Fentanyl is about 80 times more potent than morphine and bout 40 times stronger than heroin. The street version of the drug is being blamed on an increase in overdoses that in some cases, can take as many as six injections of Naloxone to save the person's life.
Fentanyl the prescription drug and fentanyl inside a heroin bag come from very different sources, although both can be abused.
Prescription fentanyl has been around for years, intended for chronic severe pain, trauma and cancer patients. Brand names include Actiq, Duragesic, and Sublimaze where the drug is administered through a patch, injection or lollipop.
Fentanyl sold on the street under names like Apache, China Girl, China White, Dance Fever, Murder 8 and TNT, is an entirely different monster.
With a recent increases in overdoses, drug field tests started turning up positive for street fentanyl. Brunswick County Sheriff's Office Vice Agents say dealers have been mixing the powder version of fentanyl into their heroin bags to boost sales.
The drug dealers marketing techniques have been successful - and lethal.
"I could literally take the smallest grain that you could see with your eye and that would be a dose," explained Sim,* who sold fentanyl in Wilmington before getting arrested. "I started taking that around and giving it to people and it just blew up my reputation."
The drug is a narcotic, like heroin. But unlike heroin, which requires the poppy plant, fentanyl is a synthetic drug that's easy to make with the right precursor ingredients.
Similar to heroin, morphine, and other opioid drugs, fentanyl binds to opioid receptors inside the body which control pain and emotions. The subsequent surge of euphoria and relaxation fuels the need for more and more.
"You're getting more bang for your buck," said Sim, who bought his first order of fentanyl at age 19. Just a gram and a half of the drug netted him close to $90,000.
Mixing fentanyl into heroin magnified the potency and also, the risk.
As Sim explained, a single gram could kill thousands of people. Having been a good student with a strong talent in science, Sim was able to measure and mix just the right amount of fentanyl to give his customers a high they had never experienced. Several overdosed which he linked to their mixing in alcohol and other substances.
Still, at microgram measurements the danger to users is extreme.
At a routine traffic stop, BCSO patrol discovered 118 grams of pure fentanyl. New Hanover County's drug unit is also seeing more of the drug mixed into dope bags.
"The heroin we've been getting over three or four months, we've been testing it for both fentanyl and heroin and I would say 90 percent of it tests positive for both. People are selling bags that are supposed to be straight heroin and they're nothing but fentanyl," said Entanglement Steve Lanier of BCSO Vice Unit. "That's the bad thing, taking the word of a drug dealer that what you are getting is what they say it's going to be, which ultimately ends lives."
The drug nearly destroyed Jonette Greenwell's life. Unlike injection drug users, she was abusing her doctor-prescribed fentanyl patches.
Her addiction was something no one would ever expect from a self-proclaimed "soccer mom."
Greenwell got hooked on narcotic pain medication after back surgery. With her husband being a pharmacist, she admits she had always looked down on addicts, yet was surprised in herself when she felt happier on the pain meds.
It was a feeling she didn't want to end.
Her husband identified her dependency having seen it in his customers before.
"He tried to take them away from me and we got into a fight," Greenwell remembered. "And I stabbed him."
She smiled after finishing her sentence, not over what she did, but acknowledging how out of control and ridiculous her life had become.
It's often said that addiction does not discriminate and Greenwell is a living example. Pick any neighborhood and that's where addiction lives.
"I like to call it the shiny trashcan," Greenwell said. "As long as everything looks good on the outside it doesn't matter about the garbage on the inside."
After another back surgery she was prescribed fentanyl patches on the assumption she could not abuse them.
"I called a rehab friend and he told me how to cut them up," Jonette explained. "He said, 'Don't chew a whole one it could kill you,' and heaven forbid I don't want to do that, so I cut it into fourths and just chew on it with the gel in it."
When her husband would apply a fresh patch to her back, Greenwell would pull out an old patch and put it in it's place so she could get high on the new one.
"It's like every blood vessel is alive," she described. "Like when you climb up a roller coaster and all that adrenaline just - you're just alive."
As nice as that experience may sound, it leaves out the consequences. Rehabs, overdoses, a coma, suicide attempt and several years of struggling.
Today Greenwell is sober. And happy.
"The best thing my husband ever did for me was ask for a divorce," Greenwell said. "And he knows that. It saved my life because he was loving me to death."
But how is a pharmaceutical patch going from prescription to street-level powder?
"It just came in a regular envelope, a letter," Sim said. "Looked like it came from a business."
Clandestine labs across the globe manufacture fentanyl into a synthetic powder. When Sim started selling it he had just graduated high school where he had top grades, good parents and before he turned 20, a major drug operation going between a house and apartment he rented.
"Money laying all over - every counter, all over the floor, and every surface," he said.
He did it through what's called the "Dark Web" and it took him all of ten minutes to show how to send pure fentanyl and just about any other drug to our front door.
The Dark Web is a collection of websites that can hide your IP address, basically your computer's name tag on the internet. Once on it, buyers can search global drug marketplaces that use scrambled web addresses which constant change.
Fentanyl, a variety of narcotics, ingredients to make drugs and just about anything else was all just a few Bitcoins away.
That's how Sim and many other dealers operate under the radar.
"It's scary to think that these products are available and so easily attainable to those not trained or educated in drug metabolism," said Buck Martin of King's Pharmacy and Compounding. "When you're relying on somebody who has no medical background, no regulation at all, then you're just playing with your life."
People have already lost that game and more surely will.
With such a strong narcotic some members of law enforcement are having to use as many as six injections of Naloxone to reverse the overdose. Without Naloxone and immediate medical attention, the risk of death is extreme.
Right now, local agencies are receiving free Naloxone kits thanks to the efforts of the North Carolina Harm Reduction Coalition and grant money. The cost of each kit can range from about $30 to several thousands.
State funding is critical to keep the supply at a low or no cost.
As our county vice agents fight back against what's being sold on the streets, fentanyl patch users can take extra safety measures as well. After a patch is used it may still contain residual levels of the drug. Fold the patch onto itself so it sticks, place it in a plastic bag and dispose of it away from kids and pets.
*Some names have been altered to protect identities.
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