Death by Fentanyl

Last chances in the second city

Last year, Chicago hospitals reported 74 narcotics overdoses in 72 hours. On the city's notorious “Heroin Highway,” addicts and activists showed Fusion how fentanyl is taking over the black market — and their lives.

By Peter Moskowitz and the Fusion Investigative Team

There’s no census question that asks about opioid or heroin use. So to get a sense of Chicago’s problem, some stand-in stats must be used.

There’s the heroin overdose deaths in Cook County in 2014: 432, down from 461 the year prior, but up by 100 from 10 years ago, and nearly double the rate 10 years before that, according to unadulterated data a state worker shared with me. There’s the number of overdoses from fentanyl – the powerful opioid sometimes prescribed for extreme pain, and increasingly manufactured in street labs in Mexico with components from China: 59 last year alone.

But those stats only get you so far. Overdose deaths are no longer a great proxy for opioid use thanks to naloxone (aka Narcan), a drug that blocks opioids from attaching to receptors in the brain, and which revives heading-toward-death overdose patients within minutes.

So here’s one more stat: The Chicago Recovery Alliance, the biggest drug-harm-reduction group in the city, gave out about 3 million syringes last year, along with 10,000 vials of naloxone (three vials per person, max) last month. In 2014, just by asking drug users who’d come to the group’s trucks and treatment centers, Alliance staff heard of 5,767 overdoses reversed with naloxone. In other words, while overdose deaths are holding relatively steady, there’s an insane amount of heroin and opioid use going on each day in Chicagoland.

The rates of opioid abuse mean that when something new – a synthetic like fentanyl, or a particularly strong batch of dope – enters the system in Chicago, its effects can spread rapidly, causing dozens or even hundreds of ODs in a short period of time.

This is happening everywhere in America, not just Chicago. It’s especially bad in New England, where Fusion reporters met a detective who has seen up to nine overdoses in a single shift, a fire chief whose department is saving far more people from overdoses than fires, and a mother who has lost two of her three sons to the epidemic.

“You can't get just heroin without any trace or touch of fentanyl in it,” David Harak, a recovering fentanyl addict in Boston, said. “Around here, it's almost in everything.”

But New Hampshire has an early presidential primary, and a media spotlight to address its issues. The Heroin Highway here in Chicago seems forgotten. Treatment programs are lacking, budgets for places like the Chicago Recovery Alliance are strained, and law enforcement’s whack-a-mole approach to drug enforcement as ineffective as ever.

As one former heroin, oxycontin and fentanyl user told me, “It’s really bad right now. It’s worse than it’s ever been. It’s crazytown.”

She felt great. “I was so damn high, I couldn't keep my mind straight. So I started telling people about it.”

A few months ago, local news outlets reported that 74 people had overdosed in 72 hours on a batch of heroin laced with illegally manufactured fentanyl, imported from abroad. That estimate is likely a vast undercount: It doesn’t include anyone who was revived with naloxone on the streets by another drug user. Those people likely didn’t end up in the hospital. It’s unclear how many died.

A woman I’ll call Laura was one of those undocumented overdoses. She doesn’t want her name used because she fears she’ll be killed by drug dealers for speaking out about fentanyl. I meet her in a McDonald’s on the north side of the city. She’s 40-something and Hispanic, a Chicago native with a lot of trauma in her past.

She orders a chicken sandwich and a large pop before telling me that the past few months had scared her so much that she’d moved out of the city completely, to a suburb about an hour away, where she can stay disconnected from her old group of using friends – and keep purposefully ignorant of where drug dealers deal.

Laura, I was told by a prominent harm reduction advocate, is a “connector.” People know her. She helps those looking for dope find it; she helps those looking for naloxone and clean needles to get them. So when fentanyl-laced heroin hit Chicago’s streets back in September, Laura helped spread it around the city.

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I was told over and over again in Chicago that there’s a perverse market logic to providing heroin users with fentanyl and extra-strong heroin: the more people who OD, the better people will think the heroin is. Word spreads fast, and before you know it, you have people lining up to try the super-strength stuff.

Back in late September, Laura heard about a batch of dope on the West Side that was causing people to “fall out” (aka pass out).

