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Why Fentanyl Is About More Than Just the Opioid Crisis

Fentanyl didn’t kill George Floyd.

The toxicology report from Floyd’s autopsy revealed that when he stepped into a Minneapolis Cup Foods store on May 25 to buy a pack of cigarettes, he had the synthetic opioid in his system, along with caffeine, a metabolite of nicotine, and THC from marijuana. He also had coronavirus.

But none of those things caused his death.

Officially, according to the local medical examiner, Floyd died of “cardiopulmonary arrest,” meaning he stopped breathing and his heart stopped pumping blood. But as anyone who watched the video of what happened to Floyd could see for themselves, he died after a Minneapolis police officer knelt on his neck for nearly eight minutes. An independent autopsy commissioned by his family found he died of “asphyxiation due to neck and back compression.”

In the aftermath of Floyd’s death, the presence of fentanyl in his system has mostly been a footnote. Police often justify deaths by citing the presence of drugs, but this time the drugs didn’t matter; his killing was caught on camera for the world to see.

But while fentanyl didn’t kill George Floyd, the fact that it was in his system does matter. The powerful synthetic opioid is fueling a surge in overdose deaths across the United States. It’s tied up with everything happening today, from the pandemic to the civil rights protests.

We spent the last year at VICE News reporting a podcast called “Painkiller: America’s Fentanyl Crisis,” investigating where fentanyl comes from and why it’s causing so many overdose deaths. We finished production a few weeks before Floyd was killed, but our hope is that the show — the people we meet, the places we visit, the history we explore — will help shed some light on how we ended up here today, in 2020, with fentanyl, coronavirus, and rage against systemic racial oppression all colliding with one man’s tragic death.

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The story of fentanyl and the opioid crisis is about intergenerational trauma, and a healthcare system that remains unequal and ill-equipped to treat addiction. It’s about drug laws that are steeped in racism. We saw evidence of that nearly everywhere we went, from the South Bronx to the Standing Rock Sioux Reservation. In Oakland, we met Denise Lopez, who works for HEPPAC, a harm reduction group that provides sterile syringes, the overdose-reversal drug naloxone, and other supplies to drug users.

Lopez grew up in the Bay Area during the crack epidemic of the late ’80s and early ’90s, but even back then, she recalls, heroin use affected the Black community. She saw it in her own family, and in her neighborhood in Oakland. Back then, drugs were considered an “inner city” problem. It’s portrayed differently now that the opioid epidemic affects white America.

“It’s like a new trendy thing,” Lopez said. “White people are dying, so it’s like real fancy now and everybody is coming to the rescue. We’ve been dying! We’ve been going to jail. We’ve been having our families broken.”

From 2015 to 2017, according to the CDC, nearly all racial and ethnic groups experienced significant increases in synthetic opioid death rates, but the increases were especially steep in George Floyd’s demographic. Among Black people ages 45-54 in large metro areas, fatal overdose rates have more than doubled, from 19 to nearly 42 deaths per 100,000 people.

For all the talk of embracing a kinder, gentler approach to the war on drugs that prioritizes treatment over punishment for addiction, little has changed with fentanyl. According to the U.S. Sentencing Commission, 77% of the people who face federal prosecution for fentanyl are Black or Hispanic. Nearly half of all those convicted for fentanyl in 2016 were mules or street-level sellers, at the bottom of the drug supply chain.

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Racism has been ingrained in U.S. drug policy from the very beginning. The first anti-opioid laws targeted Chinese immigrants in San Francisco in 1875. Mass incarceration and many of the insidious police tactics that disproportionately affect people of color can be traced back to the crack era, including the type of no-knock raid that led to the police shooting death of Breonna Taylor in March. George Floyd himself had been incarcerated for low-level drug cases, and he was reportedly detained several times during police sweeps of public housing projects.

It’s possible that Floyd, who also had meth in his system, wasn’t even aware that he’d used fentanyl. It’s a painkiller that can be prescribed by doctors, but the illicit supply — produced by Mexican cartels or rogue Chinese chemists — is what’s behind the soaring overdose rates. It can be cheaply made with chemicals, it’s 50 times more powerful than heroin, and it can be easily blended with other drugs. It’s now ubiquitous, but low-level dealers can never be sure exactly what they are selling, leading to unpredictable and deadly doses.

Those who knew Floyd have said he moved to Minneapolis to seek a fresh start and get treatment for addiction. He found work as a security guard and truck driver and was trying to make the best of his life after years of struggling. We saw firsthand over the past year how stigma and racial disparities play out in the healthcare system. The bottom line is that it’s harder for people of color to get access to medication-assisted treatment. Some of the same systemic inequalities help explain why minority groups are disproportionately affected by COVID-19.

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Fentanyl is often talked about with wild hyperbole — as a weapon of mass destruction capable of wiping out entire towns. There’s a myth that just touching it with your bare hands will cause an overdose. Most recently, the fentanyl crisis has been blamed on pharmaceutical companies giving kickbacks to doctors and the DEA not doing enough enforcement. That did happen — but it barely scratches the surface of how we ended up with this fentanyl crisis. It ignores the pain and racism at the root of the problem.

And it’s a problem that’s not going away. The CDC reports that fentanyl caused at least 35,000 fatal overdoses in the past year. The coronavirus has overshadowed other public health concerns, but the opioid epidemic is quietly worsening. Overdoses spiked over 17% across the U.S. in the weeks after stay-at-home orders took effect, according to one monitoring group. Addiction treatment centers have been overwhelmed with new patients.

Dr. Andrew Stolbach, a medical toxicologist at Johns Hopkins University, told me the level of fentanyl in Floyd’s system — a miniscule 11 nanograms per milliliter of blood — can be fatal, but users with a tolerance can handle far more. Stolbach said the fact that Floyd was functioning normally prior to his encounter with police makes it clear that fentanyl was not a factor in his death, but its presence combined with everything else is telling of where we are in society.

“Is there anybody more symbolic of the problems we’re facing in 2020?” Stolbach asked. “This man is tragically killed by police. He also happens to have fentanyl onboard. He also happens to have coronavirus onboard. You know, these are three huge problems that we’re facing right now all, unfortunately, wrapped up in one guy.”

Cover: Collage by Hunter French | Image via Getty.

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