This article originally appeared on VICE US.
Last May, staff from New York City’s Department of Health and Hygiene toured bars and nightclubs to spread the word that the city’s cocaine was being laced with the lethal synthetic opioid fentanyl. “We want [people] to know that fentanyl is in our cocaine supply, and they are at risk of an opioid overdose,” said New York’s then-Health Commissioner Dr. Mary T. Bassett. “If you use cocaine, make sure someone is with you who can call 911 or administer naloxone in case you have an opioid overdose.”
This was no idle threat. NYC’s health department, one of the largest public health agencies in the world, had gone on record to say that the average cocaine user doing lines in the bar bathroom was at “exceptionally high risk of overdose” from fentanyl-laced cocaine. Drinkers, who began to question why their dealers were trying to poison them, were handed coasters warning them of this danger. Venue owners and bar workers were given kits of naloxone, the medicine used to reverse opioid overdose, to store with first aid supplies.
It was a stark warning and a further sign from authorities around the US that the opioid crisis had reached a second threat level: that fentanyl had seeped out of the opioid world and into America’s mainstream, recreational drug market. Over the past couple years, institutions nationwide—health officials, criminal justice agencies, and the media—have warned that fentanyl is not just being added to heroin and other opioids, but also to drugs such as cocaine and even cannabis.
Last July, one of America’s most senior drug health experts, Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), told a doctor’s conference that fentanyl “is being used to lace a wide variety of drugs—including marijuana." NIDA’s website says that fentanyl is also being mixed by dealers into MDMA. And at a White House news conference last week, Kellyanne Conway, President Donald Trump’s opioids czar, repeated her mantra that fentanyl is being “laced into heroin, marijuana, meth, cocaine.”
If this is to be believed, then with America’s roughly 5 million users of cocaine, 1.4 million users of methamphetamine, and 37.6 million cannabis users, per the CDC's most recent numbers, the deliberate mixing of fentanyl into the mainstream-drug food chain could turn the opioid crisis into an outright massacre.
Yet a closer look by VICE reveals that the threat of fentanyl being intentionally mixed into recreational drugs has been overblown by the authorities. Independent experts say the strong financial incentive that tempted America’s heroin suppliers into switching from heroin to a cheaper, more potent opioid, even if it meant killing of thousands of customers, does not apply to cocaine. In some instances, cheap street cocaine shows evidence of having been contaminated with trace amounts of fentanyl. It's an important and dangerous reality for some users, but nothing nearly along the lines of what authorities are suggesting.
This is part of the reality of drug supply chains. Cocaine is packaged and repackaged and cut multiple times as it gets distributed down the line from bulk importers, to high-level distributors, to dealers selling larger amounts of higher-quality product to upper- and middle-class users, down to the poorest dealers selling the most stepped-on cocaine and heroin to the poorest users, who have always had to contend with unscrupulous dealers and low-quality product.
That's not to say that cocaine is safe to use if you’re buying the expensive kind. There are plenty of risks involved with a drug whose provenance you can never be completely sure of, so users would still be well-advised to tread cautiously. An estimated 150-300 million grams of cocaine are snorted, smoked, or injected each year by the rising tide of US cocaine users, and it is inevitable that fentanyl, a powder that can be deadly at a dose of just 2mg, will become mixed with other powders that are packaged, cut, and sold alongside it. There have been small, sporadic outbreaks of crack and powder cocaine contaminated with fentanyl in Philly, Connecticut, San Francisco, San Diego, Atlanta and Ohio. And last September, rapper Mac Miller died in LA from an overdose of fentanyl, cocaine, and alcohol, although it is not known how Miller, a long-term prescription and street drug user, consumed the fentanyl.
But according to experts, nationwide drug studies, and the DEA's own data, fentanyl contamination in non-opioid drug supplies is exceedingly rare, and largely centered on a specific, highly-vulnerable subset of users. Critics say this is why the alarm raised by health officials and law enforcement is so concerning: Authorities stoking broad, misleading fears of fentanyl poisoning the non-opioid drug supply marks a damaging mission creep in the battle to stem the opioid crisis. As we've seen previously in the War on Drugs, narratives based on fear, not data, distract policy makers, public health advocates, and even first responders away from those who are at real risk.
