The death toll from fentanyl and other synthetic opioids is falling for the first time since the drugs began flooding America’s streets a decade ago. Users and police in this city’s beaten-down Hilltop neighborhood credit another drug flooding the United States: the overdose antidote naloxone.
James “Sleaze” Morgan says naloxone has saved him after overdosing – as many as 20 times in the last several years.
The lifesaving nasal-spray medicine is everywhere in the 10 or more Hilltop “trap” houses where users come to buy and take fentanyl. Distributed free by local officials, supplies are abundant at the house where Sleaze smokes fentanyl and works security in exchange for drugs.
On a recent day, a customer heated up a dose of white fentanyl powder, sucked in the smoke through a short straw, and stopped breathing almost instantly. Sleaze says he grabbed several naloxone canisters and sprayed three doses up the comatose man’s nose, snapping him back to life.
“It’s second nature to me,” says Sleaze, whose nickname is tattooed just above his left eye. “I hit him with three canisters, and he came to.”
Many narcotics researchers say the widespread availability of naloxone appears to be the main factor in the sharp drop in synthetic overdose deaths this past year. In the 12 months through July 2024, deaths fell 22% percent in the U.S. and 34% in Ohio from the same period a year earlier, according to the most recent data from the U.S. Centers for Disease Control and Prevention. Nationwide, about 17,500 fewer people died than in the prior year.
The drop coincides with the U.S. Food and Drug Administration’s move in March 2023 to allow the sale of naloxone without a prescription. Several brands are available at pharmacies and online for between $30 and $45 per kit. Today, Ohio and other states have giveaway programs for the drug. The Columbus Police Department cites naloxone as a prime factor behind a decline in 911 calls for overdose emergencies here.
Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, says a federal effort to get naloxone and other addiction treatments into communities is driving the steady decline in overdose deaths. Prosecutions of fentanyl suppliers and the drug’s ingredient makers have disrupted the entire supply chain, he adds, resulting in less potent fentanyl on the streets.
The death tally remains high, though. As Reuters has documented, illicit fentanyl – synthesized from Chinese-made chemical ingredients smuggled into the U.S. and Mexico – remains cheap and plentiful. In Columbus, it’s $10 a fix.
To explore what the drug’s intricate global supply chain means for the ultimate consumers, journalists visited Ohio. The state was one of the first overwhelmed by fentanyl fatalities – no one can say why for sure – and is now among the first seeing the wave of deaths ebb. But the stories of Sleaze and other users in Columbus show how even with a powerful antidote on the streets, it’s proving difficult to break fentanyl’s grip on America.
Between 50,000 and 60,000 Americans are projected to die from synthetic opioid overdoses this year, most from taking fentanyl or closely related drugs. That would be a roughly sixfold increase over 2015, the year before the fentanyl crisis began. The U.S. is approaching some 450,000 deaths from synthetic opioids since then.
Scott Sanders is executive director of the Hope Resource Center, a haven and support provider for Sleaze and other users in the Hilltop area of Columbus. He hands out roughly 1,000 naloxone kits a month, each with two nasal-spray canisters. But while naloxone is saving lives, Sanders says, the number of substance abusers on Hilltop’s streets is growing.
Visits to Hope’s drop-in center have risen about a third this year, to about 18,300 in the 12 months through November 2024, up from about 13,400 in the prior 12 months.
“And that scares me to death,” Sanders says. “Because all the powers that be are going to be throwing parties. Like, wow, look, it’s not a problem anymore,” he says of the fatality trendline. “But we’re busier than ever.”
Beyond naloxone, researchers cite two other possible factors behind the falling toll. Illicit narcotics distributors are increasingly adding “tranq” – veterinary tranquilizers – to the fentanyl they sell. Why they’re doing so is unclear. But tranq is less deadly than fentanyl. It also provides a longer-lasting high, potentially delaying the onset of fentanyl withdrawal and the desire for another fix. The fewer times users take fentanyl, the fewer chances they have of overdosing. Some researchers believe tranq may be as big a factor as naloxone in the falling toll.
Others are examining the drop in the number of “susceptibles” – the possibility that the huge number of overdose deaths in recent years, about 280,000 since 2021, has so sharply culled the population of potential fentanyl abusers that the number of overdoses was bound to fall.
