For the past several years, law enforcement and public health officials have warned that fentanyl — a potent, synthetic opioid powder causing a spike in overdoses on the coasts — would soon arrive in Colorado.
It’s clearly here, and the statistics for 2020 reveal a drastic jump in use of the drug considered 10 times more deadly than heroin.
In Denver, overdoses involving fentanyl more than doubled in 2020 compared with 2019. And the 119 deaths from fentanyl last year were seven times the number in 2018, when 17 people overdosed on the drug in the city, according to the Denver medical examiner’s office.
Statewide, overdose deaths involving fentanyl also more than doubled, rising 111% to 452 deaths last year from 214 in 2019. All overdose deaths, including from heroin, cocaine and methamphetamine, totaled 1,223 in 2020, up nearly 20% from 1,062 the year before, according to state health department data that is preliminary and expected to rise even higher.
Health officials worried that the coronavirus pandemic, which kept people isolated and led to increased rates of anxiety and depression, would also lead to more drug deaths. Data released at the close of 2020 proved those fears true.
“Fentanyl is like kerosene. Methamphetamine is like natural gas. Then the COVID pandemic is like, ‘Let’s add some diesel fuel,’” said Dr. Joshua Blum, an addiction medicine doctor at Denver Health. “It’s like one flammable agent added to another.”
A 16-year-old girl who died after ingesting fentanyl that she was told was oxycodone while at a party in Aurora is included in the 2020 fentanyl overdose count. The man who authorities say provided the drug, Jorge Alexander Che-Quiab, was charged in December with her murder.
In another 2020 case, a 2-year-old child died of a fentanyl overdose in a Lakewood motel room. Her parents, who were charged with child abuse resulting in death, had a trash bag in the room filled with multiple drugs, including Xanax and oxycodone, according to law enforcement.
Seizures of fentanyl, which is smuggled in from Mexico and found along the Interstate 70 and Interstate 25 corridors, have doubled each year for the past four years, including in 2020, according to the Denver field division of the Drug Enforcement Administration.
Four or five years ago, fentanyl was a street-drug problem relegated to the coasts, and basically nonexistent in Denver, Blum said. Now, he said, “fentanyl made its way to the middle of the country.”
The drug is sometimes added to heroin to stretch production and increase potency. Illicit drug producers use pharmaceutical industry machines to press the powder into pills that look like Xanax, Percocet or a generic oxycodone.
The counterfeit Percocet or Xanax is sold on the streets and on the dark web, though the DEA has cracked down on online sales in recent years, including shutting down the infamous “Silk Road” online drug site in 2013.
Fentanyl is up to 100 times more potent than morphine and typically is used in hospitals to treat pain after surgery. Its potency is measured in micrograms, meaning it’s easy for illegal drug producers to mess it up, Blum said. Every batch is not the same, and a batch with a few extra micrograms can kill a person.
People accustomed to taking four oxycodone tablets per day are at serious risk of overdose if their next illicit purchase is actually fentanyl shaped to look like oxy, he said.
A 2017 study conducted by Xanax manufacturer Pfizer, along with law enforcement, found that just 5% of the tablets purchased on the darknet were actually Xanax. Out of 138 pills purchased, just seven were authentic.
Blum said he is seeing a huge increase in patients at his Denver Health clinic whose urine tests positive for fentanyl, but he noted that most patients are using more than one substance. About 60% of overdose deaths in Denver in 2020 involved three or more substances. Fentanyl was present in 43% of deaths, compared with 9% of deaths in 2018.
Still, about 80% of patients needing substance abuse treatment at Denver Health are suffering from “good old-fashioned alcohol abuse,” Blum said. “The pandemic has made everything worse,” he said. “It’s made alcohol abuse worse.”
Needle exchange program provides fentanyl test strips
The rise in fentanyl is evident, too, in tiny test strips handed out at the Harm Reduction Action Center, a needle exchange and overdose prevention center in Denver’s Capitol Hill neighborhood.