There is no debate about the seriousness of the opioid crisis, a national emergency in which 47,000 US citizens died from opioid-related overdoses in 2017. The key driver behind the escalation of fatal overdoses has been fentanyl, now the most deadly illegal drug in America. Alongside similar synthetic opioids such as carfentanil, fentanyl was involved in 28,000 of the 70,000 total drug overdose deaths in America in 2017.
The rising devastation caused by fentanyl is closely linked to a jump in heroin use, itself influenced by an increase in recreational painkiller use. Many of America's heroin users were first addicted to prescription opioids, but switched because heroin became easier or cheaper to get than prescription pills. To feed growing demand for heroin, criminal gangs started mixing fentanyl into heroin batches, and to a lesser extent counterfeit opioid pills, because it saved money. As a result, deaths among heroin users soared, from 8,200 in 2013 to 15,000 in 2017.
It is also clear that there's some sort of cocaine-fentanyl connection: overdoses involving both cocaine and fentanyl soared from 180 in 2012 to over 4,000 in 2016. And, as Jill Head, the DEA’s forensics lead on emerging trends, tells me, although the number of drug deals containing cocaine and fentanyl being seized by police are small, they are on the rise.
It is this uptick in deaths involving both cocaine and fentanyl, alongside a string of claims by officials and the mainstream media about the drugs being routinely cut together, that has led the authorities to issue such dire warnings about fentanyl-laced cocaine. Coast to coast, police and public health officials have been quick to correlate a jump in fatal overdoses involving both cocaine and fentanyl to cocaine being laced with fentanyl.
On the face of it, this narrative is backed by solid evidence put forward by the organizations that are meant to know about these things. New York City’s health department used the cocaine-fentanyl death correlation to rubber stamp its series of warnings to New Yorkers about fentanyl-laced coke, noting in one health alert that “fentanyl was detected in 37 percent of cocaine-involved overdose deaths without heroin in 2016, up from 11 percent in 2015.” The DEA is also convinced. In its latest National Drug Threat Assessment, it states: “The expansion of fentanyl-contaminated cocaine is fueling a surge in cocaine-related overdose deaths. Due to the ongoing proliferation of fentanyl and other synthetic opioids into the expanded domestic cocaine supply, cocaine-related deaths will continue to rise through 2018, potentially reaching epidemic levels in the next few years.”
But does the evidence back up the theory that people dying with cocaine and fentanyl in their bodies means they had been using cocaine cut with fentanyl? And does it even make sense for drug dealers to routinely mix opioids, which have a depressant effect, into stimulant drugs such as cocaine?
Experts VICE spoke to said there are other, far more likely, explanations—ones that reflect the inherent inequality of America’s diverse groups of drug users.
First off, postmortem forensics only show the drugs people consumed before they died, not whether they were mixed in the same bag when they were bought. Drug users often take different substances throughout the day or week. A significant proportion of people who use heroin also use crack or powder cocaine—35 percent nationwide, according to the National Survey on Drug Use and Health, and up to 70 percent in some cities. The two drugs are often sold together by the same street dealers. Users often take heroin to reduce the comedown of cocaine. They are also being mixed in the same hit by users as speedballs, a rising trend in New York, according to former heroin user and dealer Tino Fuentes, who works to reduce the harm being caused by fentanyl on the East Coast.
Added to this, the heroin these people are buying is not just being increasingly cut with fentanyl, but is being completely replaced by it. In his study published in February into the drivers of the US opioid epidemic, Professor Daniel Ciccarone, a leading authority on US drug markets at the University of San Francisco, said that in some parts of the US “what is driving increases in opioid mortality now are deaths due to fentanyl-adulterated or fentanyl-substituted heroin.”
Indeed, the DEA acknowledges this in its National Threat Assessment: “It is increasingly more common for fentanyl to be mixed with adulterants and diluents and sold as heroin with no heroin present in the product.” Given the spread, and in some areas dominance, of fentanyl in the heroin food chain, coupled with a rise in cocaine use since 2012, it's not surprising to see cocaine and fentanyl more frequently found in fatal overdose cases. This likely contributed to the spike recorded by NYC officials in overdoses involving fentanyl, cocaine, but not heroin: As fentanyl replaces heroin in the supply chain, some users are mixing cocaine and fentanyl—perhaps without even knowing it.
"Do dealers wipe the table down after chopping heroin before chopping out their cocaine? No. Now with fentanyl in the food chain, this cross-contamination has become meaningful, because it’s so much more potent."
