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F Is the New H

People in Seattle who would never touch heroin are trying fentanyl. What they don’t know is that it’s basically the same thing, only stronger.

by Brendan Kiley

A HALF GRAM A mound of fentanyl about the size of a quarter. This sold in Seattle for $120.

Brian is a rock musician who moved to Seattle about a year ago from a small town in the South. "I was straight-edge for a long time growing up, and there wasn't much down there," he says. "Just small-town potheads and some guys doing meth in a shack somewhere." His most intense drug experiences involved beer and marijuana.

Within months of moving, he was in a popular underground band. John, also in the band and one of Brian's roommates, brought a lot of drugs into their place—pot, pills, cocaine.

"One night, we're hanging out and—typical John—he brings out this white powder and asks me if I want some," Brian remembers. "He doesn't tell me what it is at all. We're freebasing—he pours the powder on some foil, gives me the straw, and lights it up. And I'm like, 'This is fucking awesome!' I just felt so good, so light, just so relaxed. And I ask him: 'What is this?' 'Fentanyl.' 'Oh, what's that?' 'It's heroin.'"

Brian went on: "I was mad—like, 'Oh my god, I just did heroin?!' It could be said that addiction runs in my family. Ever since I was a kid, I was told to be careful. I've got aunts and uncles in and out of rehab. And this feels so fucking good—I can really see this becoming a problem. It feels like total relaxation. Finally. It feels like you've been at a spa the whole day. Instantly."

Brian has used fentanyl since then at his place, mostly during parties. "F at this place is pretty open," he says. (This is a little unusual—most fentanyl users treat it as a secret, sometimes shameful thing.) "If we're doing it, we'll freebase, because we want to be all sleazy, you know?" Brian says. "There's a bit of novelty to it, the freebasing. Like: 'We're doing this fucking heroin, we're already being such scumbags.'"

Another musician, Jake, first tried fentanyl in a room at a party with a few bandmates. Nobody really knew what it was. "It didn't really have an identity at that time," he says. "So some people did it and some people didn't, and it wasn't a big deal—nobody thought of it as heroin." Eva first tried it with her boyfriend, a dealer. He didn't really explain what it was, either. Charles was offered a line to sniff by some coworkers during an office party. Keith, Stilly, and others—I've changed all the names—told similar stories: They saw it (usually at a party), didn't really know what it was, used it a few times, would probably use it again, and haven't found themselves addicted to it yet.

Then again, there are others—Sam, Claude, Bony—who tried it a few times and had, or still have, an urgent, daily, metabolic need to constantly keep some F in their bodies.

Claude, another local musician, first came across fentanyl through a friend who happened to be a dealer. Before long, he'd wrapped himself in its web. "I didn't realize it was happening," he says. "It grabs hold of you."

You don't become a narcotics addict after your first dose. It is a process, a subtle inching along a hallway, into a room whose doorframe you don't even notice as you're walking through it. But once you're inside—once you first feel the thrumming pangs of withdrawal—you're an addict. It always comes as a surprise.

Soon, Claude was spending several hours a day at his friend's house: freebasing, playing video games, and listening to music with a crew of six or seven people. Because it's cut with sugar and smells sweet when it's heated, they called it "shug."

Claude kept his habit secret, even from his friends and bandmates. He has connections in the hiphop world where—unlike Brian's rock 'n' roll friends who "want to be all sleazy"—freebasing is frowned upon.

"No, no, I definitely don't see F in the hiphop and DJ community," Claude says. "Because it's hiphop. Freebasing is not a glamorous-looking thing. There could be any kind of shit in there." Claude saw a few small overdoses among his crew during his time with fentanyl—some requiring a little resuscitation, none requiring professional medical help—but finally decided to quit when he overdosed.

"I had already realized it was a problem," he says. "Eventually, on shug, everything turned gray—no ups, no downs, no range of emotions. If you offered me either a date with a super-hot chick or a $50 bag of F, I would've taken the F and gone home."

One night, he nodded off and a friend said he'd stopped breathing. The day after, he had a blowout fight with his dealer-friend and hasn't been back. He suffered through withdrawals—"irritable, achy, my skin feeling like the chemical was burning while it seeped out of my body"—and that was that.