The strips are similar to a pregnancy test, but they detect whether fentanyl is present in meth, heroin or opioid pills. After cooking their drug, people can add water to the residue, then put the liquid on a test strip.
It takes three to five minutes for the result — one line if there is fentanyl, two lines if there isn’t.
Of the 2,161 test strips used in 2020 and reported back to the Harm Reduction Center, 42% were positive for fentanyl.
People who used the strips reported to the center that they often decided not to use the drug, used less of it than they had planned on before finding out it contained fentanyl, or asked a friend to stay with them in case they overdosed, said Lisa Raville, executive director of the Harm Reduction Action Center.
Harm Reduction began giving out the test strips in mid-2018 as one more overdose-prevention tool offered at the center, which also dispenses clean syringes and doses of naloxone that can save someone from an overdose. About 100 people visit the center each morning, filling their backpacks and bags with overdose antidotes, test strips and clean needles.
The center trained 680 people to use the fentanyl test strips in 2020.
Raville said last year was the perfect storm for overdose deaths. Fentanyl was taking hold in Colorado at the same time the pandemic caused long periods of social isolation. Plus, the stress of the pandemic caused people to relapse, and people are at higher risk of overdosing after a period of abstinence because their tolerance has decreased.
The center tracks the number of life-saving injections of naloxone, mostly given by friends who carry the preloaded syringes, and says those were up by about 40% last year. “We have our folks who are out there saving lives left and right,” Raville said.
She has pushed for a few years to get permission to open a supervised drug consumption site at her center, a place where people could use heroin, meth and other drugs without fear of arrest and in the presence of trained staff that could discuss treatment options or reverse an overdose. The Denver City Council approved an ordinance in 2018 allowing such a site in the city, but the state legislature voted down a bill that would have made the necessary change in state law.
Raville is hoping that the visible drug use on Denver’s streets during the pandemic will sway state lawmakers in her favor. With businesses closed, public restrooms locked and even the public library closed to visitors, people who are addicted are more likely to use IV drugs in alleys, parks and encampments, and without access to sterile water, she said.
“There is nowhere for people to go,” she said. “I feel like I’m shouting into the void saying, ‘Where is my overdose prevention site?’”
Public drug use, when the user is in a rush trying to avoid getting caught by police or seen by a person walking their dog, leads to more overdoses, particularly when people don’t have time to check for fentanyl, Raville said. “If I’m going to inject in an alley behind a dumpster, I don’t have three to five minutes to check and see if fentanyl is in there.”
An overdose-prevention site — Raville’s term for an injection site where people could inject or ingest drugs purchased elsewhere — would allow users to survive so they could eventually enter treatment, she said.
“No one has ever died from an overdose at one of them. The same cannot be said for Starbucks, 7-Eleven, King Soopers and Whole Foods and RTD transit stations,” Raville said.
The Harm Reduction center moved about a year ago from a small, brick building on Colfax Avenue across from the state Capitol to a more spacious building that previously was a French restaurant called Le Central. Raville maintains she has plenty of space to house a supervised injection site.
What she doesn’t have, at least now, is the legislation to allow it to happen.
Safe injection site conversation continues
State Rep. Leslie Herod, a Denver Democrat, said Colorado is already behind in addressing fentanyl overdoses, but she does not have plans to introduce legislation that would allow a supervised drug consumption site.
Herod, who traveled to Vancouver, British Columbia, a couple of years ago to visit a government-sanctioned drug injection site, said there is plenty of evidence showing the sites save lives and that she would support one here if that’s what the community wants. Such a site could warn people about fentanyl, help detect it in the drugs brought on site, and coordinate with law enforcement to make sure dealers are caught, Herod said.
Colorado policymakers have been warned for the last five to eight years that fentanyl was on its way, she said.