“Among heroin users, some of whom may also use cocaine, risks for fentanyl overdose are high, given fentanyl is increasingly marketed as heroin,” said UCLA professor Steve Shoptaw, who studies substance abuse. “On the other hand, few people who use cocaine recreationally [by itself] have unexpected fentanyl overdoses. At this point, there just isn’t any evidence of a wide-scale substitution of fentanyl for cocaine, or methamphetamine, in drug markets.”
It wouldn't make sense for a dealer to take fentanyl and label it cocaine, but contamination is a concern for a subset of users. Philadelphia-based freelance journalist Chris Moraff has been using fentanyl testing strips to test hundreds of drug deals around the city. Some street-level cocaine deals have tested positive. “But it’s a different story when you move off the street. I’ve tested middle class cocaine—eight-balls bought by finance guys and bros—and they always, always come up negative,” he told VICE.
The gates to fentanyl have now swung open, and there is risk for recreational drug users. But it is not an evenly distributed one. To say, as Kellyanne Conway does, that fentanyl is “indiscriminate” and can be found in any street drug deal, is not merely misleading. It's a narrative that distracts from the needs of the thousands of people who will be killed by fentanyl-contaminated opioids this year. It has always been the case that the threat from tainted drugs disproportionately affects the most disadvantaged people in society.
The people dying with cocaine and fentanyl in their bodies are generally not the people who might plonk their beer down on a NYC Health Department-issued coaster in a Brooklyn bar. Opioid drug overdoses are closely linked to economic inequality, low education levels, long term addiction, and homelessness, with deaths from heroin and synthetic opioids such as fentanyl spiking in “economically beaten-down communities.” Like any other trade, two polarized drug-using communities—the wealthy and the poor—are rarely served by the same dealers. While street-level cocaine dealers selling bags to homeless users might end up selling deals that have become cross-contaminated with fentanyl and heroin in bagging-up dens, those zipping in and out of bars and universities to deliver "premium" powder to the middle classes are unlikely to be in the heroin selling game.
“A white-collar user is safe [from this particular concern],” said Ciccarone. “If someone can show me someone who has overdosed from fentanyl-laced cocaine at a music festival or in a trendy club or bar, I’d like to see it. In the street supply, the nickel and dime bags, yes, there is evidence for fentanyl [contaminating] cocaine. But in the cocaine of the privileged, I’ve not seen it.”
The people who are overdosing with cocaine and fentanyl in their bodies are not your average coke user, according to Dr. Kendra Viner, Opioids Program Manager at Philadelphia’s Department of Public Health. “People who died from overdose with cocaine and fentanyl in their system look similar demographically and in death scene presentation to those who died from overdose with cocaine and heroin,” said Viner.
“They are demographically different than folks who died with cocaine detected and no other opioids," Viner said. "We believe individuals are intentionally speedballing cocaine with an illicit opioid. To date, we only know of one exception to this which was a fentanyl outbreak among crack cocaine users in west Philadelphia last year. This outbreak was attributable to a single point source outbreak among opioid naïve crack-cocaine users that to our knowledge has only occurred this one time.” But the outbreak, in which two crack users died, appeared to be highly concentrated among a small group of 20 users in the city. In the weeks after the outbreak, Moraff tested multiple street level cocaine deals, including this batch, but found no fentanyl.
The best way of gauging how much of America’s cocaine is being adulterated with fentanyl is to look at the product before it is consumed, when it’s seized in bags and in larger stashes by the police. And the data does not support the narrative that there is enough cocaine laced with fentanyl in circulation to cause the deaths it is being linked to.
At the DEA’s office in Pennsylvania, a state with one of the highest opioid death rates in the US, staff were curious enough to fill what they admitted was an “intelligence gap” about how much the state’s cocaine supplies were really being tainted by fentanyl. Their forensic investigation last year looked at 30,914 cocaine exhibits (mostly drug samples but also paraphernalia and storage cases) submitted to the National Forensic Laboratory Information System (NFLIS) from the state between 2015 and 2017. It found only 214—less than one percent—contained traces of fentanyl.
The DEA’s report is clear: “Overall, analysis of the presence of multiple illicit drugs in laboratory analyzed seized-drug exhibits in Pennsylvania indicates that the deliberate introduction of fentanyls into the cocaine-only user market is almost non-existent in Pennsylvania.”
