Every five minutes in this country, someone dies from fentanyl poisoning. Last July, my 23-year-old son Henry was one of them.
A student at the University of Colorado, Henry had returned home from Boulder hoping to catch up on sleep and heal a nagging rib injury from a snowboarding accident. We had a wonderful week of dinners with family and friends. Just before going to bed on his last night alive, after playing with two young cousins for hours, Henry told me he wanted to be well rested for our next day’s outing.
The following morning, I found Henry draped over his desk as if sleeping, his head resting near the keyboard of his open computer. Later, we found texts on his phone from a dealer he’d found on Craigslist. It was clear that Henry thought he was buying another drug, not something containing a lethal dose of the most powerful, non-natural opioid ever synthesized. So, I will always think of his death as a fentanyl murder.
I have been digging into the facts of the fentanyl crisis to understand the explosive increase in fentanyl deaths. It’s a topic I never wanted to know about and one to which I am now obsessively and tearfully drawn. It is clear to me that the already staggering death rate from fentanyl will accelerate. My math suggests — and I hope I am wrong — that by the end of 2023, fentanyl will become the third-largest killer nationally, behind cancer and heart disease and ahead of accidents and the fading menace of COVID. The CDC reported that, in 2021, more than 100,000 people died from drug overdoses, 70,000 of which were fentanyl poisoning. The numbers about fentanyl are shocking, and they are also out of date and misleadingly low.
Fentanyl is rarely a stand-alone drug. It adds potency to other drugs and increases the potential for addiction. A synthetic drug like fentanyl can be produced for a fraction of the cost of a cultivated product, and the makeshift labs that produce it can be broken down and quickly moved to evade law enforcement.
A hundred times more potent than heroin, fentanyl is the most lethal drug ever to hit America’s streets — and it is everywhere, claiming lives in every socioeconomic group and demographic. Despite this, I have heard from many people who think they are immune to the fentanyl scourge and that it will naturally fade. “It is a bad business model to kill customers,” they say. A naive and callous comment, it also reveals a shaky grasp of the economics of the drug trade. Fentanyl is low cost, highly addictive, and easy to press into a myriad of prescription lookalikes. The cartels know it’s a perfect storm for financial opportunity.
At the same time, social media has super-charged fentanyl’s reach. “There are literally hundreds (if not thousands) of platforms that allow users of all walks of life to connect, and drug dealers are attuned to all of them,” the American Addiction Centers warned last September in its Guide to Drugs on Social Media. (See also Social Media, Fentanyl and Illegal Drug Sales, a terrifying March 2023 report on the topic from the Colorado attorney general’s office.) Those platforms include everything from Facebook, Snapchat, and eBay to LGBTQ dating apps.
The dealers elude sophisticated filters designed to flag prohibited drug content by using common emojis — snowflakes, diamonds, hearts — and words as innocuous as “reds,” “blues,” “bars,” “lemonade,” “pasta,” “ice water,” and “butter” to signal to buyers in-the-know what they are selling.
Narcotics officers have told me that 85 to 90 percent of all illegal drugs contain fentanyl. The list of affected street offerings goes beyond opioids; fentanyl is found in amphetamines, methamphetamines, benzodiazepines, hallucinogens, and even marijuana. Worse still, 60 percent of all pills containing fentanyl have lethal doses, according to an analysis by the Drug Enforcement Administration cited by the United States Attorney in Manhattan, where 50,000 multicolored pills were seized last month.
We face a daunting crisis, but we are not powerless. Here are just a few things that we can do.
1. Make Narcan, also known generically by its drug name, naloxone, as ubiquitous as fentanyl. Just this week, the FDA approved naloxone hydrochloride nasal spray for over-the-counter, non-prescription use. Narcan attaches to the opioid receptors and reverses fentanyl’s lethal suppression of respiration. It is already widely used to save lives in certain states by hospitals, EMTs, and police forces, and some communities dispense it for free. The next hurdles will be to determine a price point for the 4 mg OTC dosage and a timeline for its availability on the market. Let us hope that the manufacturer prioritizes affordability in setting the drug’s price, because Narcan should be in every home medicine cabinet, school nurse’s office, and homeless shelter, and on every college campus, in every public-facing business’s first aid kit, and beyond.
2. Make fentanyl test strips, with which a user can test a drug for fentanyl before taking it, available for free and without judgment. These inexpensive, non-prescription paper slips work with a high degree of accuracy in water. Last November, the American Medical Association came out in support of increased distribution of the test strips, which are available on Amazon, but are only explicitly legal in 22 states and expressly branded as illegal drug paraphernalia in many states. If they’re banned where you live, write to your elected officials and clamor for a change in the law. Teach your loved ones how to use them.
3. Start drug awareness education early. Talk to your kids. Children as young as middle schoolers are dying from fentanyl poisoning. It’s not enough to teach drug avoidance. If a child ingests fentanyl, intervention must happen within minutes to save that child’s life.
Even in our large extended family, Henry was one of a kind — funny, smart with high emotional intelligence, handsome, and athletic, but also humble, disciplined, and self-directed. Unable to continue playing football because of serious injuries in high school and following surgeries that first introduced him to opioid painkillers, Henry redirected his energy to hiking and the outdoors. He made the most of his COVID isolation, teaching himself guitar and piano and climbing the 46 high peaks of the Adirondacks several times, including all 46 peaks during a 17-day period of subzero weather. But he also grappled with perfectionism and anxiety, unable to show himself the generous compassion and kind patience he extended to the rest of us. Before his death, Henry was studying philosophy and psychology, where, amid the Colorado mountains and wilderness, he had found peace and purpose.
While Henry was alive, I wish I had known what I know now about fentanyl. Just maybe I could have shifted his timeline enough that he would be alive today. I couldn’t do that for him, but I know that Henry would have wanted me to try to help others. I miss him endlessly.
Peter Zurkow was a lawyer and investment banker and has spent most of the last decade involved with plastics recycling.