“It was only a matter of time that it made it into Colorado,” the lawmaker said. “We have been warned by health officials in other states as well as right here in Colorado. Unfortunately, the providers weren’t given the tools and we have not provided the options in state law to utilize some of the best practices to keep people alive.”
Herod said she wished the fentanyl test strips distributed by the Harm Reduction center were available throughout the state, for example. She also wishes Colorado had more robust plans to keep people from dying in their homes from overdoses without “access to life-saving medication they need.”
Most overdoses happen in private residences, not on city streets or homeless encampments. In Denver in 2020, about 11% of overdoses happened outside, and others occurred at motels and businesses.
“The challenge is the people who are dying alone, who are away from the public eye,” Herod said.
There is no legal supervised drug injection site in the United States, but there are 150 sites in 11 other countries.
The U.S. city that’s come the closest is Philadelphia, where a nonprofit called Safehouse raised enough money to open an injection site and the city approved it. But the plan has been mired in legal battles. Last month, a U.S. Court of Appeals ruled that such a site was a violation of a federal law known as the “crack house” statute.
Colorado Attorney General Phil Weiser last year supported the Philadelphia nonprofit’s efforts, joining six other states and Washington, D.C., in filing a friend-of-the-court brief.
This week, Weiser’s office said while the attorney general “believes states and local governments that wish to innovate should have the authority to do so,” he does not support opening a safe drug consumption site in Colorado, citing a lack of data and concerns from law enforcement.
“While he is sympathetic to the desire to find new methods to curb overdoses and needless deaths, the data is mixed on the effectiveness of such sites,” Weiser’s spokesman Lawrence Pacheco said. “As experiments and data gathering on them go forward, we can continue to evaluate the data on the use of safe injection sites.”
Legislation in 2018 that would have allowed an injection site to open in Denver was swiftly struck down by a Republican-controlled committee and met with skepticism in both parties by those who didn’t want Colorado to lead the nation on this front.
Colorado’s top prosecutor is also against the idea. U.S. Attorney Jason Dunn said last month that he supported the court ruling in Philadelphia to prohibit an injection site in that city, adding that legalized injection sites would only further the illicit drug trade.
“The idea of a government-sponsored drug house is anathema to the principle that government’s primary duty is to do no harm,” he said in a news release. “We cannot combat the opioid epidemic by enabling individuals to access and use illegal deadly drugs, particularly in light of the recent rise in illicit fentanyl use.”
Ingredients are shipped from China, smuggled up from Mexico
Here’s how fentanyl makes its way to Colorado:
Ingredients used to make fentanyl, its “precursor chemicals,” are shipped from Chinese drug trafficking organizations directly to Mexico, where illicit manufacturers turn them into fentanyl in garages and warehouses. The drug comes across the border through Texas and New Mexico and into Colorado, said Steve Kotecki, public affairs specialist with the Denver field office of the DEA.
Fentanyl has started replacing black tar heroin in Colorado because it’s more powerful and more profitable, he said. Also, opioid pills are in high demand.
Up until a few years ago, the country’s fentanyl supply was mainly on the coasts, entering via ship. The West Coast ports were receiving fentanyl shipments from China, Kotecki said. But tougher enforcement by the DEA, as well as the Chinese government, helped stop the flow. At the same time, the federal agency focused on shutting down online sales of fentanyl.
Both actions pushed the drug trade through Mexico, Kotecki said.
Drug cartels are pressing counterfeit oxycodone pills that are sold on the street in Colorado and look nearly identical to the real kind, he said. “If you hold them in your hand, they feel a little more brittle, a little more crumbly,” Kotecki said. “If you are someone with a pain management issue, and you become reliant on them and can’t get a prescription anymore, and you go to the street, you might be looking for oxycodone and then getting sold fentanyl without your knowledge. They look very close.”
Fentanyl is considered deadly at about 2 milligrams, while it takes about 20 milligrams of heroin to overdose. “It’s 10 times more deadly than heroin,” Kotecki said. “This stuff is really dangerous.”