Illicit drug buys conjure images in the popular imagination of dark alleys and whispered exchanges bargaining the price of the next fix.
Too much. That's the cost for thousands of Americans in the midst of a new kind of drug use that often defies stereotypes. Transactions start like many others -- with a credit card and a website.
Experts say some websites and dealers are selling accidental deaths by importing pills from secret labs in Mexico, China and India that lace opioids with fentanyl, making them cheaper and driving overdoses to deadly new depths.
States across the country are seeing spikes in fentanyl overdoses, but experts will tell you that almost no one is seeking that drug in particular. They're looking for Vicodin, Percocet, Oxycontin, maybe heroin or cocaine, and accidentally ingesting enough of the synthetic additive to draw their last breath.
“As easy as clicking a button, she could get any drug that she wanted,” Andrea Thomas of Grand Junction, Colo., told Audacy in a recent interview about how her teenage daughter has found advertisements for illicit drugs on mobile apps such as Snapchat.
Four years ago, Thomas lost her older daughter to a fentanyl overdose.
Already this year, the DEA says it has seized 9.5 million counterfeit pills from dealers and fake pharmacies. Two out of five of these pills contained a lethal dose of fentanyl, per their data.
A simple Google search leads to websites selling pills imported to the U.S. from labs across the globe. While customers may think they are buying prescription medications on the cheap or known street drugs such as heroin, often what they are getting alongside these is a big dose of synthetic opioids such as fentanyl.
How easy are these to get? One quick google search for Vicodin pulls up numerous sites advertising the ability to order that powerful painkiller without a prescription, 50 pills for $7. Hydrocodone, Percocet, Oxycontin and more are just as cheap and simple to order.
On one site, the words “opioids” and “anxiety” are both misspelled. The site makes this promise: “We make it simple for our customers to gain access to quality opioids, which has always been difficult in the past. Our opioid drugs are thoroughly tested in the laboratory before getting approved. With us, you can have a fantastic shopping experience with a hassle-free process on offer. Just place an order, add the item to the cart and make payment in a breeze. We will take care of the rest!”
But so many of these unlicensed, unregulated online pharmacies and street dealers are cutting their drugs with fentanyl that experts say ingesting a pill is playing with fire.
An Audacy analysis found that, out of the states with available data, from March 2020 through this February compared to March 2018 through February 2019, all but one – New Hampshire – saw increased deaths related to these synthetic opioids. While data from Florida showed a decrease in overall fentanyl overdoses in 2020 compared to 2019, the drug was responsible for the largest percentage of overdose deaths in the state last year.
Among states with the highest increases were Colorado, Louisiana and Mississippi, where numbers were increased from 300 percent to more than 400 percent in 2021 compared to 2019. New Mexico, Nevada, Texas and Washington also saw significant increases. Overall, 25 states saw synthetic opioid related deaths at least double in size.
“This rise has been going up and up and is not limited to a particular region or location, you can see it emerging around 2016,” said Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health.
People from all demographics have been impacted by fentanyl. In recent years, the drug made headlines when musicians Mac Miller, Lil Peep, Prince, Tom Petty and Jay Bennett of the band Wilco died from fentanyl-related overdoses.
Last month it made headlines again when actor Michael K. Williams of “The Wire” died of an accidental overdose that included fentanyl.
Just a few weeks later, Deputy Attorney General Lisa O. Monaco and DEA Administrator Anne Milgram announced a law enforcement surge to protect American communities from “the flood of fentanyl and fentanyl-laced pills across the United States.”
They said the drug is the primary driver of increased opioid deaths nationwide.
As of February, synthetic opioids such as fentanyl have been connected to at least 58,514 deaths in the U.S., according to provisional data compiled by the Centers for Disease Control and Prevention. Due to incomplete reporting, the real number is likely more than 60,000.
Overall overdose deaths for all drugs tracked jumped 30 percent during the 12-month period ending in March compared to the previous 12-month period, according to the National Center for Health Statistics provisional data.
What is fentanyl?
Fentanyl was first produced in 1960 by Belgian physician Dr. Paul Janssen. It is a synthetic opioid, similar to morphine but 50 to 100 times more powerful. In hospital settings, carefully measured amounts of the drug are used to treat severe pain following surgery.
“When people…overdose with fentanyl and the first responders arrive, many times there’s been reports of people being dead with the syringe still in their arms,” said Volkow, who explained that synthetic opioids are fast-acting as well as extremely powerful.
Since fentanyl is an opioid, it is often associated with opioid-related deaths such as heroin overdoses. However, in a slew of data released this year, the drug’s name pops up in relation to all types of drug overdoses, including counterfeit prescription opioids, methamphetamine, Adderall and Xanax. For example, Michael K. Williams’ overdose was also associated with heroin and methamphetamine.
