Fentanyl: a game of 'Russian Roulette' - Albuquerque Journal

Fentanyl: a game of ‘Russian Roulette’

Copyright © 2021 Albuquerque Journal

Editor’s note:

Today, the Journal concludes a two-day series on fentanyl with a look at fatal overdoses and how the drug is affecting hospitals, treatment centers and those who become addicted to it.

He had been sober for years, a beacon in the recovery community who inspired dozens of people to get clean.

When the pandemic hit, the Narcotics Anonymous meetings that served as a sanctuary for him and so many others were shut down or went virtual.

Then, as those in recovery sometimes do, he faltered and started using again.

The man had told colleagues in the harm reduction community he was going to straighten up and wanted to get back to work.

But the 44-year-old never got the chance. He was found in a West Side parking lot in August, dead from an unintentional overdose after someone sold him a bag of heroin laced with fentanyl.

It was another notch in a disturbing trend.

Last year, the New Mexico Department of Health recorded 304 fentanyl overdose deaths between January and November, a 135% increase over 2019. From 2018 to 2019 officials had tallied a 93% jump, from 67 to 129, in fentanyl overdose deaths as 74% of overdose deaths in the state involved opioids.

The steep rise saw fentanyl-related overdose deaths catch up to meth overdoses, the largest contributor, for the first time. Full 2020 and 2021 data is not yet available.

But Dr. Robert Kelly, substance abuse epidemiology section manager at the state Health Department, said fentanyl overdoses have continued that pace into the summer of 2021.

“We’re seeing deaths in people because they don’t know there’s fentanyl in there,” he said. Oftentimes, other drugs are found alongside fentanyl in overdose patients, mostly cocaine and benzodiazepines like Xanax.

A box full of discarded pieces of foil showing the black lines made by smoking fantanyl is left in an enclave off Chico where people use drugs.

As fentanyl overdose deaths spiked there was a slight drop of 2% in those involving heroin. Kelly said some people turn to fentanyl because it does the same thing as heroin but “more and faster.” Others don’t know what they’re getting.

“There are two groups of folks. And some of the folks who know how to use fentanyl, they go out and that’s their drug of choice. … It’s the folks who don’t know that they’re getting fentanyl that’s the problem,” Kelly said.

In 2019, New Mexico had the 12th highest drug overdose death rate in the nation, with unintentional overdoses accounting for 85% of deaths.

Between 2015 and 2019, Bernalillo County had the highest number of unintentional drug overdose deaths and opioid-related overdose emergency room visits in the state. Rio Arriba County had by far the highest rate of overdose deaths, nearly double that of second place San Miguel County.

In that time, use of the overdose reversal drug Narcan went up more than 1,000% in the state – from 8,158 to 94,743 doses. Its recorded success, however, rose only 432% – from 779 to 4,144.. Those who hand out Narcan to opioid users and often revive people themselves say the reversal drug doesn’t work as well, and sometimes not at all, for a fentanyl overdose.

‘Here to stay’

Dr. Brandon Warrick, an associate professor in the Department of Emergency Medicine at the University of New Mexico Hospital, put it bluntly: “Fentanyl is here, and fentanyl is here to stay.”

He said overdoses from the drug come into UNMH on a daily basis and they have seen the numbers “ramping up very fast” since 2019.

“I have never seen such a rapid increase or shift in an illicit drug source – or come anywhere near what we’re seeing with fentanyl,” said Warrick, whose work has centered around drug abuse for more than a decade.

He said a recent troubling trend at UNMH is fentanyl overdoses in children.

In the past year and a half, the hospital has treated 10 children for fentanyl overdoses. Before 2020, the hospital had treated only two children.

None of the children died, but one child suffered significant brain damage from the drug. Warrick said the children, some as young as 1 and 2 years old, often take pills that were left sitting out.

In other cases, kids have become hooked.

Down south, in Carlsbad, such an incident led to charges against a mother and a grandmother.

Alexis Murray and Kelli Smith, 35 and 55, were charged with child abuse in the Sept. 28 death of Murray’s son, 12-year-old Brent Sullivan.

Police found the boy unconscious from a fentanyl overdose in his grandmother’s backyard. Smith told officers she tried to give Narcan to Brent but it didn’t work.

Murray told police she and Smith dealt fentanyl regularly and Brent had been stealing the pills from her for months. Murray said her son had overdosed three times prior and each time they had used Narcan to revive him.

The last time proved fatal.

Warrick, who bounces between the emergency department, poison center and addiction clinic, said he has seen a noticeable decrease in those using heroin, with fentanyl “essentially replacing that.”

He said those who survive an overdose are not as receptive to treatment or rehab as those who develop complications, like an infection or disease, from their drug use.

“The last thing that the person remembers is they were in their sweet spot, they were feeling good,” Warrick said. “The whole period of them being unconscious – near death – is experienced by everybody but the person who overdosed.”

In an effort to encourage recovery, he said they often turn the lights up bright and announce “welcome back from the dead” when they revive someone from an overdose.

“When you get bright lights and a whole bunch of strangers saying, ‘welcome back from the dead,’ I mean, that’s just like a scary experience,” Warrick said.

Despite that, many fentanyl users are resistant to change. He said more so than the patients, the families hurt the most.

“What’s more difficult than seeing somebody overdose is seeing … how their continued use really affects their personal lives … how much their children and families just suffer,” Warrick said.

‘A dime a dozen’

Before his death from an overdose at 18, Jennifer Burke’s son used to tell her that heroin would call to him. Like a siren’s song.

