Debunking myths about the fentanyl crisis can help us address it

TThe bowling ball on my chest is always heaviest at 3 a.m. Its steady pressure jolts me awake most mornings before the sun rises on either coast. I could set my alarm for it, but I don't have to. Wherever I wake up – in hotel rooms, at friends' houses, or in the home I share with my husband – the bowling ball is there, in the pocket just between my ribs and just north of my stomach.

When weight wakes me up in the morning, there's never a good reason. Every day, I talk to friends, parents, loved ones and peer support workers who are facing yet another unspeakable tragedy. One in ten Americans has lost someone to an overdose, and that number is constantly rising.

An entire generation is dying out as if it had been wiped out by a plague whose name no one dares to mention.

There are no words for these losses – these deaths. What I felt at the beginning – the hot anger and outrage that fueled my advocacy, my push for bipartisan legislative solutions and the distribution of life-saving naloxone – has faded into a dull ache that sits in my body and never goes away.

It feels like sadness. Or maybe heartbreak.

There is no bad time to quit heroin, but I am sure I quit at exactly the right moment. In 2014, I was at the end of my chaotic drug use. After years of living on and off the streets, I was in a bad place.

I know that if I had continued using heroin, I would be dead today. Years after starting rehab, it takes more than my fingers and toes to count the number of people I know who have lost their lives to fentanyl. In recent years, that number has grown exponentially; it seems that fentanyl is in everything from cocaine to counterfeit prescription drugs to heroin bags. Fentanyl has no discernible taste, smell, or color. The only way to know if your substances are contaminated with it is to test them—how many people like me who live on the streets or want to party with their friends actually do that?

There are many misconceptions surrounding fentanyl. Some law enforcement agencies believe it is a weapon of mass destruction that kills indiscriminately, like poisons or anthrax. Every September and October, some TV anchors promptly tell viewers that drug dealers lace Halloween candy with it. Lay people have been advised not to pick up dollar bills lying on the ground because any bill could contain fentanyl and lead to an overdose. In 2017, a police department in Arkansas asked customers to wipe down their shopping carts because there could be fentanyl residue on the handle. A firefighter once told me he wouldn't perform CPR on an overdose because he could overdose himself if the victim's sweat got in his mouth.

This is all utter nonsense.

People believe such myths and urban legends because they are afraid. Maybe they have lost friends and loved ones to addiction and overdose and are grieving. Maybe it is simple ignorance. But the truth about fentanyl is scary enough without these fantasies and fairy tales. To prevent more people from dying, we need to be honest and say what we are dealing with.

Read more: We can prevent overdose deaths if we change our attitudes

That's why it's critical to understand the science and history of fentanyl. It was created by humans, and we're in the midst of an all-too-human crisis. It's up to us to do something. But first, we need to see the bigger picture.

Like many other drugs today, the story of fentanyl begins with a powerful pharmaceutical company. In 1959, an ambitious chemist named Dr. Paul Janssen first synthesized the painkiller fentanyl while tinkering with the chemical structure of morphine. He was only 33 years old and working in a laboratory provided to him by his father, a well-known family doctor in Belgium. In this small laboratory with just a few scientists, Janssen discovered a drug that would change the world.

Unlike morphine, an opioid derived from the sap of poppy plants, fentanyl is completely synthetic and made in a laboratory. This means that fentanyl production does not require farmers, fields of delicate flower crops, or a perfect growing climate. All it takes to produce tons and tons of fentanyl is a chemist, a laboratory, and the right precursors (the chemicals used in the reaction that creates fentanyl).

The manufacturing of fentanyl is of great importance when it comes to understanding how this drug is so widely used and available today. If you have seen news about fentanyl, you have probably heard how dangerous and potent it is. Fentanyl is at least 100 times more potent than morphine. While drugs like morphine are measured in milligrams, fentanyl doses are measured in micrograms.

Until Janssen's invention, the world had never seen such an effective opioid. The development of synthetic opioids represented rapid progress in medicine. It revolutionized surgery.

