Every year in the United States, more than 100,000 people die from drug overdoses. Of that horrifying total almost two-thirds – 64,000 – are killed by fentanyl, a powerful synthetic opioid that is 50 times more potent than heroin and 100 times stronger than morphine. Fentanyl is now by far the leading cause of death for Americans aged 18-45, killing as many each year as Covid, car accidents and suicide combined. The overdose rate is highest in Black and Indigenous Americans, and has risen most rapidly among young people. Huge numbers of these deaths go unreported, but a handful make national headlines. Just last month, NFL linebacker Jaylon Ferguson was found dead from the combined effects of cocaine and fentanyl. He was 26.
Many of those who die from fentanyl overdoses have no idea they’ve even taken it. The substance has been found in counterfeit pills that purport to be prescription medications including Oxycodone, Percocet and Xanax. It has also found its way into street drugs such as cocaine, meth and heroin, which means even longtime users may be unprepared for their potency. After the death of The Wire actor Michael K Williams last September from a combination of cocaine, heroin and fentanyl, his nephew Dominic Dupont made it clear that Williams “would not have knowingly taken fentanyl”, stating: “I know that like I know my first name.”
The dangers are so serious that in April the Drug Enforcement Administration (DEA) sent a letter to federal, state and local law enforcement bodies warning of a nationwide spike in fentanyl-related mass-overdose events. These types of events, defined as three or more overdoses occurring around the same time in the same location, had taken place in seven American cities stretching from Colorado to Florida. “Already this year, numerous mass-overdose events have resulted in dozens of overdoses and deaths,” said DEA administrator Anne Milgram. “Drug traffickers are driving addiction, and increasing their profits, by mixing fentanyl with other illicit drugs.”
This interpretation – that dealers add fentanyl to other illicit drugs in order to cut costs and hook users – is disputed by experts. Morgan Godvin, the founder of Beats Overdose, a harm reduction charity based in Portland, Oregon, has lost people close to her from overdosing. “My friend died last March of a fentanyl overdose after doing cocaine,” she says. “This is real, but when people say that dealers are bulking out cocaine that’s very ignorant because that’s just not how the business works. It’s not logical for dealers to add fentanyl to their cocaine. They don’t want to kill their customers, that’s bad business, and people who are doing uppers don’t want downers. It’s actually about cross-contamination, when people are selling fentanyl and cocaine simultaneously and they get mixed up.”
Dr Ryan Marino, a medical toxicologist and addiction medicine specialist at University Hospitals Cleveland Medical Centre, concurs with this explanation. “It seems for the most part to be about accidental contamination rather than anything malicious,” he says. “Because fentanyl is so potent, even trace amounts can be a problem. If there had been cross-contamination of other drugs in years past it maybe wasn’t as much of a problem and that’s why we didn’t see [a similar increase in overdoses]. It does seem to be a more contemporary phenomenon. I don’t really remember anything like this before.”