“What's crazy about us dope fiends is that when we figure out someone fell out, the first thing's like, "Hey, where'd they get that at?’” Laura said.

At that point, Laura didn’t know the heroin was laced with fentanyl. She said she wouldn’t have bought it if she did. But other drug users told me it wouldn’t have mattered: People ODing is a sign you might be able to get really high off $5 of heroin, which is a luxury, no matter what the stuff is cut with.

The first time Laura shot the fentanyl-laced dope, she took just half a bag, half her usual amount. She immediately knew something was different. Her eyes wouldn’t stay open. Her legs were wobbly. She felt great. “I was so damn high, I couldn't keep my mind straight,” she said. “So I started telling people about it.”

The second time she did it, a few days later, she was at a friend’s house on the west side of the city. Her friend was asleep. Laura went into the bathroom, left the door unlocked in case she overdosed, and cooked up a bag. The last thing she remembers is shooting the dope. She woke up sometime later – maybe an hour – on the tiled floor.

The third time she shot was the last time. She was with a friend, a man of about 40. They were in an abandoned house in the northwest of the city. He’d bought the same dope as her.

Her friend shot first, and as Laura pushed the needle into her arm she saw his eyes roll into the back of his head. She knew something was wrong. She woke up half an hour later with blood dripping from her forehead – apparently she’d fallen hard on the concrete floor. She looked over and saw her friend lying there. His eyes were still rolled back in his head. He was foaming at the mouth.

Laura remembered the vials of naloxone and clean needles she always keeps in her knapsack. She’d been given them by Kathleen Kane-Willis, the director of the Illinois Consortium on Drug Policy and a researcher at Roosevelt University. So Laura dumped everything out of her bag and called Kane-Willis over and over until she picked up. Kane-Willis walked Laura through the procedure: Fill up a syringe with 1 cc of naloxone and inject it into a muscle.

Laura pushed the needle into her friend’s thigh, pushed the plunger down – first slow and then all at once. It seemed like it was working: He sat straight up.

If this was normal heroin, that would have been the end of it. But Laura’s friend fell back down again.

“He wasn’t foaming at the mouth, but he wanted to get up and couldn’t,” Laura says. “He kept picking his head back up and laying back down, hitting his head on the floor.”

She hit him with another cc of naloxone and he jumped to his feet, disoriented and yelling, asking Laura what the fuck had just happened.

“Well, I had to give you a shot of Narcan,” she explained. “It was for some bad dope. It must have had fentanyl in it… You were as good as dead.”

“You knew it had fentanyl in it this entire time?” the man asked Laura.

"No, sweetie,” she told her friend. “If I did that on purpose, I might as well leave a suicide note.”

Laura saw two other people OD on the stuff before she decided to tell Kane-Willis about the house where she’d bought the dope. A few days later, police arrested two dealers in connection with fentanyl-laced heroin. Asked about the case, the Chicago Police Department declined to comment.

“We overestimated the safety of opiates. We prescribed a lot of them and there have been a lot of deaths as a result.”

Fentanyl is a particularly scary opioid because of its strength: It’s 50 times more powerful than heroin. That makes it much more economical to smuggle across borders or in the mail – it’s easier to get a small brick of fentanyl past customs than a huge cooler of heroin.

The fentanyl responsible for the last rash of overdoses likely came from China, and was probably purchased via Silk Road or a similar darknet site, according to Dennis Wichern, who directs the Drug Enforcement Administration’s operations in the five-state region surrounding Chicago.

It’s easy to screw up a batch of dope with the illicit stuff.

“In any bag of heroin there’s x amount of heroin and x amount of other shit,” Kane-Willis tells me. “It’s not so much about the fentanyl as about making sure the potency of the opiate isn’t vastly different day-to-day. But when somebody makes a mistake, it doesn’t usually mean going from, say, 10 percent potency to 80 percent potency. Fentanyl can do that.”

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But, Kane-Willis says, fentanyl isn’t really the problem. It’s a problem, but not the problem. The problem is that thanks to the overprescribing of related painkillers like fentanyl, Vicodin and OxyContin, more people than ever are hooked on opioids, and there are more opportunities than ever to get the wrong cut from some random dealer. One in 15 people who take a nonmedical prescription pain reliever will try heroin within 10 years, according to the National Institute on Drug Abuse.