"I'm so glad I'm off it," he says. "I have friends who didn't even know I was using who said my whole personality seemed to come back."

Or take Sam, whose story is like a cliché from D.A.R.E., except that it has a happy ending. (Almost all of the fentanyl users interviewed for this story, by the way, went through the federal government's Drug Abuse Resistance Education program in the public school system.) Sam is in his mid-20s and works at what he calls "a corporate job." He hangs out with the glitch-hop crowd—"an electronica scene with a little bit of Burner crossover," in his words—where he first ran across fentanyl.

"I've always experimented with stuff over the years." Sam says he's used marijuana, psychedelics, the occasional Vicodin or Percocet, and it never seemed to do him any harm. At a small party about three years ago, one of his friends brought out some white powder and explained it was a strong opiate called fentanyl. "People are not aware of what fentanyl is, and that may be the reason they are willing to try it," he says. "If someone put heroin in front of you and asked if you wanted some, 99 percent of people would say, 'No way.'"

He sniffed a line or two, liked it, tried it a few more times, really liked it, and then the city's fentanyl supply—or at least his connections to it—seemed to dry up.

Then, in the summer of 2009, he started hanging around with a girlfriend who liked opiates. He'd heard that fentanyl was back in the city, so he went back to it. "I was kind of doing it recreationally for a while, but your tolerance builds almost immediately, after just a week," he says. (The half-life of fentanyl is only about two hours, experts say. The half-life of heroin is around six.) "I would start to go into withdrawals on a daily basis."

Within a couple of weeks, Sam was in deep. He managed to hold down his corporate job, but he needed a steady supply of fentanyl to keep him going. "At the height, I was using in the morning, at lunchtime, and in the evening just to stay normal." Sam had set some rules for himself—how often he'd use, how much money he'd spend—and was horrified by how quickly he broke them all. Withdrawals set in quickly and sharply whenever he couldn't make his connection: insomnia, hot flashes, cold chills, full-body aches, his guts seeming to liquefy into vomit and diarrhea.

"I ended up blowing through all of my savings, and everything hit the fan," he remembers. "It broke up my relationship with my girlfriend. And then fentanyl dried up in the city—all at the same time. In retrospect, it kind of worked out for me in a way. If it were still around, I probably still would have used it."

Sam has health insurance through his job, so he sought help from an addiction specialist and started taking Suboxone, a narcotic replacement-therapy drug. (Suboxone has advantages over methadone but is considerably more expensive.) Suboxone staved off the most acute withdrawals, and Sam pulled his life back into shape. He started saving money and even got a promotion at work. Soon he'll be taking a long business trip to a faraway country he's never visited before, and he's very excited. "It worked out," he says. "It's almost storybook."

But if fentanyl crossed his path again, would he use it?

He pauses. "If someone put it in front of me, I would probably do it," he says. "And I would probably have a lot of regrets because of what the cycle entails, the extreme ups and extreme downs. It's horrible. Horrible. But I still think about it every day."

Sam pauses again, then adds: "This is my absolute overall perspective on that stuff—it's absolutely amazing, it will ruin your life, it will steal all your money, and you will still love it more than anything."

There's surprisingly little hard data on the new popularity of fentanyl—it doesn't seem to be on the official radar. In the first half of 2010, King County law enforcement submitted 840 pieces of drug evidence to the state lab, and only 4 (or 0.5 percent) tested positive for fentanyl. The federal Drug Abuse Warning Network, which collects data from a sampling of emergency rooms and coroners, saw 2,229 reports of opioids in the Seattle metropolitan area, but only 57 instances of fentanyl. (That's 2.5 percent—still low, but it shows that fentanyl users are crossing the paths of doctors more often than police officers.)

Local experts aren't hearing much about it anecdotally. Dr. Phillip Coffin, an infectious-disease senior fel- low at the University of Washington who has studied drug use in New York City and Seattle and has been active in the harm reduction community, hadn't heard anything about it. Monte Levine, who runs a needle exchange in Kitsap County, said, "I haven't heard of any fentanyl use out here." He asked some of his clients—many of whom go to Tacoma to score—but says they haven't heard anything, either.

