ARI SHAPIRO, HOST:
The synthetic opioid fentanyl is killing a lot more people in Western states like Arizona and California, where it used to be rare. Mexican drug cartels are mixing street fentanyl into all kinds of drugs, including cocaine and meth, and that's led to thousands more Americans overdosing and dying. NPR addiction correspondent Brian Mann went to Phoenix for our story.
BRIAN MANN, BYLINE: When Jake got out of jail seven months ago, he expected to go back to using heroin, his drug of choice. But he found the street market for illegal drugs in Phoenix had changed.
JAKE: I just started, you know, smoking pills because that was the thing that was around here. It was so easy to get pills.
MANN: He's talking about street fentanyl, the incredibly powerful and deadly synthetic opioid. When I meet him, he's wearing a ball cap and a backpack, pushing his bicycle on his way to buy more.
JAKE: As soon as I wake up, I have to have a pill. And the high is not very long. So, I mean, 20 minutes after I smoke a pill, I want to smoke another one, you know?
MANN: Several times a day, he crushes an illegally manufactured fentanyl pill on a piece of foil, then cooks the powder with a flame, sucking in the fumes. NPR is only using Jake's first name because he fears being arrested for speaking openly about his drug use. He's in his late 20s, lives on the streets and in motels in Phoenix. I ask him how hard it'll be to find his next dose.
JAKE: It's extremely easy. Like, I could walk through the motel and have at least, you know, three or four people tell me they got pills for sale.
MANN: Researchers say what Jake's experiencing is part of a devastating new development in America's opioid epidemic. Chelsea Shover is an epidemiologist at Stanford University.
CHELSEA SHOVER: After 2018, the vast majority of synthetic opioid overdoses occurred east of the Mississippi River.
MANN: Fentanyl didn't catch on in the West in part because people addicted to opioids in those states tend to use a different kind of heroin, one that doesn't mix easily with fentanyl powder. But while studying overdose deaths, Shover found what she describes as a fentanyl breakthrough in the West. Starting last year, fentanyl began killing far more people in cities like LA, San Francisco, Seattle and Phoenix. She says fentanyl is in everything now.
SHOVER: You think you're using heroin, or you think you're using ecstasy or Xanax or what looks like an OxyContin pill, but it's actually fentanyl.
MANN: The spike in fentanyl deaths in the West contributed to a record number of fatal overdoses last year. Roughly 72,000 Americans died.
MATT DONAHUE: It's just getting worse, and it's just killing too many people.
MANN: Matt Donahue heads the U.S. Drug Enforcement Administration's overseas operations. It's his job to fight smugglers bringing fentanyl into the U.S. He thinks there's one major reason fentanyl is surging in the West. Last year, under pressure from the Trump administration, the Chinese government cracked down on direct shipments of fentanyl to the U.S., so Chinese companies adapted. They started doing business with middlemen, with drug traffickers in Mexico.
DONAHUE: Sending the precursor chemicals directly to cartels in Mexico to produce the fentanyl along with fentanyl and pills.
MANN: Once they got into the fentanyl trade, Donahue says, Mexican cartels used their existing drug routes and street markets in Western cities to push the new product. Their motives are simple. Fentanyl is deadly, but it's also cheap, easy to make and highly addictive, making it far more profitable than heroin or cocaine.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED REPORTER: Phoenix police announcing a major bust, seizing nearly 170,000 fentanyl pills from someone's car.
MANN: The DEA and local police have responded, making a series of massive fentanyl seizures in Phoenix this year. But Sergio Armendariz, a street outreach worker for a program called the Phoenix Rescue Mission, says that hasn't done much to dent supply. He worries the city's homeless camps offer a vulnerable and still mostly untapped market.
SERGIO ARMENDARIZ: Everyone's talking about the fentanyl on the street. When I come up to camps, you see the foils.
MANN: His group and others are scrambling to adopt the public health response already widespread in eastern cities. That means educating people with addiction that fentanyl is different, more toxic, while handing out Narcan kits that can revive people suffering overdoses. Despite the dangers, Armendariz says some people addicted to opioids are turning to fentanyl as their new drug of choice.
ARMENDARIZ: Knowing that it's very powerful, that that's a driving force for people who are just looking for that extreme high.
MANN: That's Jake's story. He says he understands the danger, but the pull of fentanyl is just too strong.
JAKE: It's just the high I really think about.
MANN: He already overdosed once on fentanyl last summer but was revived. I ask if he thinks he'll survive this new, deadlier addiction.
JAKE: I think that I'm careful enough to, you know? But I've had plenty of friends that have died of that same thing, you know? So I don't know.
MANN: So now Western states, too, face an escalating fentanyl crisis. Researchers and law enforcement tell NPR if street fentanyl continues to spread without more treatment and a better, more coordinated public health response, the U.S. will see another record number of overdose deaths this year.
Brian Mann, NPR News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.