“I think fentanyl is like that, times 10. It draws them back in. It’s so potent and once it grabs ahold of these kids, it’s so hard for them to get back on their feet,” she said.

Burke, who runs Serenity Mesa, a 14-bed rehab center on the West Side, said in the past year fentanyl has “turned everything upside down.” Clients, ranging from 14 to 21 years old, went from an even split of heroin and meth to 80% fentanyl users.

Jennifer Burke, executive director at Serenity Mesa, stands in front of a mural of her son, who died of a heroin overdose at 18. Burke said the 14-bed facility has seen a huge influx of young people trying to recover from fentanyl use in the past year.(Roberto E. Rosales/Journal)

“When fentanyl hit the market here in New Mexico, it took over really quickly, and I think people that had an addiction to opiates, that became their drug of choice,” she said.

Burke said the influx was so great they have had a waitlist, often up to 20 people, stretching back a year. The facility has had more referrals in the past 18 months than it has ever had since it opened in 2015.

“We haven’t been able to keep up,” Burke said. “It’s hard because I don’t want to turn anybody away, especially somebody who’s young, who’s struggling.”

She said the whole point of their program is to “catch them when they’re young” before they end up in prison or worse. Burke said it’s much easier to help a young person turn their life around than a 40-year-old who’s been using for decades.

Because of the drug’s prevalence and profits, Burke believes the only solution is prevention.

“There’s too many drug dealers out there making tons and tons of money,” she said. “… If nobody’s going to buy the product, then they’re not going to make any money and there’s no product to sell – we have to get people to stop using.”

She said fentanyl users who are able to get into the 14-bed facility have a much harder time than those hooked on meth or heroin. The withdrawals are much more painful and they often see psychosis and mental health issues with the drug.

Burke said they sometimes take clients back two or three times after a relapse as the cravings and triggers can last for months. And the users are getting younger and younger.

“I mean, 14- and 15-year-olds being addicted to fentanyl is not uncommon,” Burke said. “… It’s really sad because it’s altering their brain.”

For those who are still out there, Burke said it’s a game of “Russian roulette.”

“These are drugs being made by people that really don’t care if you live or die, they could care less, you’re a dime a dozen to them,” she said. “… You don’t know what you’re getting when you buy – the next dose that you get could be fatal and that’s what scares me the most.”

Hooked as a teen

They were all baby-blue and stamped the same, but Hezekiah Beltran began to notice that each pill was different.

“Not every pill had the same amount of whatever inside of it,” he said.

One day, a day like any other, he said he smoked a fentanyl pill and suddenly got dizzy. The last thing he thought is he was overdosing.

Beltran said he woke up after the people around him, strangers who became friends over a shared vice, revived him with Narcan.

It was just another day for the 17-year-old.

“I never thought that I would be anything more than a drug addict … that’s what I felt my life was going to be,” he said.

Beltran, who has been recovering from a yearslong fentanyl addiction at Serenity Mesa, said his foray into the world of drug use came early.

“Being brought up in the lifestyle – crime, violence and stuff like that – I feel like I always knew too much at a young age,” he said.

Beltran, of Raton, started smoking marijuana at 9 and by 15 had graduated to meth, using with the same people who once did drugs with his older relatives. After getting arrested for meth distribution and firearm possession, the teen skipped town.

He said he landed in a neighborhood in Rio Rancho where everyone was hooked on fentanyl. The next door neighbor sold it, $10 a pill before noon, $20 after midnight.

“I just cut everybody off and at that point, it was a whole new group of people that I associated myself with. They were all fentanyl addicts,” Beltran said.

It wasn’t long before he was smoking five or six pills a day. He said the drug made heroin look like aspirin, it was that much stronger. And the sickness that came after was hell to pay: He couldn’t move, was in pain all over and couldn’t stop throwing up.

Those he hung around with were in the same boat, good people who just “got caught up in the life.” They ranged from their teens and up, committing petty crimes to support their habit.

Overdoses were common. One man bragged about having survived 27 of them.

“I’m very grateful that I got out of that mess. I could have easily died with all the things I was doing,” he said. “I feel lucky – because a lot of people don’t get out.”

Beltran thought back to a woman, in her 20s, who had stayed with him. He said they smoked fentanyl together and she overdosed. The Narcan, at least two doses, didn’t work.

“She didn’t come back – they just kept on trying and trying,” he said. “… There was no color in her eyes. You know how my eyes are brown?… There was nothing there. I’ll never forget that look in her eyes.”

‘There is hope’

Beltran said a police call to the house he was living at in April saved his life.

He said he spent a month and a half withdrawing in quarantine at the Metropolitan Detention Center. From there, he went to a treatment center in Santa Teresa before landing at Serenity Mesa.

“Maybe getting help is the only way to get through, but there is hope. There is a better future,” he said.

Hezekiah Beltran, 17, is looking ahead to being released from Serenity Mesa later this month and leaving his drug use in the past.

Eight months later, Beltran said he has started feeling again. Happiness, sadness, worry, hope. At first, sobriety was scary and overwhelming. There are still triggers – a certain smell, crumpled tin foil – but he moves past them. Ever forward.

Beltran, set to be released in late December, said he plans to move to Tennessee to live with family, get his GED and pick up a trade. For the first time in a long time, he is hopeful.

“People are scared to get off of dope or get off fentanyl because they’re scared of the sickness, because they’ve been minimizing feelings … for so long,” Beltran said. “It is hard, but I would like other people to know that it doesn’t last forever, the sickness doesn’t last forever, and there is hope.”

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