Shilo Murphy, who runs the People's Harm Reduction Alliance (also known as the U-District Needle Exchange), says he's heard of fentanyl as a cutting agent for heroin, but not regularly used on its own. Same goes for Mark Kinzly, who works with opiate users in Connecticut at the Yale School of Public Health (and spent some time as an opiate addict himself). At first, Kinzly thinks my stories about people freebasing fentanyl sound like "an urban myth."

I tell him it's not an urban myth.

"Most of the time, we see it mixed in with heroin," he says. "But it's concerning to me that you're even hearing about people using fentanyl on its own. We had such an awful experience here in 2006..."

Pure fentanyl is 100 times more potent than morphine, and doses are measured in micrograms instead of milligrams: Unless it's mixed very precisely and very evenly, the strength of the drug can vary dramatically—dangerously—from one hit to the next. A few years ago, the Midwest and East Coast saw at least 1,000 heroin overdoses after a lab in Toluca, Mexico, produced fentanyl that was then cut into the heroin supply chain, making the heroin much, much stronger—unevenly so.

"That's always the danger with really potent stuff," Dr. Coffin says. "Imagine you've got a big pot of drugs and you're stirring it up. Some of that is inevitably going to clump. And some clumps are going to be weaker and some clumps are going to be much stronger." According to the Drug Enforcement Administration: "One gram of pure fentanyl can be cut into approximately 7,000 doses for street sale."

Fentanyl is a good cutting agent for heroin because it's entirely synthetic and therefore cheaper to produce—manufacturers don't need lots of land or lots of labor, or all of the risk and the bribes that come along with cultivating acres of poppies. In 2006, some Mexican drug-trafficking organizations figured that out and started cutting their heroin with fentanyl to increase their profit margin. Mexican authorities busted the Toluca lab near Mexico City in May of 2006. Fentanyl-related overdose deaths in a sampling of US cities peaked a month later at 150 before declining sharply to a single death in February of 2007—a rare instance in which the two divided schools of drug policy (law enforcement versus harm reduction) worked together to save lives.

The very first wave of fentanyl-cut heroin, Kinzly says, hit the United States in the 1990s. "I don't know if you know this, but bags of dope on the East Coast have stamps," he says. "It's a marketing tool. And there was a particular stamp called 'Tango and Cash.' That was heroin cut with fentanyl, and people were dying left and right. But as you're well aware, any consumer wants the best product, the most for their dollar, so we had people running up and down the street trying to get the product."

The deaths, he says, were an advertisement of quality.

Fentanyl was first synthesized in 1960 by one of the geniuses of pharmacology—Belgian chemist Dr. Paul Adriaan Jan Janssen. Before he died in 2003, Janssen was awarded 80 medical prizes and 22 honorary doctorates, and was made a baron by King Baudouin I. Dr. Janssen is so famous in his own country, he won second place in a 2005 Flemish television poll for "the Greatest Belgian." (First place went to Father Damien, the "leper priest" of Moloka'i, Hawaii.)

Along with his researchers at Janssen Pharmaceutica, Janssen synthesized more than 80 medicines in his lifetime. Four of his drugs (including the antipsychotic Haldol and the cattle deworming agent levamisole) are on the World Health Organization's list of essential medicines—an accomplishment that is, according to Janssen Pharmaceutica director of language and documentation Guido Theunissen, "quite unique." (Guido is being modest. It's a world record.)

Fentanyl has three major medical uses. First, for terminal cancer patients and others living with a constant level of baseline pain that cannot be controlled by high doses of morphine (for this use, it's often prescribed as a skin patch). Second, in surgery, where it sometimes suppresses a patient's breathing, requiring artificial ventilation (among recreational users, that is known as an overdose). Third, in ambulances as a first-aid response to massive, extraordinarily painful trauma.

The availability of the drug to medical professionals has resulted in some spectacularly sad fentanyl-related crime.

In November of 2010, prosecutors charged a nurse on Long Island with six counts of "unlawful release of regulated medical waste," claiming that he had been stealing hospital garbage (bags of syringes, blood vials, etc.) and rifling through it for used fentanyl skin patches. "He was actually sucking the residue off the patch," Suffolk County district attorney Thomas Spota told reporters, "the way you would eat an artichoke." The nurse was accused of dumping the rest of the waste in public places—a few parks and at least one school playground.