But on a November visit by Reuters to Ohio, it’s naloxone that most everyone is talking about. Users here refer to the overdose-reversal drug as Narcan, the first brand to hit the market with a nasal spray.
Sleaze is one of 10 Ohio users who told Reuters they have been revived numerous times by naloxone. Their individual stories couldn’t be confirmed, but Sanders of the Hope center says he knows of a number of people who’ve been revived multiple times.
Sleaze and others repeatedly saved by naloxone also describe a dark side to the miracle drug. It immediately plunges them into a harrowing withdrawal from fentanyl, a drug 50 times more potent than heroin – spurring an instant need for another fix.
THE CASE FOR NALOXONE
Ohio has been at the forefront of the fentanyl crisis since the drug appeared on the streets of nearby Dayton in 2017. State and local authorities distributed nearly 320,000 two-dose naloxone kits in the first 10 months of this year. That’s 20,000 more than in all of 2023 and 110,000 more than in 2022. Synthetic overdose deaths in Ohio dropped about a third to 2,676 in the year ending in July, CDC figures show, the fewest since 2016.
In Columbus, Sanders encourages visitors to the Hope center to take as many free naloxone kits as they want. On a damp and chilly day in mid-November, Ryan Hall pokes his nose into Sanders’ office to say hello. Hall, who says he has 13 kids by “six baby mamas,” has come by to celebrate his 41st birthday. He has gone in and out of addiction treatment repeatedly in recent years and has been “Narcan-ed” numerous times, Sanders says.
Hall says he’s clean; Sanders is dubious. Sanders – who kicked his own crack addiction in 2017 – encourages Hall to call him later, promising to get him back into treatment when he’s ready. (On Dec. 9, Sanders would take Hall to a rehab center.) Much of what Sanders does is arrange for people to get into treatment and sober housing.
A few minutes later, Sleaze, 40 years old, walks into Sanders’ office and sits down. Across Sleaze’s forehead, in three-quarter-inch-high letters, is tattooed “FUCK COPS.”
“I love getting high,” he says.
But he doesn’t love being Narcan-ed. A fentanyl overdose kills by causing respiratory failure. Naloxone works by pushing the fentanyl molecules off the brain’s opioid receptors and then blocking any further fentanyl from attaching to the receptors.
The result is immediate: The user starts breathing and comes to. But the downside kicks in, too: For those addicted to opioids, the craving begins anew. Police say revived overdose victims sometimes react by violently flailing their arms and legs. Others vomit uncontrollably.
Sleaze says he finds himself in agony when he’s dosed with naloxone, and often sprints away from the spot in a panic. Someone Narcan-ed him just a few weeks ago, he says.
His first brush with naloxone came in 2022, which was also the first time he took fentanyl. He had just been released from prison after serving seven years on a burglary conviction for stealing TVs from a Walmart. Even behind bars, he says he managed to continue taking opioids, an addiction acquired in early adulthood.
But he’d never taken “fetty”: Too many of his own friends had died of overdoses. He was homeless and sleeping in his girlfriend’s car. His mother had just been sent to prison for dealing cocaine.
“My whole fucking world just crumbled,” he says. That day, someone had given Sleaze a small bag that once contained fentanyl powder. Sleaze injected residue from the bag and passed out immediately. “I didn’t even get the needle out of my arm.”
He was brought back when his girlfriend sprayed naloxone up his nose. Withdrawal kicked in. He’d never experienced such intense “dope sickness.”
“I hurt so bad, I was like, bitch, why didn’t you just let me die?” he says.
Sleaze’s now-former girlfriend and his mother couldn’t be reached to talk. His mother is serving a minimum nine years at the Dayton Correctional Institution on the drug charges.
Five minutes after talking with Reuters, Sleaze is outside in an alleyway near the Hope center, looking over his shoulder. This past summer, after his latest release from prison, he cut off his ankle monitor and stopped reporting to his probation officer. He pulls his knit cap down over his forehead, covering the “FUCK COPS” tattoo, and smokes a dose of powder.
Source: https://www.reuters.com/investigates/special-report/fentanyl-ohio/