The first time Nicki Saccomanno used fentanyl, she overdosed.
It was 2016, and the 38-year-old from Kensington hadn't known that the drugs she'd bought had been cut with the deadly synthetic opioid. She just remembers injecting herself with a bag, and then waking up surrounded by paramedics frantically trying to revive her.
Saccomanno, who has been addicted to heroin for 10 years, was shaken. But, before long, there was barely anything else to take but fentanyl to stave off the intense pain of withdrawal. Every corner, it seemed, was selling it. Saccomanno and other longtime heroin users found themselves forced to adapt.
For younger users, like the twentysomethings who live in the camps off Lehigh Avenue, fentanyl is all they've ever known. Like others before them, many graduated from using legal painkillers to illicit opioids in the last few years — except when they turned to the streets to feed their addictions, they were buying a drug much more powerful than their older counterparts had started on.
Young and old are paying for it with their lives. Fentanyl was present in 84 percent of Philadelphia's 1,217 fatal overdoses last year, and in 67 percent of the state's 5,456 overdose deaths in 2017, according to a wide-ranging report on the state of the opioid crisis in Pennsylvania released this month by the U.S. Drug Enforcement Administration.
The report shows how, over the last five years, the opioid crisis ballooned into an overdose crisis — how fentanyl contaminated the state's heroin supply, overwhelmed county morgues with overdose victims, and shocked advocates, people in addiction, and law-enforcement officials alike with its sudden ubiquity.
But to all of them, the explosion of fentanyl makes a kind of terrible sense: Fentanyl is significantly cheaper to produce than heroin. It draws a significantly larger profit. It's significantly more powerful and more addictive than heroin, even Kensington's supply, which has long been known as the cheapest and purest in the country.
These days, Saccomanno uses a combination of heroin and fentanyl, even though she hates it.
"You get sicker," she said. "You need to get more fentanyl more often. It makes being able to get well and stay well even harder. But you can't find anything else."
‘A dramatic shift’
Pure economics.
That's what law-enforcement officials say is driving the rise of fentanyl in Pennsylvania.
It has legitimate use as a drug to treat serious pain, like that in cancer patients, and has been on the illicit drug market for at least 15 years, said Pat Trainor, spokesman for the Philadelphia branch of the DEA. But it mostly turned up in unusual overdose rashes and would disappear from the scene again.
"Two or three years ago, we really saw a pretty dramatic shift," Trainor said. "It was initially seen as a cut or an adulterant in low-quality heroin, and it's really shifted now that it's pretty much largely — but not completely — replaced most of the heroin supply in Philadelphia."
In Philadelphia, he said, a kilogram of heroin, or 2.2 pounds, sells for $50,000 to $80,000, and a drug trafficker can make about $500,000 in profit off it. A kilogram of fentanyl sells for $53,000 to $55,000, is 50 to 100 times stronger, and can turn a profit of up to $5 million.
"For a lot of drug-trafficking organizations, it's that simple," said Trainor.
Most of the fentanyl that ends up in Pennsylvania is manufactured in China and smuggled through Mexican drug-trafficking organizations into the United States along the same routes used to traffic heroin, according to the DEA report.
People have also tried to make it closer to home, however. Unlike heroin, which is derived from opium poppies, fentanyl and its analogues can be produced in a lab. Earlier this year, DEA agents raided what they thought was a methamphetamine lab in a hotel room in western Pennsylvania. To their surprise, it turned out that the room's occupant had been trying to make fentanyl.
Seeking out fentanyl
Earlier this year, researchers from the Philadelphia Department of Public Health, conducting a survey of opioid users at Kensington's needle exchange, posed a question to 400 people in active addiction.
They knew that most of the city's heroin supply had already been tainted with fentanyl, and wanted to know how people in addiction were reacting. And so they asked drug users what they would do if they knew that fentanyl was in the drugs they were buying.
The answers they received shocked them. Of the drug users the Health Department surveyed, 45 percent told researchers that they weren't trying to avoid fentanyl at all — that they would be more likely to use a bag of fentanyl.
"There was more acceptance — it had become part of the community in a way it hadn't been initially. It was actually something people were going for because it was an enhanced high," said Kendra Viner, manager of the department's Opioid Surveillance Program. "And people between 25 and 34 years old were significantly more likely to say they would seek out fentanyl."
by Aubrey Whelan, Philidelphia Inquirer | Read more:
Image: John Duchneskie
It was 2016, and the 38-year-old from Kensington hadn't known that the drugs she'd bought had been cut with the deadly synthetic opioid. She just remembers injecting herself with a bag, and then waking up surrounded by paramedics frantically trying to revive her.