In January of 2011, a 60-year-old fire department captain and paramedic in Camas, Washington, was sentenced to 27 months in prison for stealing fentanyl from the medical kits of his local fire department and refilling the injectable vials—meant for emergency first-aid patients—with tap water.

Last month, a 33-year-old nurse in Minnesota was charged with stealing two-thirds of a man's fentanyl dose just prior to his kidney surgery. According to the complaint, she told him, "You're gonna have to man up here and take some of the pain, because we can't give you a lot of medication." While the patient screamed and writhed on the table, and hospital staff debated whether to restrain him, the nurse rambled, gesticulated wildly, and kept passing out. A hospital technician later found two empty syringes with the labels torn off in the nurse's pocket.

And just a few days ago, the Tenth Circuit Court rejected a hospital technician's request to overturn her 30-year sentence for stealing fentanyl from Colorado hospitals where she worked. She was shooting up with syringes that were later used during patient surgeries—dirty syringes that infected at least 17 people (and maybe over 25) with the technician's hepatitis C. The nurse confessed she had probably contracted the disease by sharing heroin needles during her long history of opiate addiction. According to Judge Carlos Lucero, at least one of her victims deprived of fentanyl "awoke mid-surgery in severe pain."

Drug addiction—and, specifically, opiate addiction—has been part of the mythology of the physician for centuries. There's Dr. Wilbur Larch, the fictional doctor and ether addict of John Irving's novel (and Oscar- winning film) The Cider House Rules. There's William Stewart Halsted (1852–1922), the real-life surgeon who pioneered techniques in aseptic surgery, mastectomy for breast-cancer patients, and anesthetics—which led him and some of his fellow surgeons into lifetime morphine and cocaine addictions. And there's Crawford Long (1815–1878), the American physician who introduced ether as an anesthetic. According to a 2004 article in Psychiatric Clinics of North America, Long came up with the idea "after noticing that the injuries he received in intoxicated falls at ether parties did not produce pain until after the drug had worn off."

However, fentanyl addiction among medical professionals might be more complicated than a simple matter of having access to the drug. A series of 2006 articles published in the Journal of Addictive Diseases, the Lancet, and Medical Hypotheses show that secondhand fentanyl "has been detected in the air within operating rooms, the highest concentrations being close to the patient's mouth, where anesthesiologists work for hours." That exposure and subsequent sensitization, the studies argue, may subtly nudge people toward tolerance, addiction, and the extreme drug-seeking behavior of the nurses in Minnesota, Colorado, and New York, and the paramedic from Washington.

These studies took other risk factors into consideration—the availability of opiates, the stresses of the job, the thrill-seeking personality types who tend to go into medical careers—and still found that anesthesiologists were overrepresented among opiate addicts. One study, based in Florida, noted that only 5.6 percent of the state's physicians were anesthesiologists—but anesthesiologists accounted for almost 25 percent of the physicians followed for substance-abuse problems. Their drugs of choice were opiates. Especially fentanyl.

Fentanyl's official—if not always legal—use extends from the medical to the military. It has been tested, and occasionally used, as an agent of chemical warfare.

In 2002, Chechen Islamic separatists stormed a large theater in Moscow that was showing a production of the popular musical Nord-Ost. Around 50 heavily armed Chechens, some with explosives strapped to their bodies, took around 850 people hostage, including the cast and crew, and demanded that the Russian military abdicate Chechnya or hostages would start dying. After three days of standoff and negotiation, Russian soldiers blasted a mystery gas through the theater's ventilation system, incapacitating the rebels and the hostages, and then raided the building. The mission was not entirely successful. Between 115 and 200 of the hostages died—depending on whose numbers you believe—but only one, according to Dr. Andrei Selt- sovsky, chair of the Moscow health committee, died from gunshot wounds. The other 114 to 199—including 17 cast members of Nord-Ost, two of them child actors—were killed by the gas.

