The new wave of homemade synthetic drugs spreading across the U.S. and worsening the fentanyl crisis

The new wave of homemade synthetic drugs spreading across the US and worsening the fentanyl crisis - Author, Quentin Sommerville - Author Title, International Correspondent, BBC News - Reported from, Columbus, Ohio - Publication Date - Reading Time: 12 min Warning: This story contains descriptions of drug use from the beginning and refers to suicide. A few grains of fentanyl rest on aluminum foil as Mike holds a straw between his lips, which rests on them and warms them with a lighter underneath. The 48-year-old army veteran is crouched in an alley in the Linden neighborhood of Columbus, Ohio, United States. "This drug practically makes you do anything, unfortunately," he comments. The dose being smoked cost three or four dollars. "If you inhale too much, there's no turning back. It's like a shot. You can't pull the bullet back," he says. He burns the aluminum foil and inhales. As the opioid takes effect, he clings to the fence behind him. He sways as a moan bubbles up from the depths of his throat; he might be humming a melody. We have spent a few days with Mike; he has guided us through the alleys of the neighborhood. Everyone seems to know him and cares for him a lot. He works at pawn shops and local gas stations, and that is how he finances his opioid addiction, which he has had for 20 years. Synthetic opioids are more potent and abundant, and they have transformed the drug landscape. Fentanyl, which is completely synthetic, is 50 to 100 times more potent than heroin, which is obtained from opium poppy. It is currently often mixed with other synthetic tranquilizers, which makes it difficult to revive overdose victims. It is a homemade threat, as cocktails of these substances can be manufactured in basements and bathtubs in the United States. We carry naloxone (brand name Narcan) in our pockets, in case any member of our team comes into contact with fentanyl or if someone around us suffers an overdose. It is a nasal aerosol that immediately reverses opioid overdoses and its widespread use has transformed the number of fatal overdoses in the United States. At its peak in 2022, 110,000 Americans died from overdoses, mainly from opioids. Since then, the number has been decreasing, down to about 70,000 last year. But that does not mean the opioid crisis is over. The medication in our pockets, which has saved the lives of tens of thousands of drug addicts, probably would not have worked for Mike. Because he was not just smoking fentanyl. The pupils of his bluish-gray eyes constrict into small dots. "Opioids make the pupils constrict, but not that much," he says with a sigh. Even with fentanyl, which is already dangerous on its own, other synthetic substances are added. When we ask him what he thinks has been added to his drugs, he replies: "With xylazine and that we can't pronounce." He is referring to medetomidine. Like xylazine, it is also known as tranquilizers for animals, and both are synthetic tranquilizers for animals. "Large animal tranquilizers," an expert in rehabilitation told me. They help prolong the effect of fentanyl, but they are sedatives that slow down breathing, and importantly, naloxone does not counteract them. Xylazine also causes necrotic skin ulcers, wounds so deep they can reach the bone and are difficult to treat. A Rehabilitation Group That Offers Hope In the Glenwood church, across town, the members of the Hope Dealer Community (Hope Dealers Community), a rehabilitation group, meet weekly. For many, their struggles are reflected in their pain-marked faces, and their eyes belong to those who have survived great trauma. They go up to the stage in front of the church and share their stories with brutal and brave honesty. One man recounts his overdose in July 2022. Two paramedics attended him, trying to save his life. They administered naloxone intravenously into both arms. They applied the opioid antidote three times, without success. "That's it, I'll leave it here," one of the paramedics said. But the other insisted on trying one more time, and that is what saved his life. As the crowd cheers him on, Tonya goes to the lectern. She recounts how her nephew died from an overdose while she herself was suffering from a simultaneous overdose of crack, a stimulant adulterated with fentanyl, a synthetic opioid. "It's not luck. I should be here," she reiterates with tears in her eyes. The audience shouts in approval. Both in Columbus and later in Chicago, we have heard talk of crack users who died from overdoses after their drugs contained fentanyl. On the street, it is called "hot dose." "In the last 12 months in Franklin County (in Columbus), 78% of fatal overdoses are due to stimulants," explains Scott Sanders, 65, who leads the Hope Dealers. Scott has been sober