This study was matched by similar lab tests carried out nationally in 2016 and 2018. Of more than 34,000 seized drug deals containing fentanyl that were sent to NFLIS for further testing in 2016, 1.4 percent also contained cocaine. And of 2,555 drug batches containing fentanyl the DEA sent to its labs for analysis last year, 1.1 percent contained only fentanyl and cocaine. (It is important to note that even these figures of around 1 percent probably overstate the threat from cocaine and fentanyl found together in exhibit tests. Some positive samples contain traces of fentanyl so minute as to have no effect on the human body, or were taken from drug paraphernalia that may have been in contact with many different substances over time.)
The difference between the claims and the facts is even more alarming when it comes to fentanyl’s infiltration into other recreational drugs. Despite a flurry of claims by district attorneys, coroners, and government health officials about fentanyl-laced cannabis and similar claims about fentanyl in MDMA, the DEA reports that there have been “no indications of marijuana and fentanyl identified” and “no exhibits found to contain fentanyl and MDMA.” Mixtures of methamphetamine with fentanyl are “a rare occurrence,” with only 18 out of thousands of methamphetamine samples tested by the DEA testing positive for fentanyl since 2014.
Drugs intelligence officers and forensic scientists contacted by VICE via NIDA’s National Drug Early Warning System widely rejected claims that cannabis is being adulterated with fentanyl. Barry Logan, chief scientist at NMS Labs, which tests drugs seized by law enforcement agencies around the US, said that of 34,000 exhibits tested since 2016, 100 showed positive for both fentanyl and THC. But he said most of these exhibits were not drug samples, but paraphernalia or drug storage boxes, where contamination during the owner’s storage of their drug stash could easily have occurred. “My assessment is that there is no pattern of marijuana being doped with fentanyl, certainly not at the dealer level," Logan said.
The game changer would be if drug dealers had started to deliberately and routinely lace cocaine with fentanyl—something the DEA claims to be true, but other experts reject. According to Wade Sparks, a DEA special agent attached to the agency’s Office of National Media Affairs, the mixing of fentanyl into cocaine is happening very deliberately, and from high up the drug chain.
“I can tell you as a DEA agent who is speaking to other agents daily in the field, this is happening," he said. "I’m not saying it is widespread, but I am saying there are some organizations that are absolutely purposely putting fentanyl into cocaine or meth at the bulk level. DEA has interviewed defendants who have admitted they are purposely mixing fentanyl with these drugs.”
VICE asked the DEA for evidence of any bulk-level cocaine shipments that had been laced with fentanyl. The agency came up with one example, a recently seized a 2-kilogram batch of white powder containing cocaine and fentanyl being trafficked over the US’s southwestern border. But the DEA said that purity tests had not been done, so they could not rule out the possibility that the batch was actually fentanyl with traces of cocaine.
Yet in its National Drug Threat Assessment, the DEA plays down the wholesale theory. “The overwhelming majority of fentanyl reports and cocaine reports submitted to NFLIS contain only fentanyl or only cocaine," the report states. "This, along with law enforcement reporting, indicates most cocaine-fentanyl mixtures are most likely not mixed at the wholesale level and the majority are probably unintentional.”
The contamination theory—that cocaine becomes more likely to contain trace amounts of fentanyl the nearer it gets to the fentanyl-dominated street heroin trade, is backed up by a deep-dive analysis carried out in Ohio. Harm Reduction Ohio, a drug policy NGO operating in a state with the second-highest drug-death rate after West Virginia, found that none of the state's 68 bulk seizures of cocaine in 2018 tested positive for fentanyl. The nearer the cocaine got to the bottom of the narcotic food chain, the more likely it was to become tainted by fentanyl, with 5 percent of gram bags and 7 percent of half a gram bags containing fentanyl, a far higher amount than the national average.
Some drug users may make speedballs themselves, but historically, suppliers and street dealers have never habitually combined the two. It makes no business sense to put fentanyl in cocaine, nor would it be appreciated by the end user. Because cocaine is a stimulant and opioids are depressants, a dealer selling cocaine laced with fentanyl or heroin would lose customers.
“I don’t think this is purposeful cutting, I don’t buy the evil dealer hypothesis,” said Ciccarone. “Both cocaine and heroin get stepped on many times before they hit the street, and sometimes they accidentally get mixed up. Do dealers wipe the table down after chopping heroin before chopping out their cocaine? No. There has always been bits of heroin in cocaine because of this, but not actually in meaningful amounts. But now with fentanyl in the food chain, this cross-contamination has become meaningful, because it’s so much more potent.”
