Chris McGreal - Pills that kill: why are thousands dying from fentanyl abuse?
The epidemic
of addiction to prescription opioid painkillers, a largely American crisis,
sprung from the power of big pharmaceutical companies to influence medical
policy… The ingredients for fentanyl, on the other hand, are openly available
in China and easily imported ready for manufacture. The drug was originally
concocted in Belgium in 1960, developed as an anaesthetic. It is so much more
powerful than heroin that only small quantities are needed to reach the same
high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA)
has said that 1kg of heroin earns a return of around $50,000. A kilo of
fentanyl brings in $1m.
Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.” The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.
“I had to remove him
from life support. That’s the hardest thing to ever do. I had him at 15 so we
grew together. He was 28 when he died,” she said. “I had to let him die but
after that I needed some answers. What is fentanyl and how did he get it?” That was a question
asked across Sacramento
after Jerome and 52 other people in and around California’s capital overdosed on
the extremely powerful synthetic opioid, usually only used by hospitals to
treat patients in the later stages of cancer, over a few days in late March and
early April 2016. Twelve died.
Less than a month
later, this mysterious drug – largely unheard of by most Americans – killed
the musician Prince and burst on to the national consciousness.
Fentanyl, it turned out, was the latest and most disturbing twist in the
epidemic of opioid addiction that has crept across the United States over the
past two decades, claiming close to 200,000 lives. But Prince, like almost all
fentanyl’s victims, probably never even knew he was taking the drug.
“The number of people
overdosing is staggering,” said Lieutenant Tracy Morris, commander of special
investigations who manages the narcotics task force in Orange County, which has
seen a flood of the drug across the Mexican border. “It is truly scary. They
don’t even know what they’re taking.”
The epidemic
of addiction to prescription opioid painkillers, a largely American crisis,
sprung from the power of big pharmaceutical companies to influence medical
policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most
powerful prescription painkiller yet sold over the pharmacist’s counter. Even
though it was several times stronger than anything else on the market, and bore
a close relation to heroin, Purdue claimed that OxyContin was
not addictive and was safe to treat even relatively minor pain. That turned out
not to be true.
It spawned an epidemic
that in the US claims more lives than guns, cutting across class, race and
geographic lines as it ravages communities from white rural Appalachia and
Mormon Utah to black and Latino neighbourhoods of southern California. The
prescription of OxyContin and other painkillers with the same active drug,
oxycodone, became so widespread that entire families were hooked. Labourers who
wrenched a back at work, teenagers with a sports injury, just about anyone who
said they were in pain was put on oxycodone. The famous names who ended up as
addicts show how indiscriminate the drug’s reach was; everyone from politician
John McCain’s wife Cindy to Eminem became addicted.
Clinics staffed by
unscrupulous doctors, known as “pill mills”, sprung up churning out
prescriptions for cash payments. They made millions of dollars a year. By the
time the epidemic finally started to get public and political attention, more
than two million Americans were addicted to opioid painkillers. Those who
finally managed to shake off the drug often did so only at the cost of jobs,
relationships and homes.
After the government
finally began to curb painkiller prescriptions, making it more difficult for
addicts to find the pills and forcing up black market prices, Mexican drug
cartels stepped in to flood
the US with the real thing – heroin – in quantities not seen since the 1970s.
But, as profitable as the resurgence of heroin is to the cartels, it is labour
intensive and time-consuming to grow and harvest poppies. Then there are the
risks of smuggling bulky quantities of the drug into the US.
The ingredients for
fentanyl, on the other hand, are openly available in China and easily imported
ready for manufacture. The drug was originally concocted in Belgium in 1960,
developed as an anaesthetic. It is so much more powerful than heroin that only
small quantities are needed to reach the same high. That has meant easy profits
for the cartels. The Drug Enforcement
Administration (DEA) has said that 1kg of heroin earns a return of
around $50,000. A kilo of fentanyl brings in $1m.
At first the cartels
laced the fentanyl into heroin to increase the potency of low-quality supplies.
But prescription opioid painkillers command a premium because they are trusted
and have become increasingly difficult to find on the black market. So cartels
moved into pressing counterfeit tablets.
But making pills with
a drug like fentanyl is a fairly exact science. A few grammes too much can
kill. “It’s very lethal in very small doses,” said Morris. “Even as little as
0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could
barely see it. It’s about the size of the head of a pin. Potentially that could
kill you.”
The authorities liken
buying black market pills to playing Russian roulette. “These pills sold on the
street, nobody knows what’s in them and nobody knows how strong they are,” said
Barbara Carreno of the DEA. After Prince died,
investigators found pills labelled as prescription hydrocodone, but made of
fentanyl, in his home, suggesting he bought them on the black market. The
police concluded he died from a fatal mix of the opioid and benzodiazepine
pills, a particularly dangerous combination.
It is likely Prince did not even know he was taking fentanyl. Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.
It is likely Prince did not even know he was taking fentanyl. Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.
Jerome Butler, a
former driver for Budweiser beer who was training to be a security guard,
thought he was taking a prescription pill called Norco. His mother’s voice
breaks as she recounts what she knows of her son’s last hours. Natasha said she
was aware he used cannabis, but had no idea he was hooked on opioid
painkillers. She said her son at one time had a legitimate prescription and may
have become addicted that way. She has since discovered he was paying a doctor,
well known for freely prescribing opioids, to provide pills.
“I didn’t even know,”
she said. “You find stuff out after. It’s killing me because they’re saying,
‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was
doing what?’” Jerome may have had a
prescription, but like many addicts he will have needed more and more. The pill
that killed him was stamped M367, a marking used on Norco pills made of an
opioid, hydrocodone. It was a fake with a high dosage of fentanyl. “If Jerome had known
it was fentanyl he would never have took that,” said Natasha. “This ain’t like
crack or a recreational drug that people been doing for so many years and
survived it but at 60 or 70 die from a drug overdose because their heart can’t
take it no more. This is fentanyl. The first time you take it you’re not coming
back. You’re gone.”
That wasn’t strictly
true of the batch that hit Sacramento. It claimed 11 other lives. The youngest
victim was 18-year-old George Berry from El Dorado Hills, a mostly white
upscale neighbourhood. The eldest was 59. But others survived. Some were saved
by quick reactions; doctors were able to hit them with an antidote before lasting
damage was done. Others swallowed only enough fentanyl to leave them seriously
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