for almost ten years; he is a stout man of about 60 years with overwhelming energy. When he asks those present to raise their hands if anyone has suffered an overdose, most do. "The crisis has simply changed," Scott tells me afterward. "The tragedy is that stimulant users who buy crack believe that's what they are consuming, but it isn't so. They are consuming crack mixed with fentanyl or other opioid cocktails and suffering an overdose without realizing it." He adds that deaths from overdoses among Black men in Ohio are increasing. His organization collaborates with the Centers for Disease Control and Prevention (CDC) in a drug testing program. Participants bring their needles or pipes for testing, which are sent to the CDC laboratory in North Carolina. This is how we learned that Mike's instincts were correct; he was probably not just smoking fentanyl. One of the drug testing kits he brought tested positive for medetomidine. "The drug supply in 2026 is the next: we believe we buy crack, but it isn't so; we buy several different substances," Scott states. "Today, the drug is mixed, not just adulterated, but mixed with other drugs like fentanyl or methamphetamine, and then with other chemical adulterants made in basements." And it was the synthetic drugs made in basements that caused a drastic increase in overdose deaths in the neighboring state of Illinois. I met a trafficker in Chicago who works for Mexican cartels selling fentanyl. He only agreed to talk to us if we promised to hide his identity. When questioned about his role in the 50,000 annual deaths caused by the opioid crisis, he claims he knows it's wrong. But when asked why he continues to do it, he replies that the end justifies the means. He told me that despite the latest efforts by the US government to contain the cartels by declaring them terrorist groups and labeling fentanyl as a weapon of mass destruction, their supply chain remains as solid as ever. When I ask if the Trump administration's pursuit of vessels with suspected traffickers has had any effect, he replies that their product still arrives from Mexico. "If it doesn't go over the wall, it goes under. If it doesn't cross the border, it enters through the border from above (the north). This game is about adaptability." And when I asked what had changed in his business, his answer was clear. "The synthetic (drugs). We haven't seen yet... what synthetics are capable of. It's not even the tip of the iceberg," he states. A New Method The largest prison in Chicago, and one of the largest in the United States, is Cook County Jail. Traditional drugs used to be introduced into the prison hidden in body cavities, so the prison had the same scanners found at airports to prevent this from happening. "In 2023, we suddenly saw a drastic increase in overdose deaths, but in parallel, we saw papers everywhere, around the people who had died or been revived," explains Sheriff Tom Dart, who runs the prison. "We saw burned papers and all this was completely new." The center, which records an average of one or two overdose deaths per year, lost eight inmates that year due to fatal seizures. Security footage shows inmates convulsing and collapsing. It also shows them setting papers on fire in microwave ovens in the cell block kitchens. As Dart rightly said, it was a new method. Drugs were sent by mail to the prison soaked in pages from books and letters. "It was cannabinoids and a variety of other impregnated substances that they would later light and inhale to get high," the sheriff explained. Cannabinoids, also known as K2, are a completely synthetic version of an extract from the cannabis plant. They are extremely dangerous and were responsible for the fatal seizures. In August, I accompanied Dart's prison guards as they prepared for a dawn raid in the maximum-security block D of the prison. About twenty agents walked carefully and spoke in low voices as they gathered in front of the block door. "Don't let them hear. Silence, silence," one of the agents leading the search ordered. As the agents enter in a hurry, I smell burned paper in the air and hear the sound of the toilet cisterns, presumably while they quickly dispose of contraband. As the search progresses, attention focuses on any documents found in the cells: the books and letters belonging to the inmates. The detainees are escorted to a waiting area while the cells are inspected. The officers examine every piece of paper in the rooms. There are burn marks on the ventilation grates of many cells, where inmates place burning matches to set the soaked paper on fire. Now, every postal shipment entering the prison is scanned to detect moisture. Between a quarter and a fifth of all packages and letters test positive and are rejected. Outside the prison walls, it is not difficult to perceive the effects of the synthetic drug