Jimbo tries to be cautious these days. The middle-age heroin user says he buys only from dealers he knows – a hedge against getting heroin mixed with the pain-reliever fentanyl, a concoction that has killed at least 150 people in recent months.
Many of his friends, though, seek out fentanyl-laced heroin for its potent high, swapping information about where the latest overdose victim got his dope.
"They always say, 'It's gonna be different with me, 'cause I'm not going to use so much,' but it's still too much," says Jimbo, as he exchanged used needles for clean ones at a mobile van run by the Chicago Recovery Alliance. "It's a whole new ballgame."
Demand for the potent heroin-fentanyl mixture is just one factor complicating officials' efforts to contain, if not eliminate, a street drug that is raising alarms in cities in the upper Midwest and the Northeast. So far this year, the drug combo has been responsible for between 150 and 300 deaths in a handful of cities.
Last week, Chicago police and the US Drug Enforcement Administration (DEA) arrested 29 members of a southside street gang suspected of trafficking in the specialty heroin. Over the weekend, police in Detroit arrested a local man suspected of being a major provider of the drug in that city, which has counted the largest number of fentanyl-related deaths.
Also impeding efforts to crack down on the drug is the fact that it remains something of a mystery. Officials acknowledge they have much to learn, including where the fentanyl is made. They also are concerned because, as a synthetic drug made in sophisticated labs, fentanyl may point to a new territorial opening in the war on illegal drugs.
"Even if this episode subsides, what it represents is a very serious and emerging problem. The rise of synthetic drugs manufactured in labs in the developed world is a very different phenomenon than Afghan warlords or coca crops being smuggled in," says David Murray, a senior policy analyst with the White House Office of National Drug Control Policy in Washington. The good news, he says, is that federal and local law-enforcement and public-health officials have been able to test a new system of coordination and data-sharing. "We think we're seeing progress on this, but this is the kind of agility we'll require in the future for multiple synthetic threats."
Fentanyl, used as an anesthetic and pain reliever when prescribed, can be 100 times more potent than heroin – one reason addicts seek it out, but also the reason it's so deadly if the minutest error occurs when it's cut into heroin. Health officials measure its doses in micrograms rather than milligrams.
Reports about the drug began circulating in Chicago last winter, when a rash of overdoses occurred in the same place. Toxicologists discovered fentanyl in the bodies of those who died, though they still don't know if the drug may have been present earlier. At the beginning of June, the Norwegian-American Hospital on Chicago's west side was seeing an average of 10 overdose victims a day, instead of the usual one or two, says Chuck Thomas, the hospital's director of emergency medicine.
The blended drug has played a role in at least 60 deaths in Chicago this spring, including the teenage son of a suburban police official, and in many more nonfatal overdoses. Detroit, Philadelphia, and Camden, N.J., have also seen significant numbers of deaths, and the drug is beginning to spread to other cities.
The DEA and Chicago police got accolades for the raid at a public housing project last week, where they arrested 29 alleged members of the Mickey Cobras gang and seized more than 100 kilograms of heroin.
"It lets people know there's a concentrated effort [to crack down] in areas that have been known for overdoses or deaths due to fentanyl," says Christopher Hoyt, a special agent with the DEA in Chicago. The arrests, he says, are part of a larger investigation.
Some public-health officials have tried to use the deaths to get out more information to addicts about all overdose issues, but their advice can be at odds with the instincts of drug users. The Mickey Cobras, for instance, had been using the recent deaths as a marketing ploy, calling their product names like "Reaper," "Drop Dead," and "Lethal Injection." Elsewhere, the mix has been sold under the name "Get High or Die Tryin'."
"The typical addict in Chicago is spending $25 to $30 a day on heroin, not actually getting high but just keeping them from going into withdrawal," says Greg Scott, a sociologist at DePaul University who studies drugs and gangs in the city. "If for that same $30 you can get high the way you used to, it makes sense."
Of the five drug crews Professor Scott has spent time with in Chicago, four are dealing at least 50-percent fentanyl-laced drugs, he says. They tell him they're willing to accept a certain number of deaths among their customers because the profits increase so much in the days immediately after the overdoses. Some gangs have even given out free samples as a marketing ploy.
The overdose rate has not necessarily been worse than the numerous fatal overdoses Chicago has routinely had – about one or two a day, Scott says. But he's glad to see the increased attention on the issue. "It's really opening discussion for how marginalized injection drug users are from healthcare services," he says.