In the midst of the ongoing opioid epidemic, the drug in the spotlight has shifted. The main cause of death is no longer prescription painkillers, but fentanyl, often mixed with heroin or another street drug.
Jefferson County is no different, and has experienced an increase in fentanyl use and overdoses this year, according to Stephen A. Jennings, public health planner at Jefferson County Public Health Services.
In 2018, there have been 13 overdose deaths in the county, eight of which were caused by fentanyl or a fentanyl synthetic.
Compared with the past two years, though, the total number of overdoses has decreased. In 2016 — the highest year for overdoses from data starting in 2000 — there were 23 overdoses, 16 from opiates, of which seven were from heroin and nine from fentanyl. By 2017, the number of total overdoses decreased slightly to 18, with 12 from opiates, zero from heroin and two from fentanyl.
Nearly 29,000 people died last year in the United States from overdoses linked to synthetic opioids, a category that experts say is dominated by fentanyl and its chemical cousins — a staggering surge from the 3,100 such deaths reported in 2013.
One reason for the increase: The drug is so powerful that a sugar-packet-sized bag of it can contain 500 lethal doses. That also means it can be smuggled through the mail in what officials call micro-shipments, which are far harder to identify and interdict than bulkier loads of heroin, cocaine or marijuana.
Chinese companies send fentanyl in small quantities to dealers in the United States or Canada, but ship the drugs in bulk to criminal cartels in Mexico. The cartels then mix the synthetics into heroin and other substances, or press them into counterfeit pills. The product is then smuggled across the border.
While total fentanyl seizures more than doubled last year, to 1,196 pounds, officials say far more of the illicit drug is getting through. Some of the biggest fentanyl busts have been in California because of the Mexican connection.
In September, for example, U.S. Customs and Border Protection agents seized 52 pounds of powdered fentanyl at the Pine Valley checkpoint near San Diego — and that wasn’t a record. In December, officers discovered nearly 80 pounds in a college student’s car.
This summer, authorities discovered 20,000 fentanyl pills in a hidden compartment of a Mini Cooper at the San Ysidro checkpoint — a week after confiscating 11,500 pills in another vehicle.
U.S. drug dealers also purchase directly from China with a few clicks of a computer mouse on company websites or in so-called dark web drug bazaars, where communications are encrypted and dealers often pay with cryptocurrencies or gift cards that are difficult to trace.
Mr. Jennings said the ongoing decrease in overdoses could be related to Jefferson County’s efforts in building capacity and infrastructure to help residents affected by the opiate crisis. Even with the victory of fewer prescription opiate deaths, it has led those dependent on the drugs to the streets for their fix.
“Many states have tightened regulations on the amount of opioids physicians can prescribe, which has in part led to the increased use of heroin, and more recently fentanyl,” Mr. Jennings said. “If someone addicted to prescription narcotics suddenly can’t get them through their provider and a pharmacy, many individuals turn to heroin.”
Fentanyl is also a lot trickier to target, according to Kristyna S. Mills, head of the Metro-Jefferson Drug Task Force. Most people who are getting high on fentanyl don’t even realize it until it’s too late because it is typically marketed as another drug, she said.
“People aren’t selling it as fentanyl; they are labeling it as heroin. It’s not until we get lab reports back after overdoses that we realize it was laced with fentanyl,” Ms. Mills said.
Anita K. Seefried-Brown, project director of the Alliance for Better Communities, said that in addition to the troubles of targeting fentanyl, there is a lack of continuity with what constitutes a spike in overdoses.
“Is it one death, is it two? Is it more altogether?” Ms. Seefried-Brown said.
To help with this, Jefferson and St. Lawrence counties are High Intensity Drug Trafficking Areas, a drug-prohibition enforcement program run by the U.S. Office of National Drug Control Policy. Within this is an Overdose Detection Mapping Application Program that was introduced earlier this year to help collect pertinent information about where overdoses are occurring.
Ms. Seefried-Brown said the north country counties are in the earlier phases of implementing this program.
“When the police come to a scene, they would enter the data of whether the overdose was fatal or nonfatal, how many doses of medications they administered on the scene, etc.” Ms. Seefried-Brown said. “All that would go into a central database, which over time could be extremely helpful in having more policing in that area or having Narcan readily available.”
It isn’t hard to find fentanyl and similar drugs on the internet, and sales tactics rival those of online retailers, according to federal investigators.
“A simple Google search of ‘fentanyl for sale’ returned a number of potential sellers,” a Senate Homeland Security Committee report released in January said.
It said investigators, “posing as a first-time fentanyl purchaser,” had contacted six online sellers overseas, and each offered to ship purchases to the United States — sometimes with aggressive salesmanship.
The sellers “actively negotiated … to complete a deal by offering flash sales on certain illicit opioids and discounted prices for bulk purchases,” the report said. When investigators “failed to immediately respond to an offer, the online sellers proactively followed up, sometimes offering deeper discounts to entice a sale.”
Fentanyl was developed decades ago as an ultra-powerful painkiller — 100 times more potent than morphine — for use in surgery. It is still used to help hospice-level cancer patients.
Drug dealers began dabbling in the drug in the mid-2000s, but it surged in popularity in 2014 and 2015 because it was easy to obtain and hugely profitable.
A $1,500 kilogram can bring $1.5 million in profits after the drug is cut and sold on the street, according to the DEA.