A wave of homemade, synthetic drugs sweeps US and deepens crisis

Warning: This story contains descriptions of drug-taking from the start and discusses suicide

The few grains of fentanyl sit in the silver foil as a straw, held between Mike's lips, hovers above, with a cigarette lighter below. The 48-year-old army veteran is crouched low in an alleyway in Columbus, Ohio's Linden neighbourhood.

"This drug will damn near make you do anything, unfortunately," he says.

The hit he's smoking cost three or four dollars.

"You can snort too much and you can't take it back. Kind of like a gunshot. Can't call the bullet back," he says.

He burns the foil and inhales. As the opioid takes hold, he grips the fence behind him. He sways as a low moan comes from deep in his throat - he could be humming a tune.

We've spent a few days with Mike - he's been our guide through the neighbourhood's back streets. Everyone seems to know him and he's regarded fondly. He helps out at a local pawn shop and gas station, and that's how he feeds his 20-year-old opioid addiction.

Synthetic opioids are more powerful and in plentiful supply, and they have transformed the drugs landscape.

Fentanyl, which is entirely man-made, is 50 to 100 times more powerful than heroin, which is cultivated from poppies. It is now often cut with synthetic tranquillisers, which make reviving overdose victims more difficult. These are homemade threats, where cocktails of synthetics can be made in American basements and bathtubs.

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We have Naloxone (brand name Narcan) in our pockets, in case anyone on our team comes into contact with fentanyl or anyone around us overdoses. It's a nasal spray that immediately reverses opioid overdoses and its widespread adoption has transformed the number of fatal overdoses in the United States.

At its peak in 2022, 110,000 Americans were dying from overdoses, mostly from opioids. The number has been dropping since, down to around 70,000 last year. But that doesn't mean the opioid crisis is over.

It's likely that the reversal drug in my pocket, which has saved tens of thousands of drug users' lives, would not have worked on Mike. Because he wasn't just smoking fentanyl.

The pupils in his milky blue eyes shrink to pin pricks. "Opioids make your pupils go smaller, but not that small," he says in a singsong voice. Even the fentanyl, dangerous enough on its own, has other synthetics added.

When we ask what he thinks his drugs have been cut with, he replies: "Xylazine, and the one we can't pronounce."

Medetomidine is what he means. Like xyalzine, it is also referred to as tranq and both are synthetic animal tranquilisers. "Large animal tranquilisers," as one recovery expert told me.

They help prolong the high from the fentanyl but are a sedative that slows breathing and, importantly, naloxone doesn't work against them. Xylazine also causes necrotic skin ulcers, wounds so deep they can make it down to the bone and are difficult to treat.

Recovery group offering hope

At the Glenwood Church on the other side of town, members of the Hope Dealer Community, a recovery group, gather for a weekly meeting. For many, their struggles are written in their care-worn faces, and their eyes are those of survivors of a great trauma.

They take to the stage at the front of the church and share their stories with a brutal and courageous honesty.

One man tells the story of his overdose in July 2022. Two paramedics worked on him, trying to save his life. He had naloxone drips in both arms. They hit him with the opioid reversal three times to no avail. "That's it, I'm gonna call it," said one of the medics. But the other insisted on one more try, and it was that which saved his life.

As the crowd shouts encouragement, Tonya takes to the lectern. She recounts how her nephew died of an overdose while she was overdosing at the same time from crack cocaine, a stimulant spiked with fentanyl, a synthetic opioid.

"It's not luck. I'm supposed to be here," she says with tears in her eyes. The audience yells its agreement.

Both in Columbus, and later in Chicago, we would hear of crack cocaine users who had died of overdoses after their drugs contained fentanyl. On the street, it's called a "hot dose".

"In the last 12 months in Franklin County [Columbus], 78% of fatal overdoses are from stimulants," explains Scott Sanders, 65, who runs Hope Dealers.