AUDIE CORNISH, HOST:
Three-quarters of overdose deaths in Massachusetts this year have involved fentanyl. It's an opioid up to 50 times more powerful than heroin. It can be prescribed legally. And despite law enforcement's efforts, it's becoming a lot more common on the streets. WBUR's Martha Bebinger reports.
MARTHA BEBINGER, BYLINE: The latest chart of overdose deaths in Massachusetts shows a climbing blue line labeled fentanyl. Pick a spot on that line in mid-August, and picture a big, affable 40-year-old man named Joe Salemi. He died at his mom's home in working-class Everett after almost 25 years of heroin use. Salemi had OD'd before. His brother, Anthony Salemi, says he was pretty sure at the time that something besides heroin killed Joe.
ANTHONY SALEMI: I knew deep in my mind it was going to be the stuff that everybody's talking about now - fentanyl. Because I never thought straight heroin would kill him.
BEBINGER: People like Joe rarely know for sure what's in the tiny plastic bags of powder they buy. Just a few grains of fentanyl is enough to kill most users. Salemi says the medical examiner's office confirmed his suspicion - Joe overdosed on fentanyl.
SALEMI: No matter how many cops you put at the border, it keeps coming in. This is scary.
BEBINGER: U.S. agencies say they are doing a lot, but reducing the supply is complicated. Fentanyl is a synthetic opioid made from chemicals, unlike heroin from poppies. Drug enforcement agents say clandestine labs across China are the main source of the drug. It's shipped to Mexico, where it's mixed into heroin or pressed into tablets. The powder or pills are delivered to dealers or directly to users via the internet. Kara McDonald is with the U.S. State Department.
KARA MCDONALD: Synthetic drugs are a real winner - right? - because they're easy to make. They're cheap to produce. They're not dependent on a season or weather like the plant-based drugs. And they can be delivered directly to the door, in some cases, like a pizza.
BEBINGER: Dealers start with a kilo of fentanyl - which costs $3,000 to $4,000 - says Russ Baer, a spokesperson for the Drug Enforcement Administration.
RUSS BAER: Drug traffickers involved in wholesale distribution of those products can yield close to $1.5 million off that one kilogram.
BEBINGER: Baer says the DEA has six agents based in Beijing who work with China's Ministry of Public Security. The Chinese restricted 160 new chemicals last year, including 19 types of fentanyl, which Baer says helped reduce supply.
BAER: But once we control a substance, the drug manufacturers simply tweak a molecule in an attempt to circumvent the law.
BEBINGER: Keeping up seems nearly impossible.
BAER: We're identifying one to two new synthetic substances every week.
MCDONALD: It's a little bit of a game of whack-a-mole.
BEBINGER: McDonald at the State Department is working country-by-country to make sure each new drug is illegal. The U.S. is also asking the UN to ban two key ingredients of fentanyl. But U.S. Senator Ed Markey of Massachusetts says that's not enough. It's time to make these opioids the top policy issue with China and Mexico.
ED MARKEY: Far many more people are going to die from this than any threat from nuclear weapons or any devastation that's caused by an imbalance in trade.
BEBINGER: Baer at the DEA says tackling demand by addressing addiction as a disease is just as important as curbing the supply of fentanyl.
BAER: The community needs to embrace these folks, create treatment opportunities. It represents a public health crisis that all of us must work together to try to resolve.
BEBINGER: Statistics show 80 Americans will die today of an overdose. Another 580 will try heroin or what they think is heroin for the first time. For NPR News, I'm Martha Bebinger in Boston.
CORNISH: This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.
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