‘It’s all fentanyl’: opioid crisis takes shape in Philadelphia as overdoses surge

Nationally, over the past three years, fentanyl-related demises have increased by 540%, and the epidemic is felt acutely in Philadelphias Kensington area

A young woman lies unconscious, propped against the wall of a drug detox center in Kensington, Philadelphia.

” She’s wasn’t inhaling ,” says Danielle, a 26 -year-old woman wearing a baseball hat and jeans.” I found her half under a automobile. Somebody robbed her. They could have robbed her and called 911 …”

Paramedics arrive and administer Narcan, the nasal form of naloxone used to counter opioid overdoses. The female comes round and rejects farther treatment.

Minutes afterward, a man staggers and collapses. His breathing is shallow: the line between intoxication and overdose neared but not intersected. Paramedics get him back on his feet. It’s a grim dance, one that continues night and day in this rundown segment of the city.

Laura,
Laura, 28, another long-term addict who has made a home on Emerald Street, shoots six pouches every few hours. Photo: Edward Helmore for the Guardian

” It’s busiest at six in the morning when people are out are seeking to get a fix so they don’t get sick ,” said Patrick Trainor, a special agent with the Philadelphia division of the Drug Enforcement Administration( DEA) who has monitored this neighborhood for two decades.

Kensington’s street users know Trainor- at least they know his unmarked auto- and eye him warily. But it’s not DEA business to bust them, only to keep an eye on the narcotics reaching the street. A surge in fatal overdoses, blamed on the powerfulsynthetic opioid fentanyl and its analogs, is changing the decade-long opioid crisis from rural areas to cities.

Last week, the US Center for Disease Control and Prevention( CDC) released figures indicating that a sharp rise in narcotic overdose demises, which many attribute in part to fentanyl, is causing a drop in American life expectancy. Opioids killed almost 64,000 people in 2016. The figure for 2017 is likely to be higher again. In October, Donald Trump proclaimed a public health emergency.

On the street of Kensington, a crisis is taking shape that an anti-drug advertising campaign proposed by Trump may do little to ease.

” Fentanyl has drastically changed the landscape ,” Trainor said.” Sixty-four percent of fatals in Philadelphia County are fentanyl-related. There’s no dope out here now, it’s all fentanyl. Even the old timers are scared of it .”

In Kensington, many addicts congregate in a small park. It has become busier since authorities fenced off and filled in” the Tracks”, an aptly named encampment near train lines where residents once set up tables and mirrors to aid fixing in the neck. Others moved to an underpass on Emerald Street, known as Emerald City.

In either area, even junkies now carry Narcan. It’s an optimistic gesture, but barely.

Nationally, over the past three years, fentanyl-related demises have increased by 540 %. For the first time, the majority of fatal overdoses are fentanyl-related, accounting for” nearly all the increases in drug overdose deaths per 2015 to 2016″, according to the Journal of the American Medical Association. In Philadelphia, a city previously known for pure and relatively inexpensive heroin, there have been nearly 800 fentanyl overdoses this year.

Used
Utilized needles litter the ground in the Kensington section of Philadelphia on 2 February 2017. Photograph: Michael Bryant/ AP

‘ Dropping like flies ‘

The drug behind this surge in fatalities has been used by anesthesiologists for decades. Several years ago, the DEA noticed illicitly made fentanyl appearing as a cut for low-quality Mexican heroin. Then relevant agencies began assuring fentanyl itself, originating from laboratory in China and Mexico.

What started as a trickle is now a inundation. Up and down the eastern seaboard, fentanyl seizures are rising. Unlike heroin, which has a raw opium base that must be harvested in remote mountain valleys, fentanyl is constructed in clandestine laboratory use relatively inexpensive chemicals.

About 80% of fentanyl seized in the New York area appears to be linked to Mexico’s Sinaloa cartel. In Philadelphia, the drug is more likely to have come from lab in China, some of it shipped through Mexico.

Fentanyl
Fentanyl in a hospital. Photo: Joe Amon/ Denver Post via Getty Images

In November, Trump alerted Chinese leaders over the production of fentanyl. The attorney general, Jeff Sessions, traveled to New York’s JFK airport, to satisfy customs agents.

” With synthetic drugs flooding our streets, medications are now more powerful, more addictive and even more dangerous than ever ,” Sessions said.” Fentanyl is the number one killer drug in America. And as deadly as it is, you can go online and order it through the mail .”

Over four days last month, DEA confiscated 40 kg of fentanyl from Dominican traffickers, all of it destined for the Philadelphia market, in Trainor’s terms” an insane sum if you calculate each kilo yields 330,000 doses “. Local press reported that a single kilo was enough to kill half the residents in the district.

