Over the past 14 months, 113 people in the UK have been killed by the super-strength painkiller fentanyl. That's eight a month, three times the monthly average of fentanyl-related deaths in 2015.
This sharp and sudden increase should perhaps come as no surprise, considering NHS prescriptions for the opioid have increased by 143 percent over the past decade, and – more importantly – because Britain buys more fentanyl on the dark net than any other European country. It also fits within the context of the UK experiencing a record number of drug-related deaths.
Abuse of the drug in the UK pales in comparison to what's going on in the US, where more than 20,000 people were killed by fentanyl in 2016. The problem in the States stems from a culture of doctors prescribing opioid medication for pain issues, patients becoming addicted to them and then moving on to black market drugs when their script runs out. Thankfully, that problem does not exist to nearly the same extent in the UK. Still, in light of the increasing number of deaths here and the fact that, throughout Europe, Britain has the highest proportion of people addicted to heroin – which fentanyl is sometimes mixed with – I wondered what potential there is for the UK to one day find itself in a similar situation to the US.
To find out, I tracked fentanyl's path across the globe, speaking to dealers and users on different continents and submerging myself in drug boards and the dark net. Only when we understand the trip fentanyl takes to reach the UK – along with the journeys of those who sell it and use it – can we predict its next step.
What is fentanyl? Basically: an opioid painkiller used since the 1960s, which can be administered intravenously, up the nose in sprays or in patches applied to the skin. It's 50 to 100 times more powerful than morphine, 30 to 50 times more powerful than heroin, and its close relative carfentanil (used as an elephant tranquilliser) is 100 times more powerful than that. As many believe it can be absorbed by touch – it can't – gloves are often used when handling it, and the recommended surgical dose is just 50 micrograms – .00005 of a gram. Like all strong opioids it depresses heart rate, meaning that if you take more than you can tolerate, you die.
Until 2017 there were Chinese websites on the regular internet where you could buy fentanyl legally – sort of. These websites sell "research chemicals" to scientists and, at least in China, fentanyl was considered one. Under pressure from the US government, China banned the sale and production of fentanyl last March, and since then these websites list it as permanently sold out.
Fentanyl-laced heroin hit UK streets – in Hull, Barnsley, Leeds and Normanton, West Yorkshire – last summer, months after the ban, a result of sales moving onto the dark net, which is infinitely more accessible to a generation of tech-savvy users and dealers than obscure Chinese science websites (over a quarter of British drug users now buy their supplies on there).
A Canadian dark net vendor who sells fentanyl extensively to the UK agreed to talk to me on the condition of anonymity. He described the ineffectuality of the ban: "We don't manufacture any fentanyl; we use a local supplier who imports it from China," he said. "The ban hasn't affected us – we're still able to purchase bulk amounts as long as we give one week's notice."
As few users have confidence ordering directly from Chinese vendors, the Canadian serves as a middleman to UK users. "Most customers don’t like ordering internationally due to customs and border protection," he explained. But packages coming in from Canada and Germany – which also sells a lot of fentanyl to the UK – are less likely to be caught. The vendor estimates that he ships 25 to 30 orders to Britain every week, most a gram or half-gram in weight. Though this sounds like a small amount, with 50 micrograms being the recommended surgical dose – and less than 2 milligrams (the equivalent of two grains of salt) being enough to kill an inexperienced user – it goes a long way. One gram costs roughly £85 on the dark net, where it's sometimes marketed as "China White" or "synthetic heroin".
"I've many repeat customers from the UK," the Canadian told me, "and I'd say I get ten new customers a week. But because I'm considered an international vendor I'm sure I get nowhere near as many sales as a British vendor would."
Today, there's just one fentanyl vendor on the dark net in the UK. His profile points to dozens of orders per day and many thousands since 2015. I contacted him multiple times for an interview, but he never responded. Before him, though, was Kyle Enos, a 25-year-old who was sentenced to eight years in prison in February after police raided his home in Newport, Wales last May. Though considered bad practice for a vendor, Enos kept his customers' details on file, and when police tracked them down they discovered that, out of 168 over a one-year period, four had died after using fentanyl – but they couldn't say with certainty which dealer the drugs had come from.
Aware of how dangerous the drug is, Enos included handwritten notes with his fentanyl, saying things like "Please consider this" – but the National Crime Agency concluded that ultimately he was "play[ing] Russian roulette with the lives of his customers". In a statement last month, the NCA said that his arrest had "had a direct impact on the availability of fentanyl in the UK".
And it had, for as long as it took users to refresh the page.
A gram of heroin on the street is about £50. As fentanyl is so powerful, it's possible to remove most of the heroin from a batch, bulk up the weight with a cutting agent like milk powder, and add a bit of fentanyl to jack up the high. To a heroin dealer trying to establish himself on the street, the appeal is obvious, but if a user is expecting just heroin – or if the fentanyl is unevenly spread (or "hotspotted") – the result can be deadly.
The problem when talking about fentanyl deaths, however, is that no one knows exactly how many there have been. Though the published number is 113 in the UK over the last 14 months, the standard toxicology test in Britain doesn't test for the drug, meaning some fentanyl deaths are likely attributed to just heroin. In fact, the 113 number was only arrived at after specific backtesting in areas where fentanyl was known to be rife, on bloods that had been retained (after six months, bloods are discarded).
The question is: if every OD death was tested for fentanyl, what would that number be?
The people who we know died of fentanyl overdoses come mainly from the Humber region and Yorkshire, but the drug has also been reported elsewhere – London, Birmingham and the Scottish Borders being three examples. Every death is tragic, but a noteworthy case was that of three musicians who lived in the same house in Kent, who died five days apart last August. James Truscott (25) overdosed on the 24th, followed by Joshua Lambert-Price and Maximum Martin (22 and 35, respectively) on the 29th. Lambert-Price had even given evidence to police after Truscott's death.