In addition to increasing the risk of death, the presence of these drugs in stimulants also means that people run the risk of becoming physically dependent on opioids without knowing they have taken them.
“When you compare the East versus the West, you’ll see some polarization, with more deaths linked with fentanyl towards the East and more deaths linked with methamphetamine towards the West,” said Volkow. However, she said that now, 75 percent of the deaths linked to methamphetamine are also associated with fentanyl.
Producers of illicit drugs often put fentanyl into their products because of its potency and low cost, according to the DEA. Some of these drug products are counterfeit pills that look like legitimate prescription medication and the DEA has put out a public education campaign on the matter called One Pill Can Kill.
“It’s not an overdose, it’s a poisoning,” said Andrea Thomas.
When Thomas’ daughter Ashley Romero died from a lethal ingestion of fentanyl four years ago, she left behind a young son. Authorities believe that Romero had taken just half of a counterfeit pill that appeared to be the prescription drug Percocet.
It could happen to anyone, Thomas said.
According to the DEA, 42 percent of counterfeit pills they’ve tested have the lethal dose of fentanyl, 2 milligrams, and some have more than 5 milligrams.
Volkow said that fentanyl is so common in street drugs that taking them has become “a game of Russian Roulette.”
How does it get here?
Volkow said most illicit fentanyl in the U.S. originates in China.
That was where the fentanyl that killed James Rauh’s son Thomas at age 35 came from, according to The Dept. of Justice. In 2018, Chinese nationals Fujing Zheng, and his father Guanghua Zheng were indicted on charges including conspiracy to manufacture drugs.
They shipped over 16 tons of chemicals every month through various companies, said the DOJ.
Rauh, a resident of Akron, Ohio, remembers his son Thomas as a happy person who was musical, athletic, hard-working, talented and always ready to entertain his loved ones with a story. His path to addiction began with an opioid prescription after an injury. Another injury followed, and soon his need for the drug was beyond his control.
Thomas Rauh eventually ended up using street heroin and told his family that he had developed a problem. Rauh said his son tried all types of treatment methods and would be clean for long periods of time before relapsing.
He had no idea that he was injecting a lethal dose of fentanyl when he died in 2015.
“It’s killing the strong, the proud, the brave,” said Rauh. However, he said that many people overlook the dangers of fentanyl because they think it only impacts “junkies.”
“Very few people have never experimented,” he said.
“Some people are going to say, ‘another drug addict off the streets, great,’ that’s what they are going to say about my daughter,” said Andra Thomas.
After it is produced in China, some fentanyl enters the U.S. by way of Mexican cartels, she told Audacy.
Like Rauh’s son, Ashley Romero at one point had a prescription for pain medication, in her case for a chronic condition. With a change in insurance, it became harder to get. Unlike Rauh’s son, Romero’s family was not aware of any substance abuse issue or illicit drug use outside of the pill that killed her.
When Thomas got a call from authorities the day Romero died, she didn’t believe it. She thought it was a prank. It wasn’t until she drove from her mountain home and into town that she realized it was true.
They believe that preventing synthetic opioids from coming into the country is a key way to reverse the uptick in deaths. Thomas urges people to reach out to lawmakers about stopping drug trafficking.
Thomas and Rauh are also afraid of what synthetic opioids could be used for outside of the illicit drug trade. They called the drugs “a weapon of mass destruction,” both for the lives the drugs have already claimed and the possibility that they could be used for other crimes.
“You have so many broken hearts,” said Rauh.
Al Carter, executive director and CEO of the National Association of Boards of Pharmacy, told Audacy that laws need to change, too, to make it easier to shut down and charge operators of the estimated 35,000 illegal online pharmacies operating today. Ninety-five percent of online pharmacies are illegitimate, he added, and no one should buy any drug from a site that doesn’t require a prescription.
“It’s a challenge because right now we’re trying to do everything we can to educate people on rogue internet pharmacies, “Carter said. “Once one stops, another one just pops up.”
Since she formed Voices of Awareness, Thomas has received calls from parents and people around the country whose loved ones’ lives were cut short by fentanyl. Many who call her are confused and have never heard of the drug.
“Be informed,” said Thomas. “Know it's out there. Talk to your children and your family about it. Write your senators and any elected official.”
As these parents hope for more enforcement, Volkow also believes the U.S. should work on helping people before they seek out drugs, for whatever reason.
“Why are people taking so many drugs?” she asked. “We need to provide everyone with an alternative.”