The economics of fentanyl trafficking are straightforward. The chemicals needed to produce a kilo cost no more than $5,000 and there is no need to wait for the poppy harvest. At $55,000 – $60,000 per kilo delivered, fentanyl is the about the same price as heroin but yields far more once it is cut and packaged for the street.

” You’re paying the same for something that’s roughly 100 times more powerful, so why would you buy heroin ?’ Trainor said.” The demand is for the most powerful thing they can get. Heroin will never be able to compete with fentanyl. It merely can’t .”

Customers, however, are dying. Danny, a long-term Kensington drug user, said high OD rates were initially caused by traders not knowing how to handle fentanyl. According to police one brand, AK-4 7, caused nine deaths in 36 hours and was part of a batch that left 35 people dead.

” When fentanyl came on people didn’t know about it ,” Danny said.” They didn’t know what they were messing with. They OD-ing all over. Once the merchants insured people falling like flies, they were going,’ Wow, we’re doing something wrong .’ Now they getting the cut right.

” Nowadays, if anyone’s dying its largely visitors who just got out of incarcerate or rehab. They think they can do three containers. They can’t … they’re done .”

Street dealers compete for customers, selling high-purity drugs.

” We’ve seen purity of heroin leap from 63 to 93%, which is insane ,” said Trainor.” There’s no greater endorsement for a trafficker than when his product kills somebody. That’s not mythology. We see it all the time. We’ve had wiretaps of drug traffickers bragging how many people their narcotics killed .”

Another longtime Kensington resident and junkie, also named Danny, countered:” They blame the merchants but it ain’t them. The people are doing to themselves. It’s people coming down here from outta district believing they can do whatever they want .”

Authorities only started to take notice, he said, when people starting coming to Kensington and dying: people from other neighborhoods, people with money, white, maybe politically connected.” When one of them children from the other hoods OD, suddenly they make a big deal ,” he said.” When it was just Kensington people they didn’t give a shit …”

Kensington is a harsh place. For many girls there, run entails sex run. For men it’s pimping or, for the cost of got a couple of$ 5 bags, acting as a guide to clients from elsewhere. Some sell Suboxone pills from legitimate prescriptions, or clean needles for a dollar each.

‘There’s no one person controlling it’

Besides fentanyl’s frightening strength, two related factors are causing problems for the authorities: a lack of a dominant trafficker and the ease with which variants of the narcotic can be produced.

In the past, drugs coming into any area would probably be controlled by a single, relatively predictable trafficker or trafficking household. That’s not the case with fentanyl. It’s coming from China, ordered over the dark web, or coming up from Mexico.

” There’s no one person controlling it coming in, and there’s more than we know what to do with ,” Trainor said.

Because it is synthetic, fentanyl is relatively simple to modify. Each subtle change in formulation maintains DEA analysts playing catch-up.

At the top end is carfentanil, used as a painkiller for elephants and other large mammals and estimated based 10,000 times stronger than morphine. It’s still rare on the street but it has shown up in four ODs at the Philadelphia medical examiner’s office. A carfentanil overdose can take several doses of Narcan to counteract. Police and medics are warned that even touching carfentanil powder can cause intoxication.

” It used to be just fentanyl but now we’ve noticed eight different analogs in this area and around 40 nationally ,” Trainor said.” Our chemists estimate there could be 200 additional variants .”

Fentanyl is marketed in stamped bags: White House, Dynamite, Colt 45.” Right now Colt 45 is the strongest thing ,” said one Kensington resident struggling with active craving.” It’s straight-up fentanyl. You can OD on half a suitcase .”

Whatever romanticism was ever associated with opium, or later morphine and heroin, it is lacking with fentanyl. It is painful to use because it burns the vein. Some taken the decision to put the solution for the purposes of the skin, despite an elevated risk of absesses, to reduce the risk of overdose and prolong the high.

Compared with heroin, junkies say, a fentanyl rushing is intense and immediate. Overdoses come along almost instantaneously, the comedown is abrupt and withdrawal long and uncomfortable. Since tolerance builds up speedily, dependency escalates rapidly. The drug is so strong that a user who has overdosed can slip back under after the short-acting Narcan wears off.

Laura, 28, another long-term junkie who has made a home on Emerald Street, shoots six pouches every few hours.

” With fentanyl you get a strong rush but it dies away and you get sick ,” she said.” The withdrawal is much different. You can kick heroin in five or six days but with fentanyl it takes 45 to 60 days. It’s longer, it’s the chemicals in it, and it’s just worse .”

Some junkies say fentanyl had persuaded them to get into a programme.” I didn’t want to die ,” said Michael, who recently entered a methadone programme. This could ultimately prove the silver lining to fentanyl’s devastating marching – it’s ultimately only too strong and too dangerous to use.