The scope of the problem became clear to Dr. Trevonne Thompson, an emergency room doctor and medical toxicologist at the University of Illinois Hospital, in 2006, the last time there was a big fentanyl outbreak in Chicago. The hospital was so overloaded by overdose patients that it ran out of naloxone. Doctors had to resort to intubating patients while they waited for more antidote to come in.

“We overestimated the safety of opiates,” Thompson tells me. “We prescribed a lot of them and there have been a lot of deaths as a result.”

The opioid epidemic in Chicago now crosses all class and racial lines. Heroin treatments have doubled and tripled in many suburbs in the last five years, according to a Roosevelt University study. Of all arrestees in Cook County, which encompasses Chicago and several suburbs, nearly 20 percent tested positive for opioids in that period. Nationally, about 16 percent of people who enter drug treatment enter for heroin. In Chicago, it’s double that.

But treatment is lacking: Illinois lost 52 percent of its treatment capacity over the last five years, according to the same study. The state has the third-lowest treatment capacity in the country, above just Tennessee and Texas.

“Everyone will be rushing to that spot, because they want that good dope.”

I take a trip to a far-west-side stop with one of the Chicago Recovery Alliance’s silver trucks. It looks like the ice cream man got into the heroin trade: packed to the brim with clean needles, naloxone kits, condoms, and other gear to help people live safe lives. The back of the truck is used as a little office for people who want to check their Hepatitis and HIV status. The outside is emblazoned with the group’s slogan: “Any Positive Change.” Most of the people who work on the trucks are former drug users. They just want people to be safer.

The group is run by Dan Bigg, a big, convivial guy who jokes with most of the users who knock on the truck’s door before getting to the serious business of making sure they have enough naloxone, clean needles, alcohol pads, and cookers (so they don’t have to use a dirty spoon) for the coming week. People are always encouraged to take more for friends.

The latest fentanyl rush in the city has ebbed, but it could always come back, Bigg says. I meet one user who tells me he always smells his heroin before he snorts it to make sure it’s not cut with something funny. I meet another who pulls up the pant leg of his jeans to show me open sores from what he says is injecting heroin that’s been cut with something bad, probably fentanyl. (Dan Bigg says it’s likely he just missed a vein.) The same user tells me that when you cook up fentanyl-laced heroin, it burns purple, something I’d heard from several addicts. The last time he got a bag of it, he squirted it on the ground. Better to waste dope than end up dead.

Dan Bigg tells me there’s a split: Some users stay away from the stuff; others seek it out, looking to get right up to the line of ODing for a better high. He said he worried that as law enforcement cracks down further on heroin, fentanyl and other super-strength synthetics will become even more popular, and the opioid trade will become more deadly.

Ryan (he didn’t want his last name used), a 28-year-old who has been using heroin for 10 years, says he’d gotten the fentanyl-laced stuff back in October by accident, but liked it anyway.

“It maximized my nod,” he says. “I was standing like I was in the Matrix.”

Behind Ryan is Laroy. He’s 36, handsome and boyish, white (which is unusual for this neighborhood) and dressed in oversized clothes. He carries a huge backpack. Laroy, like Laura, is a connector – he knows dozens of users and seems good at convincing them to use more safely. As such, the three CRA workers treat him like a celebrity: “Are you sure you have enough Narcan? Here take a whole box of needles. Take two!”

After five minutes on the truck, his backpack is stuffed to the brim with syringes – about 1,000 of them, each wrapped in white plastic, each headed to the arm of someone on Chicago’s west side. Laroy says it’ll take him a week to use some and distribute the rest.

Laroy tells me he accidentally shot a bag of fentanyl-laced dope in October. It was fine, he said, a warmer rush than his normal dope. But his friend OD’d from the same batch and died.

Laroy is not too worried about it at this point – word on the street is that there’s no more fentanyl floating around the distribution system. That’s probably not true; as Kane-Willis said, the cut is probably just less deadly for now. And that could always change.

“When it comes back, word of mouth will spread fast,” Laroy says. “Everyone will be rushing to that spot, because they want that good dope.”