wave in the streets of Chicago. In the west of the city, day and night, men and women hunch over, swaying, as Mike did, as fentanyl and other synthetic drugs invade them. In the exclusive Oak Park neighborhood, the local subway station has a vending machine that dispenses free naloxone. Nearby, a gaunt man in a wheelchair with deep wounds on his legs is being attended to. Karen Bell, 40, is treating him. Karen works as a rehabilitation assistant in the Liv4Lali group. A former heroin user, she has been drug-free for 17 years. She radiates kindness, and when I ask her about the drugs currently being used, she says: "Many things are being mixed right now. And it's affecting our bodies, whether it's the wounds, withdrawal symptoms, and sometimes the wounds can become so severe that they transform lives." Her organization, like Hope Dealers in Columbus, distributes reaction strips that allow detecting the presence of fentanyl, medetomidine, xylazine, and other adulterants in drugs. According to Karen, drugs are now "much more dangerous." "Because before, in my time, I stopped using heroin 17 years ago, you know? That was still heroin. When you bought it, you knew it was heroin. But now, when you buy a bag, you don't really know what it is," she tells me. Dart has been sheriff of Cook County for 20 years, so I ask him how the war on drugs is going. "I don't think there is anyone involved who can say it's a resounding success. It isn't," he replies to me. And the new problem, he says, repeating the words of the Chicago drug trafficker, are the synthetic drugs. "Traditionally, law enforcement has always played an even more crucial role, as everything potent crossed the border, whether from Colombia, Mexico, China, or the opium fields of Afghanistan. Now, with the explosion of synthetic drugs, people can produce them at home, in the sink, in the bathtub, wherever." Victory in the war on drugs will not be achieved by focusing solely on supply, adds the sheriff. "Comprehensive treatment for drug addiction is essential," he states, mentioning several rehabilitation programs carried out in his prison. "The market can be reduced if the problems of drug addiction for people are addressed. And I know many people who, after long struggles, have come out positively." Women Are Struggling Karen knows how difficult it is to quit drugs. She still used to use heroin when she was pregnant with her daughter, Abby, who is now 17. After our meeting at the subway station, she meets me in a rural park on the outskirts of Chicago. With her usual caution, Karen warns me to be careful with poison ivy while we walk along a muddy trail. Not far from here, about 17 years ago, she hit rock bottom. As the wind blows between a tall oak tree next to us, she says: "The day I discovered I was pregnant, I was about to commit suicide. I was tired of trying to stop using drugs. I was tired of living in a tent in the woods, using a bucket. I was tired of losing my friends and family because I was so ashamed." A pregnancy test changed her mind. Then, she spent some time in the Cook County jail for theft. Her parents, seeing an opportunity for her to rehabilitate, refused to pay bail. So Karen rehabilitated and Abby was born in prison. When I ask Abby, who wants to be a tattoo artist, if she has ever felt the temptation to experiment with drugs, she replies: "No, I've seen how much they have affected my family, my father, my mother, killing my aunt, my uncles. You know, it's not worth using drugs just for a couple of hours." She continues: "Many people are in trouble, especially because prices are rising in our country, rising food prices, and that is what is causing the situation. Many mental health treatments are now very expensive, so people cannot access help, and one way they can seek it is through drugs." Generations of Americans have suffered the drug crisis, but it is never the same. It has evolved from heroin, through prescription opioids and fentanyl, to a new range of synthetic substances. Successive governments have waged -and lost- the war on drugs. Traffickers, suppliers, cartels, and consumers adapt, always one step ahead of the efforts to stop them. Additional Information from Darren Conway This article was originally written in English and we used an artificial intelligence tool to translate it. A BBC journalist reviewed the text before its publication. More information on how we use AI. - Download the new BBC World Service app. Choose BBC News Mundo and receive news, documentaries, and analysis alerts, all in one place. Important: the new application is not available in the UK or the United States. - You can also follow us on YouTube, Instagram, TikTok, Facebook, X, and our WhatsApp channel. - And don't forget to subscribe here to our newsletter to receive a special selection of our best content every Friday.