Seven months ago, when Jake got out of jail in Phoenix, he expected to go back to using his drug of choice: heroin. But the street market for illegal opioids had changed.
"I just started smoking [fentanyl] pills because that was the thing that was around; it was so easy to get," he said. NPR is only using Jake's first name because he fears being arrested after talking openly about his addiction.
"Soon as I wake up, I have to have a pill," Jake said. "The high is not very long, so 20 minutes after I smoke a pill, I want to smoke another one, you know?"
He lives on the street and occasionally sleeps in motels. He has been addicted to opioids — first heroin and now street fentanyl — for six years.
Several times a day, he crushes an illegally manufactured fentanyl pill on a piece of tin foil, then cooks the powder with a flame, sucking in the fumes.
Recently, Jake pushed his bike along a tree-lined street, heading to buy his next dose for $5 or $10 a pill.
"I can walk through the motel and have at least three or four people tell me they got pills for sale," he said.
Much of the fentanyl reaching American street markets is still coming from mainland China, despite restrictions imposed by the Chinese government last year.
Working with new data collected by the Center for Advanced Defense Studies, an organization that receives funding from the U.S. government, NPR found Chinese companies have found ways to circumvent export bans.
Firms are marketing chemicals needed to make fentanyl on social media and working with drug cartels in Mexico.
Researchers also point to another devastating new development: Fentanyl is making swift inroads in the western U.S. where it used to be rare.
"It's killing too many people"
"Up through 2018, the vast majority of synthetic opioid overdoses occurred east of the Mississippi River," said Chelsea Shover, an epidemiologist at Stanford University.
People addicted to opioids in western states often use a different kind of heroin that doesn't mix easily with fentanyl powder. But while studying overdose deaths last year, Shover and other researchers found what they describe as a "fentanyl breakthrough" in the West.
The data showed fentanyl had begun killing far more people in cities such as Los Angeles, Seattle and Phoenix, including people with addiction who didn't know their drugs were contaminated.
"You think you're using heroin or you think you're using Ecstacy or Xanax or what looks like an Oxycontin pill, but it's actually fentanyl," Shover said.
The spike in fentanyl deaths in the West contributed to a record number of fatal overdoses last year, with roughly 72,000 Americans dead.
"It's just getting worse, and it's killing too many people," said Matthew Donahue, deputy chief of operations for the Drug Enforcement Administration.
Mexican cartels are middleman to Chinese chemical companies
It's Donahue's job to coordinate the international fight against smugglers bringing fentanyl into the U.S. He thinks there's a reason fentanyl is surging in the West.
Last year, responding to pressure from the Trump administration, the Chinese government cracked down on direct shipments of fentanyl to American buyers.
Chinese chemical companies quickly adapted by selling their product to "middle man" drug cartels in Mexico.
"They're sending precursor chemicals directly to cartels in Mexico to produce the fentanyl along with the fentanyl in pills," Donahue said.
Once they got into the fentanyl trade, 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 and easy to make and ship. It's also highly addictive, making it far more profitable than heroin or cocaine.
In Phoenix, the DEA and local police have made a series of massive fentanyl busts over the past year, seizing hundreds of thousands of pills.
But Sergio Armendariz, a street outreach worker with a program called the Phoenix Rescue Mission, says that hasn't done much to dent supply.
Homeless may be most vulnerable
Armendariz says people living in Phoenix's homeless camps, where addiction is common, offer a burgeoning market for Chinese and Mexican fentanyl.
"It's huge over there. Everyone's talking about the fentanyl on the street. When I come up to camps, you see the foils," he said.
His group and others are scrambling to adopt public health measures already widespread in Eastern cities.
That means educating people living with addiction that fentanyl is different, and more toxic, and handing out Narcan kits that can revive those suffering overdoses.
They're also distributing fentanyl test strips, so more people might avoid tainted drugs. But Armendariz says fentanyl is already so entrenched in Phoenix that many people deliberately seek it out.
"Knowing that it's very powerful? That's a driving force for people who are looking for that extreme high," he said.
Jake described his cravings for fentanyl as far worse than those he experienced with heroin. "It's just the high I really think about," he said.
He has already overdosed once on fentanyl but was revived. His fear of the sickness that comes with withdrawal soon had him searching out more pills.
"I think I'm careful enough, but I've had plenty of friends who've died who thought the same thing, so, I don't know," Jake said.
The DEA's Matt Donahue acknowledged street fentanyl is still flowing in large quantities into more parts of the U.S., but without interdiction efforts now underway far more people suffering addiction would be vulnerable.
"We get this statement all the time that we're losing the drug war," Donahue said. "What we're trying to do right is try to have China and Mexico control those four chemicals needed to produce fentanyl. It's not a perfect system but this is a global epidemic."
Data released last month by the Centers for Disease Control and Prevention suggest drug overdose deaths spiking to record levels again in the first months of 2020, with fentanyl largely to blame.
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. Transcript provided by NPR, Copyright NPR.