Of 69 fatal overdose victims last year, 68% had taken the synthetic opioid, which Mexican cartels have learned to make and smuggle to interstate highways. The drug ‘is what is killing our citizens,’ says Manchester’s police chief

Officer Shaun McKennedy’s first overdose call comes in at 6.39pm. He turns the sirens on and rushes over to 245 Laurel street, a midsize apartment building. There’s an abandoned baby carriage in the front yard. A man wearing a Bride of Chucky shirt peeps out of his doorway as McKennedy, 24, rushes upstairs.

Several men from the local fire department and EMT department are already there, hovering around the seemingly lifeless body of a 31-year-old man on the living room floor in a soaking wet T-shirt and jeans. It’s a situation McKennedy, 24, has been through dozens of times since he joined the force last July.

Q&A Why is there an opioid crisis in America? Show Hide Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes

“Larry! Larry! Stay with us!” yells Justin Chase, a Manchester EMT medic. He injects naloxone, a medication that reverses the effects of opioids, up Larry’s nose.

His body shakes and his eyes pop open. “What’s up?” he asks, without blinking.

Larry agrees to go to the emergency room at Elliot hospital, but it will be several weeks before test results determine exactly what led to his overdose. It’s the first time he’s done that, he tells McKennedy later that night. Usually he injects between two and three grams of heroin a day; that evening he only took 0.2 grams, or a “pencil”. He’s not sure if he overdosed because he lost his tolerance – he says he’s been clean for just over two months – or if it was laced with fentanyl.

According to the Drug Enforcement Administration, fentanyl is a synthetic opioid 100 times more powerful than morphine, and 30-50 times more powerful than heroin.

“Fentanyl is what is killing our citizens,” said Manchester’s chief of police, Nick Willard, in testimony before Congress last week.

In 2013, the city of Manchester had 14 fatal overdoses, one of which (7%) involved a victim with fentanyl in their system, according to Willard. In 2015, 69 people fatally overdosed, 68% of whom had taken fentanyl.

The state statistics are no more cheery. Officials at the office of the chief medical examiner in New Hampshire say they have yet to receive testing results from 36 suspected overdoses, but they’ve counted 399 fatal overdose victims so far, more than two-thirds of whom died with fentanyl in their system.

“It’s not like Mario Batali,” said Willard from his office in Manchester, comparing heroin dealers cutting their supply with the famed chef. “These guys are just throwing it in a mixer. You could get a bag that’s perfect and no one is going to die from it. You could also get a bag [that’s] straight fentanyl and that would kill you.”

Willard said that during a recent raid in Manchester, he found a dealer mixing fentanyl with whey protein. In another sting that led to a seizure in Lawrence, Massachusetts, the dealer was allegedly mixing heroin and fentanyl in a kitchen blender.

For the most part, said Willard, the story of opiate use in Manchester follows the same patterns as the rest of the country. The crisis was ushered in by the rise of prescription painkillers like OxyContin. Addicts looking for a cheaper high frequently turned to the more dangerous, yet significantly cheaper, heroin.

The turning point, he says, happened sometime after 2010, when Purdue Pharma altered the medication to make it more difficult to tamper with and get high. Suppliers in Mexico were quick to keep up with the burgeoning market, and addicts in Manchester, which sits near Interstate 93, Route 3, Route 81, and Route 9, had no problem tapping into the supply.

Facebook Twitter Pinterest Fentanyl ‘is what is killing our citizens’, says Manchester’s police chief. Photograph: Alamy

To make matters worse for Manchester, DEA agent Tim Desmond says intelligence indicates that Mexican cartels, specifically El Chapo’s Sinaloa cartel, have increased poppy production 50% since last year and have been targeting the north-east.

Fentanyl was first developed in the 1960s as a general anesthetic, and it is still regularly administered by doctors, usually in the form of lozenges and patches, frequently for cancer patients.

Addicts have found ways to abuse the prescription forms of the drug, by sucking on the patches, for example. But more recently, Mexican cartels have learned how to make their own fentanyl by importing the necessary chemicals from China, then smuggling the product across the border and on to the interstate highway system, said Desmond.

The United States has had fentanyl problems before. Between 2005 and 2007, more than 1,000 people died from the drug, mostly in the midwest. According to a press release from the DEA, all of those deaths could be traced to a single lab in Mexico. Once the DEA shut down the lab, the fentanyl epidemic stopped too.

This time around, the DEA has not yet targeted a single lab in Mexico responsible for the epidemic in New England, said Desmond. Instead, federal agents and local police are targeting area dealers. “Sometimes we have to start at the bottom of the food chain in order to go up the ladder,” he said.

In Manchester, Willard is working to exterminate the epidemic from the ground up. When he became chief in the summer of last year, he turned over his drug unit, and ordered detectives to arrest dealers quickly to get them off the street, rather than wait to build a more thorough case or work up the supply line.

He’s also worked to build a state and federal taskforce, called Granite Hammer, which began last September; so far, he says, the unit has made 77 arrests. He has also called for an increase in state support for recovery clinics.

McKennedy responded to two more overdose calls that night. First was a man in his late 20s named Mark, who passed out in a laundromat with one needle in his arm and one full, and ready to go. Mark was less willing to accompany the EMTs to the hospital.

“Do you want to die?” asked Chase.

“Who the fuck would want to live in this life?” Mark’s statement, said Chase, is suicidal ideation, which means that the EMTs are required to take him to the hospital anyways. At the hospital, Mark asked McKennedy for his heroin back.

The next call was for a woman in her early 30s. Dawn Marie overdosed at a friend’s apartment. It took two doses of naloxone to revive her. Her friend has two children. They practiced spelling out the alphabet on a coloring book in a room next door.

Other officers responded to a fourth overdose call while McKennedy helped EMTs attend to an addict who tried to take his own life with a kitchen knife. He recognized McKennedy from a previous overdose. “Another day in paradise,” he said as the officer walked through the door.

In a moment of calm, McKennedy assisted Officer Mark Aquino with a traffic stop. Aquino is a drug recognition expert. It’s getting more difficult to recognize addicts, he said. Heroin is easy to detect, the user’s pupils get small and pin-like. “Fentanyl doesn’t restrict pupils,” he said. “They nod instead,” he explained, dropping his chin to his chest.

At 10.30, McKennedy returned to the department to fill out paperwork accounting for the calls. Another “consistent” shift in Manchester, he concluded. “Nothing out of the ordinary.”