Ciccarone believes there is not enough drug surveillance being done by police or public health departments to keep track of what substances are contained in drugs in America. “Why are we not doing that?" he asked. "If I was head of the DEA, I would demand that seizures of coke were regularly tested.”
So why the misleading claims about recreational coke and cannabis users being at such a high risk?
On one hand, public health officials are doing what they're meant to do: warn the public about health risks. On the other, the scale of the concern around fentanyl contaminating the entire US drug supply is a very familiar narrative in the War on Drugs: the belief that dealers are governed not by economics but by malice, that users are helpless addicts, and that drug eradication is the only solution to these problems.
Ever since the days of 1930s Reefer Madness, the authorities have been at ease with spreading myths and propaganda about drugs, the people who use them, and the people who sell them. And as such, we've already seen the ills of fighting drug use in moral, not data-driven, terms: more and more resources will be poured on the latest trend in drug fear-mongering, while the old problems—and most importantly, the disadvantaged individuals caught up in the drug industry—never fully get addressed.
“We have a problem on our hands with fentanyl. It's here, it's not going anywhere. But if we don't change the narrative and try something new, it will only get worse.”
Fuentes, who has witnessed first-hand the disconnect between the reality of the street drug trade and the way it is represented by police, the government, and the media, said he believes the publicity over cocaine laced with fentanyl is a cynical attempt by police and public services to push their own agendas.
“They are looking for more money to fight cocaine," he said. "They want to scare people away from using cocaine and they are trying to scare users into becoming informants by saying their coke dealers are trying to kill them with fentanyl. I'm not saying that no one is doing it. There are cases where lower-level dealers are buying a few ounces of coke then ordering a few grams of fentanyl and adding it because they think it gives the coke a rush, but that's a very small amount of people."
“We have a problem on our hands with fentanyl," Fuentes added. "It's here, it's not going anywhere. But if we don't change the narrative and try something new, it will only get worse.”
Fuentes is right. Wheeling out the classic tropes from the War on Drugs—in this case, treating all drug users as an amorphous lump when they are largely as diverse as America in general—is poor policy. Exaggerating the presence of fentanyl within the country’s hugely widespread recreational drug scene may be a well-meaning strategy for health agencies, or a way of trying to reduce the public’s demand for drugs by the police, but ultimately it could hinder more than it helps. Why target America’s mainstream recreational markets, when the contamination and deaths are occurring within a distinct group of people?
Detracting attention from the overdose crisis could have as-yet untold policy implications, and it's already having an impact on the ground. Exaggeration over fentanyl’s spread into the mainstream drug market is part of a wider panic about police and medics overdosing on fentanyl just from being near it or by touching it, despite this being impossible. The parallels with contamination hysteria during the 1980s HIV/AIDS epidemic and in homes where crystal meth has been smoked are unavoidable. But do we want to go down the same road again of wasting time and energy chasing scare stories?
“The current media frenzy around ‘deadly’ fentanyl exposure through skin contact is just one example of how urban myths can lead to bad policy on drugs,” said Leo Beletsky, an expert on drug policy at Northeastern University.
“The federal government has set aside millions of dollars for biohazard and decontamination equipment designed to address an overblown threat to law enforcement agents," he added. "It deflects from real solutions, both literally and figuratively, since every dollar spent on biohazard equipment or paying people in hazmat suits $30,000 to clean up after a heroin bust isn’t spent on real solutions.”
Cash-strapped institutions are already struggling to stem the runaway opioid epidemic. “Dramatic reports on occasional, though horrible instances of cocaine plus fentanyl-related deaths may make good click-bait,” said Shaplow. “But these also interfere with clear thinking needed for data-driven public health responses to the addiction problem in the US.”
The last thing that is needed now in the long battle against the opioid crisis is a misguided mission creep, where exaggerated and misleading public messages begin to dictate an expanded drug policy that stretches resources used to support vulnerable users. Prof Ciccarone sums it up well. “A moral panic both stems from and feeds fear. And fear inhibits us from our best actions.”
Clarification 4/5/19: This story has been updated to clarify that Dr. Mary T. Bassett was New York's Health Commissioner at the time of the press release cited in this article, but has since left the position.