Andy Brack was out cold with his head slumped back on the driver’s seat of a white pickup truck, a faint blue tinge around his lips. His friend, Ellen, had called 911 after the 50-year-old lost consciousness while driving to the store.
Brack had been smoking fentanyl for two days straight, according to Ellen, who managed to stop the vehicle from crashing. It was around 4.30pm and boiling outside, almost 108F (42C), and the pickup didn’t have air conditioning. She was doing CPR compressions when the paramedics arrived.
Unable to rouse him, the paramedics administered the drug naloxone via an injection into his upper left arm. The drug, widely known by the brand name Narcan, is an emergency treatment for opioid overdose that temporarily reverses the depressive and potentially fatal effects on the cardiovascular and respiratory systems.
Brack came to abruptly. He refused to be taken to hospital and became angry as the opioid withdrawals set-in. “I’m sober, I need a cigarette,” he said to Ellen as they drove off.
America’s opioid crisis has reached epidemic levels.
In Arizona alone paramedics and police have responded to between 700 and 800 suspected overdoses every month so far this year, administering naloxone in 80% of callouts. Just over half were aged between 25 and 44, while 6% were over 75 years old. Overall, 93% survived, at least on that occasion.
Drug overdoses accounted for more than 50,000 hospital admissions and emergency room visits between 2020 and 2021.
Nationwide, about a million Americans have died from drug overdoses since 1999, with around 100,000 deaths in the past year. About two-thirds of the recent fatalities – about 170 a day, mostly working-age Americans – have involved synthetic or human-made opioids like fentanyl, which is 50 to 100 times more potent than heroin or morphine.
In Arizona, there were 2,006 opioid confirmed fatalities last year – an 80% rise compared with 2018. Of the deaths in 2021, 94% involved synthetics like fentanyl, up from 69% in 2018. While heroin deaths dropped by 68% over the same period.
Synthetics, which are cheaper, more potent and easier to traffic in large quantities, are flooding communities across the country.
The number of fentanyl pills seized in Arizona has soared in recent years, doubling from 6m in 2020 to almost 12m last year, according to the Drug Enforcement Administration in Phoenix.
“It’s terrifying. We are talking about a tidal wave of drugs coming into Arizona and then being repackaged and shipped throughout the United States,” Cheri Oz, a DEA special agent from the Phoenix division, recently said.
Mexico is currently the dominant source for drugs manufactured in clandestine labs using easy-to-purchase precursors from China. The vast majority of the drugs enter overland across the southern border, after which the pills are often moved by regular postal and courier services.
Law enforcement has been outpaced and outmanoeuvred by criminal networks, according to a bipartisan investigation by the Commission on Combating Synthetic Opioid Trafficking.
“In terms of loss of life and damage to the economy, illicit synthetic opioids have the effect of a slow-motion weapon of mass destruction in pill form,” according to the bipartisan report published earlier this year. Drug overdoses cost the US economy about $1tn annually.
Out west, the fentanyl boom has done little to diminish the popularity of methamphetamine, or meth, a highly addictive synthetic stimulant. In 2021, meth caused or contributed to about 1,200 deaths in Maricopa county, which includes Phoenix, while fentanyl was involved in almost 1,300 fatalities, according to John Johnson, the county’s chief medical examiner.
Earlier this month, police arrested a 21-year-old man for allegedly selling fentanyl and meth to homeless people around a shelter in downtown Phoenix after an undercover operation. Cristian Machado was charged with seven felony offences after police found about 14,000 pills in his possession (on him and at his home).
Machado was operating in an area known as the zone, where numerous shelters and services for the city’s rapidly growing homeless population are concentrated. In mid-June, at least 800 people were sleeping on the streets in the zone under tents, makeshift shelters or on the ground, where the Guardian was told meth rocks are currently selling for $2 and fentanyl pills – known as blues – for $5.
“Both are risky individually, in combination they are even riskier,” said Johnson. Postmortem toxicology reports show that a significant number of fatalities have both drugs in their system.
Almost two-thirds of Arizona’s drug fatalities happen in Maricopa county where extreme heat is also playing a big role, especially among the unsheltered homeless population. Across the city thousands of people are sleeping in parks, behind dumpsters, in parking lots and along the canals without access to adequate shade or water.
Meth elevates the risk of deadly heat illnesses like heatstroke. In 2020, substance use played a role in 58% of all heat deaths, rising to 72% among unsheltered people; the vast majority involved meth.
In addition to meth’s particular physiological properties, all drug users are more likely to be malnourished and dehydrated, and it’s not uncommon for emergency services to find people passed out in the direct sun.
On a boiling hot day earlier this month, the Guardian came across a skinny young man who looked to be in his 20s, sitting on a partially shaded park bench wearing thick dark jogging pants and a hoodie. He asked for a soda, before lighting up to smoke fentanyl pills and was soon wiped out, lying in a fetal position on the bench.
It was 106F; he was breathing but could not be roused as the sun moved, exposing him further.
“It’s too hot to be homeless and using here, but managing substance use and homelessness at the same time is very difficult,” said Jennifer Morgan, director of a shelter in Phoenix who has personal experience of homelessness and addiction. “People can get very sick very quickly, it’s a deadly combination.”
* Names have been changed to protect identities
