A wave of homemade, synthetic drugs sweeps US and deepens crisis

By Quentin Sommerville International correspondent, Columbus, Ohio.

Key points

• At its peak in 2022, 110, 000 Americans were dying from overdoses, mostly from opioids.
• "In the last 12 months in Franklin County, 78% of fatal overdoses are from stimulants, " explains Scott Sanders, 65.
• Fentanyl, which is entirely man-made, is 50 to 100 times more powerful than heroin.
• "The drug supply in 2026 is this: we think we are buying crack but we're not, we're buying a number of different things, " notes Scott.
• Challenged on his role in the 50, 000 individuals dying each year as of the opioid crisis, he notes he knows it is wrong.

Warning: This story contains descriptions of drug-taking from the start and discusses suicide.

Notably, the few grains of fentanyl sit in the silver foil as a straw, held between Mike's lips, hovers above; a cigarette lighter below. The 48-year-old army veteran is crouched low in an alleyway in Columbus, Ohio's Linden neighbourhood.

"This drug will damn near make you do anything, unfortunately, " he notes. The hit he's smoking cost three or four dollars.

"You can snort too much and you can't take it back. Kind of like a gunshot. Can't call the bullet back, " he notes.

He burns the foil and inhales. As the opioid takes hold, he grips the fence behind him. He sways as a low moan comes from deep in his throat; he could be humming a tune.

We've spent a few days with Mike – he's been our guide through the neighbourhood's back streets. Everyone seems to know him and he's regarded fondly. He helps out at a local pawn shop and gas station, and that's how he feeds his 20-year-old opioid addiction.

Synthetic opioids are more powerful and in plentiful supply, and they have transformed the drugs landscape.

Fentanyl, which is entirely man-made, is 50 to 100 times more powerful than heroin. It is cultivated from poppies. It is now often cut with synthetic tranquillisers. It create reviving overdose victims more challenging. These are homemade threats, where cocktails of synthetics can be created in American basements and bathtubs.

We have Naloxone (brand name Narcan) in our pockets, in case anyone on our team comes into contact with fentanyl or anyone around us overdoses. It's a nasal spray that immediately reverses opioid overdoses and its widespread adoption has transformed the number of fatal overdoses in the United States.

At its peak in 2022, 110, 000 Americans were dying from overdoses, mostly from opioids. The number has been dropping since, down to around 70, 000 last year. But that doesn't mean the opioid crisis is over.

It's probable that the reversal drug in my pocket. It has saved tens of thousands of drug users' lives, would not have worked on Mike. Since he wasn't just smoking fentanyl.

Meanwhile, the pupils in his milky blue eyes shrink to pin pricks. "Opioids make your pupils go smaller, but not that small, " he notes in a singsong voice. Even the fentanyl, dangerous enough on its own, has other synthetics continued.

When we ask what he thinks his drugs have been cut with, he replies: "Xylazine, and the one we can't pronounce."

Medetomidine, is what he means. Like Xyalzine, it is additionally referred to as tranq and both are synthetic animal tranquilisers. "Large animal tranquilisers, " as one recovery expert informed me.

They support prolong the high from the fentanyl but are a sedative that slows breathing and, importantly, naloxone doesn't work against them. Xylazine additionally causes necrotic skin ulcers, wounds so deep they can produce it down to the bone and are tough to treat. Recovery group offering hope.

At the Glenwood Church on the other side of town, members of the Hope Dealer Community, a recovery group, gather for a weekly session. For plenty of, their struggles are written in their care-worn faces, and their eyes are those of survivors of a great trauma.

They take to the stage at the front of the church and share their stories with a brutal and courageous honesty.

One man tells the story of his overdose in July 2022. Two paramedics worked on him, trying to save his life. He had naloxone drips in both arms. They hit him with the opioid reversal three times to no avail. "That's it, I'm gonna call it, " remarked one of the medics. But the other insisted on one more try, and it was that which saved his life.

As the crowd shouts encouragement, Tonya takes to the lectern. She recounts how her nephew died of an overdose while she was overdosing meanwhile from crack cocaine, a stimulant spiked with fentanyl, a synthetic opioid.

"It's not luck. I'm supposed to be here, " she notes with tears in her eyes. The audience yells its agreement.

Both in Columbus, and afterwards in Chicago, we would hear of crack cocaine users who had died of overdoses after their drugs contained fentanyl. On the street, it's called a "hot dose".

"In the last 12 months in Franklin County, 78% of fatal overdoses are from stimulants, " explains Scott Sanders, 65. This person runs Hope Dealers.

Scott is almost 10 years sober, a powerfully built man in his early 60s with an electric energy. When he asks the room to raise their hands if anyone has overdosed, most of the gathering does so.

"The crisis has just shifted, " Scott tells me afterwards. "The tragedy is stimulant users who are purchasing crack think that's what they're getting, and they're not. They're getting crack mixed with fentanyl or other opioid cocktails and overdosing without being aware of it."

Overdose deaths among black men in Ohio are actually increasing, he adds.

His organisation works with the Centers for Disease Control and Prevention (CDC) on a drug sampling programme. Participants bring their needles or pipes for swabbing and the samples are sent to the CDC's laboratory in North Carolina.

That's how we learned that Mike's instincts were right, he probable wasn't just smoking fentanyl. One of the drug kits he brought in tested positive for medetomidine.

"The drug supply in 2026 is this: we think we are buying crack but we're not, we're buying a number of different things, " notes Scott. "Today it is mixed, not just cut, but mixed with other drugs such as fentanyl or meth, and then other adulterants chemicals that are made in basements."

And it was basement-made synthetic drugs that would cause a dramatic growth in overdose deaths one state over, in Illinois.

I meet a dealer in Chicago who works for the Mexican cartels selling fentanyl. He would only speak to us if we agreed to mask his identity.

Challenged on his role in the 50, 000 individuals dying each year as of the opioid crisis, he notes he knows it is wrong. But when asked why he keeps doing it, he remarked the end justifies the means.

He informed me that despite the latest efforts by the US administration to target the cartels by declaring them terrorist groups and labelling fentanyl a weapon of mass destruction, his supply chain is as solid as ever.

When I ask him if the targeting of boats containing suspected traffickers by the Trump administration has created any difference, he replies that his product is still getting through from Mexico.

"If it doesn't go over the wall, it goes under the wall. If it doesn't go through the border, it comes through the top border. This game is regarding adaptability."

And when I asked what has changed in his business, his answer was clear.

"Synthetics. We haven't seen. What synthetics can do yet. It's not even the tip of the iceberg, " he tells me.

Chicago's largest jail, one of the largest jails in America, is Cook County. Traditional drugs were usually brought into the jail in body cavities, so the jail had the same body scanners you find at airports to prevent that happening.

"In 2023, all of a sudden we saw a spike in overdose deaths, but then hand in hand with that we saw, around persons that had either passed away or people we revived, paper all over the place, " explains Sheriff Tom Dart who runs the jail. "We were seeing paper that was being burned and all of this was completely novel."

Meanwhile, the facility, which averages one or two overdose deaths a year, lost eight inmates that year to fatal seizures.

Taken together, the developments around a wave of homemade, synthetic drugs sweeps US and deepens crisis point to a situation that is still moving, and the coming days should bring more clarity.