Saccomanno, who has been addicted to heroin for 10 years, was shaken. But, before long, there was barely anything else to take but fentanyl to stave off the intense pain of withdrawal. Every corner, it seemed, was selling it. Saccomanno and other longtime heroin users found themselves forced to adapt.
For younger users, like the twentysomethings who live in the camps off Lehigh Avenue, fentanyl is all they've ever known. Like others before them, many graduated from using legal painkillers to illicit opioids in the last few years — except when they turned to the streets to feed their addictions, they were buying a drug much more powerful than their older counterparts had started on.Young and old are paying for it with their lives. Fentanyl was present in 84 percent of Philadelphia's 1,217 fatal overdoses last year, and in 67 percent of the state's 5,456 overdose deaths in 2017, according to a wide-ranging report on the state of the opioid crisis in Pennsylvania released this month by the U.S. Drug Enforcement Administration.
The report shows how, over the last five years, the opioid crisis ballooned into an overdose crisis — how fentanyl contaminated the state's heroin supply, overwhelmed county morgues with overdose victims, and shocked advocates, people in addiction, and law-enforcement officials alike with its sudden ubiquity.
But to all of them, the explosion of fentanyl makes a kind of terrible sense: Fentanyl is significantly cheaper to produce than heroin. It draws a significantly larger profit. It's significantly more powerful and more addictive than heroin, even Kensington's supply, which has long been known as the cheapest and purest in the country.
These days, Saccomanno uses a combination of heroin and fentanyl, even though she hates it.
"You get sicker," she said. "You need to get more fentanyl more often. It makes being able to get well and stay well even harder. But you can't find anything else."
‘A dramatic shift’
Pure economics.
That's what law-enforcement officials say is driving the rise of fentanyl in Pennsylvania.
It has legitimate use as a drug to treat serious pain, like that in cancer patients, and has been on the illicit drug market for at least 15 years, said Pat Trainor, spokesman for the Philadelphia branch of the DEA. But it mostly turned up in unusual overdose rashes and would disappear from the scene again.
"Two or three years ago, we really saw a pretty dramatic shift," Trainor said. "It was initially seen as a cut or an adulterant in low-quality heroin, and it's really shifted now that it's pretty much largely — but not completely — replaced most of the heroin supply in Philadelphia."
In Philadelphia, he said, a kilogram of heroin, or 2.2 pounds, sells for $50,000 to $80,000, and a drug trafficker can make about $500,000 in profit off it. A kilogram of fentanyl sells for $53,000 to $55,000, is 50 to 100 times stronger, and can turn a profit of up to $5 million.
"For a lot of drug-trafficking organizations, it's that simple," said Trainor.
Most of the fentanyl that ends up in Pennsylvania is manufactured in China and smuggled through Mexican drug-trafficking organizations into the United States along the same routes used to traffic heroin, according to the DEA report.
People have also tried to make it closer to home, however. Unlike heroin, which is derived from opium poppies, fentanyl and its analogues can be produced in a lab. Earlier this year, DEA agents raided what they thought was a methamphetamine lab in a hotel room in western Pennsylvania. To their surprise, it turned out that the room's occupant had been trying to make fentanyl.
Seeking out fentanyl
Earlier this year, researchers from the Philadelphia Department of Public Health, conducting a survey of opioid users at Kensington's needle exchange, posed a question to 400 people in active addiction.
They knew that most of the city's heroin supply had already been tainted with fentanyl, and wanted to know how people in addiction were reacting. And so they asked drug users what they would do if they knew that fentanyl was in the drugs they were buying.
The answers they received shocked them. Of the drug users the Health Department surveyed, 45 percent told researchers that they weren't trying to avoid fentanyl at all — that they would be more likely to use a bag of fentanyl.
"There was more acceptance — it had become part of the community in a way it hadn't been initially. It was actually something people were going for because it was an enhanced high," said Kendra Viner, manager of the department's Opioid Surveillance Program. "And people between 25 and 34 years old were significantly more likely to say they would seek out fentanyl."
by Aubrey Whelan, Philidelphia Inquirer | Read more:
Image: John Duchneskie
