contained fentanyl. He may not have realized he was taking inauthentic medication.
Since then other music stars have also died from fentanyl, one after another, including Tom Petty and the rappers Lil Peep, Mac Miller, and Lexii Alijai. In most of these cases, fake pills cut with fentanyl were suspected.
Cocaine can also be spiked with fentanyl. American cocaine overdose deaths remained fairly steady throughout the first decade of the 2000s—ranging from roughly four thousand to seven thousand—but in the second decade began to surge, exceeding fourteen thousand in 2017. Fentanyl is part of the reason for this. Cocaine production is at an all-time high, and the product is flooding the market, but it’s far from pure. Because they are both white powders, cocaine and fentanyl can be mixed easily, and fentanyl sometimes “contaminates” cocaine parcels, where the drugs are prepared in the same space. Fentanyl was involved in two of five cocaine overdose deaths in 2016, the most recent year for which such statistics are available. This trend disproportionately affects African Americans, who are nearly twice as likely to die from cocaine overdoses as white people.
In New York City in 2016, more than one-third of all fatal drug overdose victims had both fentanyl and cocaine in their systems. By the end of 2017, in Massachusetts, cocaine used in conjunction with fentanyl was killing more people than heroin spiked with fentanyl, and in Ohio, cocaine was often mixed with carfentanil, a tranquilizer used to subdue rhinos and elephants (sometimes shot from dart guns) that can be one hundred times more potent than fentanyl. In July 2018 the director of the Centers for Disease Control and Prevention, Robert Redfield Jr., revealed that his thirty-seven-year-old son had nearly died from cocaine laced with fentanyl. In December, 2018, Vine and HQ Trivia cofounder Colin Kroll was found dead with heroin, cocaine, fentanyl, and an analogue called fluoroisobutyryl fentanyl in his system. Fentanyl’s rapid growth in the drug economy is putting users, from recreational to deeply addicted, at risk of grave consequences. Until recently young people could often take drugs at parties without risking much more than a bad hangover. Now, however, any black market pill or powder could contain a lethal dose of fentanyl.
* Opiates generally refers to drugs derived naturally from the opium poppy, like morphine, while opioids generally means similar chemicals made synthetically in labs, like fentanyl.
Humanity has long mined psychoactive chemicals from the natural world to worship gods, to feel bliss, to commune with the dead, to heal, to avoid problems, to escape ennui, to make art, or to just go on a little adventure of the mind. At first, people ingested these chemicals directly from living things, eating mushrooms, cactus buttons, and morning glory seeds; chewing coca and khat leaves; inhaling tree snuff; smoking cannabis, opium, or even the venom of toads; fermenting grapes and barley; curing tobacco; steeping leaves; and roasting beans.
Historically, only a few handfuls of different compounds have been used reliably to get people high, but over the past hundred years or so, humankind has learned to synthesize the active chemicals in laboratories and to manipulate chemical structures to invent new drugs—the numbers of which began growing exponentially in the 2010s. Anyone with computer acumen can acquire hundreds of psychoactive compounds that didn’t exist even a few years ago.
According to the European Monitoring Centre for Drugs and Drug Addiction, 150 new illicit drugs were bought and sold between 1997 and 2010. Another 150 appeared in just the next three years, and since then, in some years as many as 100 new chemicals have appeared, with synthetic cannabinoids especially common.
Though they can be incredibly potent and affect the body in new ways, these latest drugs aren’t conceived out of thin air. In fact, many are derived from the same naturally occurring chemicals our ancestors have been using for thousands of years. Fentanyl, for example, is a new plague, but its natural predecessor, the opium poppy, has been used (and abused) since at least the Mesopotamian era.
The story of fentanyl, however, can be traced to one man: Paul Janssen.
A Belgian chemist, Janssen was undoubtedly a genius. He could quote Homer in the Ancient Greek. During World War II he studied chemistry and other sciences at university in Namur, Belgium—enrolling secretly, despite the Nazi occupation—and in 1948, when he was twenty-two, he funded a trip to America in part by beating opponents in chess, at venues including the Manhattan Chess Club. What Janssen was best known for was creating medicines. Over his lifetime, he was responsible for some eighty new medical drugs, including fentanyl. One biographer called him “the most prolific drug inventor of all time.” His brilliance wasn’t just in coming up with new medicines but in realizing that new medicines could be created in the first place.
Janssen was born in 1926 in the small Belgian town of Turnhout. When she was four, Janssen’s younger sister died of tubercular meningitis, a then untreatable condition that can now be controlled with antibiotics. Janssen was in high school at the time, and his sorrow over his sister’s death inspired his journey into medicine. He was mentored by his father, a family doctor in Turnhout, who would operate on patients in their own homes. In these first decades of the twentieth century, rather than give patients the available medicines—organ extracts and tonics that are nowadays discredited—Janssen’s father gave them placebos. “And he was absolutely right to do so,” Paul Janssen later wrote. “Naturally, there was insulin, cardiac glycosides, aspirin and morphine, but where most of the other medicines were concerned, one could safely say they did more harm than good.” Janssen’s father nonetheless started his own medicine company. After the discovery of penicillin, his company sold the antibiotic and also produced its own products, which mainly were combinations of existing drugs. The enterprise’s success did little to impress the younger Janssen, at the time a precocious chemistry and medical student.
“Come up with something better yourself, then,” his father challenged him.
At age twenty-six, Janssen began pursuing new chemicals, with some help from his father, who fronted him money and lab space. But Janssen wasn’t interested in slapping new labels on old chemicals. He wanted to create new drugs that actually made people feel better—and that he could patent. The key to this, he learned, was playing around with chemical structures. Based on the work of Nobel Prize–winning German medical scientist Paul Ehrlich, Janssen knew that adjusting the chemical makeup of a known drug, even just slightly, could create something that could affect the human body in dramatically new ways.
A year later, in 1953, Paul Janssen founded his company, Janssen Pharmaceutica, initially working out of the third floor of his father’s building. “We didn’t even have a calculator, let alone a computer for the simplest calculations,” Janssen wrote in 2000. “To reduce expenditure we economized by performing simple tests on pieces of gut from newly slaughtered rabbits, which I collected early in the morning from a butcher in Turnhout.”
Despite its modest beginnings, the company hit the ground running with its discovery of a drug called ambucetamide, used to alleviate menstrual pain. Janssen would also invent loperamide (Imodium), for diarrhea, as well as chemicals that became critical to the fields of psychiatry, mycology, and parasitology. To spur his company’s ascent, he recruited star Belgian scientists from the Belgian Congo, after the political upheaval there that would lead to the country’s independence and the end of colonial rule. He was soon managing a large staff—its members called him Dr. Paul—but still closely involved with creating new chemicals. He literally daydreamed about molecules. “I often watched him at meetings,” wrote Sir James Black, a physiology and medicine Nobel laureate of King’s College London, “when bored with the proceedings, finding solace inside his head as he doodled new chemical compounds!”
One of these new chemicals was fentanyl, which Janssen and his team first synthesized