Meanwhile, hundreds of British users buy heroin on the dark net every week. One well-known vendor, based in London, has been accused by multiple customers of selling fentanyl-laced heroin, with some even claiming to have had it tested. When I approached him for comment he called his accusers "deluded and degenerate", and when I asked for an interview he wrote, "Send us 5 Bitcoins [£36,000] and we can arrange a brunch appointment at Canary Wharf, my friend."
Judging by the orders on his profile – 1,500 in one year – his business seems unaffected, which comes as no surprise. Researching this story, I came across a prevailing theory among law enforcement and journalists that fentanyl-laced heroin use is almost always accidental. Yet, from talking to users and reading hundreds of posts on websites like Reddit's "Opiates" forum, it’s clear a huge number specifically search for this stuff, the same way they hunt down pure fentanyl.
John* (27) lives in Brighton and hasn't used fentanyl – knowingly, at least – for five months. He did, however, use it for several years before that, and is now a near-daily heroin user. He explained to me how he got started: "I'd already tried and liked codeine and Oxycontin, so when my guy mentioned he had this other opioid I figured I might as well give it a go. This guy sold Oxy and fent patches while I was living up north. Where he got them, I don't know, but he had some serious pharmacy connections."
Despite doing fentanyl for years, John has only ever used the patches: "I started smoking them off of foil, then for a bit switched to shooting them. But it was a lot of work to prep them – over 45 minutes per shot – and not much fun, so I switched back to smoking."
A similar story of opioid graduation came from Dave* (25), who lives in the north-west of England and has used fentanyl for three years. When we spoke he was going through heavy withdrawals, waiting for his latest order of fentanyl-laced heroin to arrive in the post. "I started climbing the opioid ladder with pills like Tramadol and codeine," he said. "When they got expensive and [my] tolerance grew, I moved to heroin. Then, when heroin became too weak, there was another option: fentanyl."
Fentanyl withdrawals occur much more rapidly than with heroin – sometimes three to four hours after a hit. Dave describes them as, "The equivalent of being sent to hell and burning alive for all eternity. Unsurprisingly, when you're detoxing you can't even leave the bed without the obligatory need to shoot water out your asshole, so my state of mind is a bit wired right now."
For John, the fentanyl high is completely different to that of heroin. Heroin is much more euphoric and warm, he says, whereas fentanyl is just extremely sedating. "I really don’t know why I like it so much," he says. "When smoked it's like the crack of the opioid world – it hits very hard, very fast, but then 15 minutes later you're sober enough to be getting the next hit ready."
Dave tells me of a near-overdose he had on the drug. He'd clearly snorted too much, and felt his breathing become shallow. "I had to go for a walk to calm down, and so that if I collapsed I'd be in public with a note in my hand that read: '999, opioid OD, use Narcan'."
Though Narcan – or naloxone, a medication used to block the effects of opioids – works with fentanyl, more doses are required than with heroin. It's likely that even the most privileged fentanyl user, with naloxone on hand, won’t have enough to counteract an OD.
I asked the Canadian vendor if he felt any responsibility for fentanyl deaths or addiction. He told me that if people were using the drug they should know what it does and what safety precautions to take, adding, "I’m supplying only fentanyl, not any fentanyl-laced products. I hope each user knows what they’re doing but, from my point of view, I’m selling a product as advertised."
I wondered if the anonymity provided by the dark net was separating him from the reality of what he was selling, so I asked a follow-up: "Have you ever used fentanyl yourself?" His answer surprised me: "Yes, I’ve used it in the past. I was addicted to it for a year-and-a-half and had to go to rehab to get off it. I've had a few relapses but am still clean."
Clearly, for him and everyone else selling fentanyl, the money to be made outweighs any perceived immorality. Instead of scaring him off the drug, his addiction – which began before he started vending – evidently made him more aware of fentanyl's economic potential. "I won’t say how much I make or have made," he said, "but I can tell you the profit margin is more than 60 percent."
For some in the dark net generation, hope of recovery lies in their youth – both John and Dave are in their mid-twenties, as are plenty on Reddit's Opiates forum. But for other fentanyl users, like those living on Britain's streets, the outlook is grim.
Naturally, if Britain's drug policies were based on harm reduction, improving mental health and homelessness would be a priority, along with providing free fentanyl tests and supervised injection sites (SIV), where naloxone would be endless. Instead, the government has blocked the UK's first SIV from opening in Glasgow. Other Conservative responses to record-high drug deaths in the UK include pushing people off methadone and the baffling Psychoactive Substances Act.
At the beginning of this, I wondered about Britain’s potential to follow the US down a fentanyl blackhole. Realistically, with a private healthcare system foisting opioids on everyone, the US is a special case. Nevertheless, the UK's problem is significant enough to warrant a health-based response, but the government have merely spent money trying to stop fentanyl hitting the streets, when, obviously, they can't.
The Canadian tells me how he avoids detection: "Law enforcement are always on my mind. I'm always switching my source of internet, my computers, phones, stash spots and packaging locations."
John, meanwhile, believes it's only a matter of time until fentanyl shows up in Brighton, his current hometown. "The amount of money that can be made shotting the stuff is too good for some people to pass up."
At the beginning of this article I wrote that, to predict its next step, we must understand the journey fentanyl takes to the UK. As I'm afraid fentanyl’s next step may be carfentanil – its more powerful cousin, recently found in several deaths in Hull – maybe our next step should be understanding the journey the UK has taken, headlong, towards it.
*Names have been changed
This article originally appeared on VICE UK.