But its legacy is complicated. Like all opioids, fentanyl has a good side and a dark side. The drug has relieved pain and suffering for millions of people and has become a staple of modern medicine, but it has also caused profound pain and suffering. A life-saving drug in hospitals can simultaneously be a life-threatening drug on the street.

That's why fentanyl is called “good medicine and bad drug.” Something so potent couldn't be safely isolated for medical use for long. In 2013, for example, there were about 3,000 fentanyl-related overdose deaths nationwide. By 2018, that number had risen to more than 28,000—a nearly tenfold increase in just five years. During that time, experts also said the official death toll was likely significantly underestimated because, as medical toxicologist and addiction medicine specialist Dr. Ryan Marino told me, so few coroners and medical examiners even knew to test for fentanyl during autopsies. Even more problematic, the CDC misclassified many illicit fentanyl deaths as being caused by prescription opioids, causing the policy response to miss its mark by a wide margin.

By 2022, the annual death toll rose to over 71,000, accounting for the majority of the more than 111,000 total overdose deaths that year. The synthetic opioid has completely replaced OxyContin and heroin.

Read more: Insights into the worst opioid addiction crisis in US history

This is the story of neighborhoods like Kensington in Philadelphia, where heroin has long been the drug of choice. In 2018 New York Times The magazine called Kensington the “Walmart of heroin.” The article painted a depressing and chaotic picture of the neighborhood: On a rainy day, drug users trying to stay dry shot up drugs in public under a Kensington Avenue underpass and nodded off on rain-slicked sidewalks. But by 2018, fentanyl was already making its way into the heroin supply. Four years later, Kensington is devoid of heroin—it's almost entirely fentanyl. There was no shortage of drug arrests in the area, but somehow the situation just kept getting worse.

It's as if the dealers and users are symptoms, not the disease. “There's a real sense of desperation,” says Jonathan Caulkins, a drug policy researcher at Carnegie Mellon University in Pennsylvania. Caulkins has studied drug markets for decades and says there has never been a crisis as deadly as the one America is currently in. “The scale of the deaths is ridiculous. And people are grasping at straws.”

Caulkins earned his PhD in operations research from the Massachusetts Institute of Technology in 1990, where he learned to analyze complex systems and networks. He explained to me that America's illegal drug supply is one of the most complex and opaque systems in the world. Illegal drugs are a multibillion-dollar industry, a vast underground market dominated by secret networks of criminal organizations.

Legend has it that there is so much drug money flowing around the world that the American financial system was largely kept afloat during the 2008 financial crash by hundreds of billions of dollars from illegal drug sales. In 2019, Caulkins co-authored a study that found that Americans spend nearly $150 billion on cannabis, cocaine, heroin and methamphetamine in just one year. That's $7 billion less than what we spend on alcohol.

Caulkins is often asked to advise government agencies on these complex issues. What does he say to local and federal officials who are wondering what on earth can be done to save lives?

He said: “When I talk to people, I usually say, 'This doesn't work so well, and that doesn't work so well.' And they say, 'Okay, Professor Caulkins, you know-it-all, what should we do?'”

His answer is depressing. “I'm deeply pessimistic about the people who are suffering from opioid use disorder right now and are buying illicit opioids,” he said bluntly. “I think even if we do everything right, a lot of people are still going to die. It's a terrible situation that we don't really have a solution for.”

Caulkins told me that uncontrolled and untraceable fentanyl was a problem without a solution. He said, “The genie came out of the bottle.”

Still, I must not give up hope that we are not doomed. There must be a way out. Faith alone is not enough to save our nation and ourselves. It takes drive, determination, and courage. It takes people you can rely on, people who will cheer you up when you question whether it is worth going on. Because if we do not stand together, we will not only lose the “war on drugs.” We will lose the people we love most, and we will lose ground to the rising tide of overdoses.

If you or someone you know may be suffering from For substance abuse or mental health issues, call or text 988. In emergencies, call 911 or contact a local hospital or mental health service.

Reprint of FENTANYL NATION: TOXIC POLITICS AND AMERICA’S FAILED WAR ON DRUGS by Ryan Hampton, published on September 24, 2024 by St. Martin's Press, a division of Macmillan. Copyright (c) 2024 by Ryan Hampton.