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The fentanyl epidemic is more than a crisis. It’s a massacre.

Opioid overdoses are the leading cause of death for Americans aged 18 to 45. Fentanyl leads the charge. Where is our outrage?

In this Oct. 22, 2018 file photo, a fentanyl user holds a needle near Kensington and Cambria in Philadelphia. Suicides and drug overdoses helped lead a surge in U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.David Maialetti/Associated Press

A darkness bleeds across New England and the nation, killing daily, indiscriminately, stealthily. We call it the fentanyl epidemic, but those who have been affected by it know it to be a massacre.

My friend C had an understanding of the addictive mind like no other person I have met. She was brilliant, her intuition razor sharp. She was 42 and the mother of a young child. We were teasing out new treatment models for women in January 2022, when fentanyl claimed her. Now, we’ve lost all she might have contributed.

My friend J was 24. She was a new soul, dreams fresh and bright. She hadn’t seen much of the world outside of New England and planned to hopscotch the globe: Paris, Athens, Tokyo. A ground-crew job at a major airline offered the perk of discounted travel. Her quick mind was an ideas factory, neurons firing at full throttle as she plotted her next move. Could she travel and be an investigative news reporter? I assured her she could. I assured her that anything was possible.

In December, I found J dead in the sober living apartment I shared with her and two other women. A pinch of fentanyl, the bag still beside her, ended everything that could have been.


Opioid overdoses are the leading cause of death for Americans aged 18 to 45. Fentanyl leads the charge. On average, the drug is 50 to 100 times more potent than morphine.

Eight to 10 years into the fentanyl crisis, deaths continue to soar. There were 106,700 overdose fatalities in the United States in 2021, a 15 percent increase from 2020. About 71,000 of those deaths involved synthetic opioids, overwhelmingly fentanyl. New Hampshire had its worst year in 2022 with 473 drug overdose deaths, 368 involving fentanyl. Opioid-related deaths in Massachusetts increased 9.4 percent in 2021 for a total of 2,301; fentanyl was present in 93 percent of cases.


In Maine, where J died, about 570 of the record-breaking 716 overdoses in 2022 “are attributable to highly lethal non-pharmaceutical fentanyl,” says a statement from Governor Janet Mills. In Rhode Island, of 435 deaths reported in 2021 – a new record high – 70 percent were attributable to fentanyl.

To understand the scope of the fentanyl crisis, compare the 71,000 who died in 2021 to other death statistics: In 2021, 43,600 people died of breast cancer in the US. About 43,000 died in traffic accidents.

There remains a difficult-to-dispel stigma attached to fentanyl-related deaths. They are often written off as hardcore drug addicts, people living in the margins who have had more than enough chances to clean up their acts.

But those who are dying are people working their way through recovery, who relapse, as many people with substance-use disorder do. They are people with brilliant ideas to contribute, lost. They are babies who are being poisoned, children who don’t know the dangers of the drugs they decide to try.

Right now, the government estimates 44 million people aged 12 and older need substance use treatment. But less than seven percent received it in this era of mass death. Where is our outrage?

In the early 1990s, AIDS activists stood outside city halls, federal buildings and the Centers for Disease Control, enduring arrests and brutality for years. Many who showed up were near death from the virus. Activists did not stop until they got seats at the table. That’s when research for a cure really got cooking. That’s when the stigma began to ebb.


There is an anti-fentanyl movement percolating, but it remains largely at the “raising awareness” stage. To be fair, the specter of activism is daunting with so many fronts to cover: local and federal law enforcement, treatment, criminal justice. With the crisis so thoroughly bungled, it’s hard to know where to start.

A bright spot is the increased availability of Naloxone, an opioid antagonist that can quickly reverse an overdose. It has become widely available without a prescription through pharmacies and free community programs. It saves a lot of lives.

But there’s a catch. Naloxone must be administered quickly – and usually by someone else. At 100 times the potency of heroin, fentanyl kills fast. The lifesaving window is usually minutes long. And if you’re alone when you overdose, it doesn’t matter how well Naloxone works.

When you are in recovery and you relapse, shame and hopelessness can make isolation and despair seem like reasonable alternatives to facing the problem. At memorial services, exhaustion and resignation fill the rooms, and words meant to comfort instead sanitize the violence of these deaths.

An overdose brutalizes the body. When I found J in our shared apartment, her limbs were frozen mid-bend, blood vessels burst open from knees to head. Since 2017, I have watched my community lose dozens of people under age 50. Activists, sober house owners, community organizers, scholars, athletes – all of these are among the horribly, violently dead.


But if we are to survive this crisis, despair is not an option we can afford.

Tamara Kerrill Field is a freelance journalist living in Portland, Maine.