The Russian government tried to keep the chemical composition of the gas secret: Doctors on the scene complained that they could not treat hostages because police wouldn't tell them what they'd been gassed with. But four days later, Health Minister Yuri Shevchenko announced that the gas was a derivative of fentanyl. (For the chemists among you, it's widely believed—but has never been confirmed—that the Russian gas was Kolokol-1, which contains 3-methylfentanyl. That's a derivative of fentanyl that's more commonly made in clandestine labs and sold for recreational use than regular pharmaceutical fentanyl. In other words, the type of fentanyl you're buying on the street is probably the same type used by the Russian military.)

The United States has also toyed with fentanyl as a chemical weapon. In 2003, Guardian columnist George Monbiot reported that the Bush administration had been trying to "wriggle free" from the US commitment to the 1925 Geneva Protocol on chemical weapons so it could use them in Iraq. (Never mind, Monbiot writes, that "the point of this war, or so we have endlessly been told, is to prevent the use of chemical weapons.") According to Monbiot, Donald Rumsfeld's office confirmed the decision had been made to use chemical "riot-control agents" in Iraq. Rumsfeld himself had been arguing against the Geneva Protocol, telling Congress's Armed Services Committee that "there are times when the use of nonlethal riot agents is perfectly appropriate." (Though the deaths of the Moscow hostages could hardly be described as "nonlethal.")

Reports from Penn State and the Lawrence Livermore National Laboratory detail research done on behalf of the Department of Justice and the Marine Corps on the use of fentanyl for "less-than-lethal targeting." The LLNL report declares fentanyl "an uncommon and very powerful drug" that could be fired at enemies as a projectile or "dispersed as a smoke... into an air duct or office building air conditioning system."

Rumsfeld was CEO and president of the US pharmaceutical firm G.D. Searle & Company from 1977 to 1985. By 2003, Searle had merged with Monsanto, which then merged with Pfizer—a major manufacturer of fentanyl.

Fentanyl users in Seattle often complain about how expensive it is. Price quotes vary wildly—people have cited prices from $80 per gram a few years ago up to $300 per gram today. It seems to depend on the month and the buyer's proximity to the source. (These days, the cheaper heroin in Seattle is going for $20 to $30 per gram.) Claude, the hiphop musician, said that when he ran out of fentanyl or out of money and wanted to stay high, he'd try to smoke heroin. "But it didn't work!" he says, shaking his head. "If you're on F and you smoke H, it just doesn't work."

Nobody I talked to knew for sure where Seattle's fentanyl was coming from, but many people told stories about local manufacturers, usually a shadowy Main Man and his even more shadowy Competitor, who have clandestine labs somewhere in the area: Some say in a house, some say on a boat, some say in a trailer. And nobody could explain why fentanyl is so much more expensive than heroin.

Jake, a user with connections to several dealers, has a theory: "If I were starting to make a new drug locally that was basically the equivalent of really strong heroin, I'd only want people with real money for customers. People who buy in their homes, people who aren't going to get caught out in the street. That makes it safer to deal and it creates a cachet."

Here's another theory: The fentanyl entrepreneurs—whoever or wherever they are—are trying to introduce China White heroin to the West Coast's longtime black tar heroin market, breaking a hallowed drug-market convention.

The difference between the two types of heroin is that black tar is less highly processed and closer to pure opium with all of its many alkaloids: codeine, morphine, thebaine. "Black tar is opium that's halfway processed to heroin," Dr. Coffin says. "Some West Coast black tar users who go on to use China White don't like it because black tar gives them more of a holistic, opium-den feel instead of the sharp, crisp high of China White." (People who have used both fentanyl and West Coast heroin say that fentanyl gives them a more cocainelike "up" feeling—which sounds like the "sharp, crisp high" Dr. Coffin is talking about.)

Most of the heroin that Americans can get west of Mississippi, Dr. Coffin and others say, is black tar from Mexico. The East Coast gets China White from Colombia and the Middle East, while Vancouver, BC, gets China White from Asia. (There is said to be a deal between Asian and Latin gangs to treat the US/Canadian border as a gangland border as well.)

