Why The Latest Fentanyl Surge Is Hitting Some Communities Harder Than Others

The powerful opioid fentanyl is cheap to produce and can yield hefty profits. It is now replacing or being added to heroin, cocaine and even meth — and the overdose death rate is soaring.

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As the powerful opioid fentanyl replaces heroin in much of the country, deaths have soared. A recent report from the Centers for Disease Control and Prevention tells us who has been hardest hit by the fentanyl surge and where. From member station WBUR, reporter Martha Bebinger dives into why.

MARTHA BEBINGER, BYLINE: Overdose deaths are spiking as tiny crystals of fentanyl show up in bags of what used to be just heroin along the Eastern Seaboard of the U.S. and into the upper Midwest. There are dozens of types of fentanyl, each can be 25 to 50 times more powerful than heroin. That's one reason fatal overdoses doubled every year from 2013 to 2016, according to the CDC. Ricky Blumenthal with the University of Southern California offers another - drug users who have taken fentanyl find they have to inject it more often than heroin.

RICKY BLUTHENTHAL: Because while fentanyl is more potent, it doesn't last as long. People begin experiencing opiate withdrawal more rapidly, and so every time you use more drug, you have a chance of overdosing.

BEBINGER: Shorter highs, increased demand and sales - that's one reason investigators say dealers began making the switch. Fentanyl is also less expensive to produce than heroin, which comes from the seed of a poppy flower. David Kelley is a federal drug investigator for New England.

BLUTHENTHAL: Heroin requires greater care and, you know, raising poppies and, you know, has cycles throughout the year, where fentanyl can be produced in a laboratory.

BEBINGER: And since fentanyl is so strong, small amounts turn hefty profits. The Drug Enforcement Administration says one kilo of fentanyl purchased in China for $5,000 can be divided 20 or more times and packaged with cheap fillers to bring in $1.5 million. Jon DeLena is with the DEA.

JON DELENA: I mean, imagine that business model. There's a tremendous windfall in there, so it's an easy solution for them.

BEBINGER: DeLena says dealers used New England as the test market for this business model back in 2013.

DELENA: They started floating samples of it up into the region and, you know, for us especially, you know, on that northern side of Massachusetts. That's where those original test loads of fentanyl ended up.

BEBINGER: While fentanyl swept down the Eastern Seaboard to Virginia and across the upper Midwest to Minnesota, it was barely present in the South, Southwest and Western states. Bluthenthal has a theory as to why.

BLUTHENTHAL: One thing that is true is that the powdered heroin that's more widely available east of the Mississippi is easier to contaminate with fentanyl than black tar heroin, which is mostly available to the west of the Mississippi.

BEBINGER: The overdose risk now goes beyond heroin users. Fentanyl is increasingly found without warning in cocaine and meth. The risk of overdose is rising faster for blacks and Latinos than whites. Young people aged 25 to 34 appear especially vulnerable, and men are dying at nearly three times the rate of women. That may be because men tend to use alone, while women use with partners and are more likely to seek help, says Traci Green, an epidemiologist at Boston Medical Center.

TRACI GREEN: Women go to the doctor more. We have health issues that take us to the doctor more, so we have more opportunities for help.

BEBINGER: Green says one solution is more outreach to men and minority groups, more places where they will find compassionate care and an opening to treatment. For NPR News, I'm Martha Bebinger in Boston.

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COLEMAN: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

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