” This is a very dangerous period for someone struggling with substance employ disorder with all of the fatal overdoses that are occurring in Philadelphia ,” said Trainor.” Law enforcement is increasingly working with public health and treatment agencies to address this crisis and to save lives, and that’s a win .”

Read more: www.theguardian.com

Sergei Skripal: Russia connections attempted slaying to deaths of Kremlin foes

Embassy issues provocative tweet as Cobra meeting hears that case involves 250 counter-terror police and 200 witnesses

Russia stepped up its war of words with Britain on Saturday as its embassy in London connected the attempted murder of double agent Sergei Skripal to the deaths of three exiled enemies of the Kremlin.

The provocative move came as the minister of the interior, Amber Rudd, chaired a meeting of emergency situations Cobra committee into how the investigation into the attack on Skripal and his daughter, Yulia, was progressing.

The committee heard that 250 counter-terrorism police have identified more than 240 witness and are looking at more than 200 pieces of evidence.

Earlier in the day, in a typically sarcastic observation, the Russian embassy tweeted:” What a coincidence! Both Litvinenko and Skripal worked for MI6. Berezovsky and Perepilichny were linked to UK special services. Investigation details categorized on grounds of national security .”

Alexander Litvinenko was a former officer with Russia’s FSB security service who was poisoned with polonium in 2006. An official report suggested the assassination had been carried out by two Russian agents with a “strong possibility” that they were acting on behalf of the FSB.

Boris Berezovsky was the exiled Russian oligarch and chief critic of Putin who was saw hanged in 2013. A coroner recorded an open verdict.

” All those who knew him believe it is difficult to think he would have committed suicide ,” said Yuri Felshtinsky, who co-wrote a volume with Litvinenko, Blowing Up Russia.

Alexander Perepilichny collapsed after jogging near his home in Surrey in 2012. He had been helping a Swiss investigated by a Russian money-laundering scheme linked to the Kremlin, and there is speculation that he might have been murdered.

Berezovsky and Litvinenko are alleged to have introduced scores of Russian agents to the former MI6 agent who turned Skripal and is understood to still gratify him regularly.

The explicit connect of the Salisbury attack to three critics of the Kremlin, all of whom are dead, represents a further low point in relations between London and Moscow.

Timeline

Poisoned umbrellas and polonium: Russian-linked UK deaths

September 1978

Georgi Markov

In one of the most chilling episodes of the cold war, the Bulgarian dissenter was poisoned with a specially adapted umbrella on Waterloo Bridge. As he waited for a bus, Markov felt a sharp pricking in his leg. The opponent activist, who was an irritant to the communist government of Bulgaria, died 3 days later. A deadly pellet containing ricin was found in his skin. His unknown assassin is thought to have been from the secret services in Bulgaria.

November 2006

Alexander Litvinenko

The fatal poisoning of the former FSB officer sparked an international incident. Litvinenko fell ill after drinking tea laced with radioactive polonium. He met his murderers in a bar of the Millennium hotel in Mayfair. The pair were Andrei Lugovoi- a former KGB officer turned businessman, who is now a deputy in Russia’s state Duma- and Dmitry Kovtun, a childhood friend of Lugovoi’s from a Soviet military family. Putin denied all involvement and refused to extradite either of the killers.

March 2012

German Gorbuntsov

The exiled Russian banker survived an try on his life as he got out of a cab in east London. He was shot four times with a silenced handgun. He had been involved in a bitter disagreement with two former business partners.

November 2012

Alexander Perepilichnyy

The businessman collapsed while running near his home in Surrey. Tracings of a chemical that can be found in the poisonous plant gelsemium were later found in his belly. Before his death, Perepilichnyy was helping a specialist investment firm uncover a $230 m Russian money-laundering operation, a pre-inquest hearing was told. Hermitage Capital Management claimed that Perepilichnyy could have been purposely killed for helping it uncover the swindle involving Russian officials. He may have feed a popular Russian dish containing the herb sorrel on the day of his death, which could have been poisoned.

March 2013

Boris Berezovsky

The exiled billionaire was detected hanged in an apparent suicide after he had expended more than decade waging a high-profile media battle against his one-time protege Putin. A coroner recorded an open verdict after hearing conflicting expert evidence about the way he died. A pathologist who conducted a postmortem examination on the businessman’s body said he could not rule out murder.

December 2014

Scot Young

An associate of Berezovsky whom he helped to launder fund, he was received impaled on railings after he fell from a fourth-floor flat in central London. A coroner ruled that there was insufficient evidence of suicide. But Young, who was sent to prison in January 2013 for repeatedly refusing to disclose his finances during a divorce row, told his partner he was going to jump out of the window moments before he was found.

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