Coffin adds that HIV transmission among IV drug users who are sharing needles is much higher among the China White crowd than the black tar crowd. "On the East Coast, prior to the impact of needle exchanges, about one-half of the HIV epidemic was due to injection drug use, and the Vancouver HIV epidemic was almost exclusively due to IV drug use," he says. "In Seattle, never more than 12 percent of HIV cases were due to injection drug use." Why? Because black tar is less conducive to HIV transmission, for three reasons:

(1) It gums up syringes, requiring users to rinse between shots.

(2) Black tar damages the veins faster. ("If [William S.] Burroughs had been shooting black tar, he wouldn't have been able to inject like he did for 80 years," Coffin says.) That leads to more abscesses and infections, but it also means that IV users turn to muscle injections and skin popping, which is a less efficient way to transmit HIV.

(3) You have to heat black tar more than China White to shoot it, which also reduces HIV transmission. "But," Coffin is quick to add, "those factors do nothing to stop hepatitis C transmission, which is our huge problem out here."

Back to the fentanyl/China White theory: Perhaps some entrepreneurs have decided to make an end run around long-standing gangland conditions and produce fentanyl so as to allow high-paying customers access to a synthetic version of China White heroin.

Which would explain why it's so expensive. Perhaps musicians like Claude and Brian and Jake are at the poorest fringes of the fentanyl market—maybe people like Sam, people with "corporate jobs," are the real target customers.

The last time I'd hung out with Bony, a local drug dealer, he'd been freebasing fentanyl. He'd smooth out a piece of aluminum foil, sprinkle powder from the bag onto the foil, heat it from below with a lighter, watch the fentanyl bubble and caramelize, and inhale the tendrils of smoke with the empty shaft of a Bic pen. His habit seemed fairly restrained a few months ago—just a guy taking the occasional hit of fentanyl the way other people take the occasional hit of marijuana.

Now, a few months later, he's taking hits every 10 minutes or so, then nodding out in the middle of sentences. I ask him a question and he closes his eyes, his head drooping. I'm starting to wonder whether I'm going to have to call 911.

"This shit..." he drawls, slowly coming back to the surface, "this shit sometimes puts me to sleep a little bit." He laughs gently and softly, like a slow-motion hiccup. "It's almost like I'm dreaming."

I repeat my question: So, do you think you have an addiction to F?

"No, no, I don't think so," he says softly, touching his face and smiling before getting up and drifting over to his record collection. "I mean, you've got to be careful, this shit can be addictive. Some people get in and out." He wanders back to the couch and prepares another hit.

I ask how often he uses F.

"Off and on, but fairly regular," he says.

How long have you been a daily user?

"I don't know," he says, a little irritated. "I haven't ever had a super-big problem with getting hooked. I can go hours and hours without feeling like I need it. But sometimes I do need it."

Hours and hours.

Bony first came across fentanyl last year. It was "a total drugs party," he says, where people were smoking heroin and sniffing cocaine out in the open. "But people were hiding in the bathroom to do the fentanyl. I put down $20, which was pretty much just a hit."

Why were people hiding in the bathroom to smoke F if they were smoking H out in the open?

"F is definitely..." He pauses, nods off a little, comes back. "It's a greedy thing. People don't want to share it because it's so fucking expensive."

Why is it so expensive?

"I don't know. I hear it's made around here, so I don't know. Maybe because it still hasn't really caught on yet."

This logic is hard to follow—if it's cheaper to make than heroin, and it's not popular yet, why would it be so expensive? Wouldn't the distributors want to make it cheaper until it caught on?

"I don't know, man," he says softly, flatly. "I don't know."

He stares off at the wall, obviously sick of talking to me.

I think of what Claude said about being in the depths of his fentanyl addiction, about how everything went gray and his personality seemed to go away. The Bony sitting in front of me isn't the Bony I know. He's somewhere else—and I'm clearly butting in on his new reality. He used to be cheerful. Now he's irritable. And he clearly wants me to go.

I ask Bony if he's heard of Washington State's new Good Samaritan law—see sidebar, page 18—which gives people amnesty from prosecution for drug possession if they call 911 to help someone who's overdosing. "It's a law you and your friends should know about," I say. "Just in case."

"I haven't heard of it," he says. "But I'll keep it in mind."