcement, according to Customs and Border Control.
To deter shipments of fentanyl and other illicit drugs, a wide-ranging opioid bill passed by Congress in October and expected to be signed by President Donald Trump includes a provision that requires USPS to obtain the same kind of basic information from all international shippers — including the name of the shipper, the name of the receiver and the contents of the package — that FedEx and other private shippers already require.