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In the Midst of St. Louis' Opioid Epidemic, a Rescue Mission



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The fentanyl crisis has hit even harder in St. Louis during the COVID-19 pandemic. - ERIN MCAFEE
  • The fentanyl crisis has hit even harder in St. Louis during the COVID-19 pandemic.

Fentanyl is scything a deadly path across both St. Louis and the nation like no other drug before it.

Cheap to make, highly profitable and extremely lethal — especially to the unwary — fentanyl is churned out at industrial scales in black market labs in China, where the necessary precursor chemicals are easy to find, then shipped to Mexico. Smuggled into the U.S., it is hauled to St. Louis and other major cities by every means possible. Increasingly, it is made in secret labs in the Midwest as demand for it surges.

Once treated as something exotic because of its scarcity, fentanyl is now nearly ubiquitous. Dealers use it to cut heroin and cocaine, and they make it the basis for counterfeit versions of popular prescription drugs such as OxyContin and Xanax.

And it has triggered an unprecedented wave of overdose deaths nationwide and locally with no end in sight. The year 2020 set a grim all-time record for overdose deaths, and 2021 is guaranteed to be even worse.

Fentanyl's impact on St. Louis' Black community has been nothing less than devastating.

The federal Centers for Disease Control and Prevention estimates that 93,000 Americans died from drug overdoses during the twelve months that ended in December 2020 — an all-time record, and a 30 percent increase from the year before.

That number is even more sobering when you consider that in 2017 and 2018, overdose deaths were decreasing — thanks to a spate of federal and state laws that cracked down on "pill mills" and set up opiate prescription databases nationwide to track the worst abusers among patients and physicians.

In addition, a series of lawsuits filed by cities and state attorneys general that targeted the biggest makers of prescription opiates, including Purdue Pharma and Johnson & Johnson, had wrested billions of dollars in legal settlements to fight opiate abuse and provide treatment.

But now fentanyl, because of factors turbocharged by the COVID-19 pandemic, has blown much of that progress to hell.

Case in point: The official overdose death toll is 1,005 for the St. Louis metro area for 2020 — a 15.3 percent increase from the year before, according to figures compiled by the Missouri Institute of Mental Health.

All in all, the St. Louis region's overdose death total has soared 42 percent since 2016, when the official drug overdose death toll for the year was slightly more than 700.

For the state of Missouri, there were 1,842 overdose deaths in 2020 — a 16.5 percent jump over 2019. Opioid-involved overdoses accounted for nearly three-fourths of these fatalities. And as the epicenter of Missouri's overdose pandemic, the St. Louis region accounted for 55 percent of overdose deaths statewide.

Pastor Pam speaking to people at the Phillips 66 in the neighborhood trying to hand out as many life-saving supplies as possible to as many people as she can reach. - ERIN MCAFEE
  • Pastor Pam speaking to people at the Phillips 66 in the neighborhood trying to hand out as many life-saving supplies as possible to as many people as she can reach.

The fentanyl plague is hitting the St. Louis Black community hardest.

Consider: In Missouri, a Black man is four times more likely to die of an overdose than a white person, according to CDC figures. What's more, overdose deaths among Black Missourians increased by 30 percent in 2020, compared to 13 percent for white people.

The high rate of overdose deaths in communities of color is largely attributable to fentanyl, says Jenny Armbruster, deputy executive director of PreventEd, a local nonprofit group that is leading the fight against substance-abuse disorder.

"It's not because more Black people are using drugs at higher rates than they previously were," Armbruster says. "But it's just now in a more fatal dose. A dose that somebody may have used with years of experience is now a fatal dose."

Overall, in the St. Louis region, opioid-involved overdose deaths shot up by nearly 24 percent, while combined opioid and stimulant-involved deaths soared by almost 55 percent, according to state figures.

Illegal drugs are like any other international import: They are intensely sensitive to kinks in the global supply chain.

Pandemic-related disruptions —lockdowns, travel bans and border closures — had temporarily cut the flow of heroin into America's cities. That led local dealers to push their customers toward fentanyl, nicknamed "fenty," which provides a more intense high than heroin, but of shorter duration, making it therefore more addictive and profitable, according to Katie Brown, project manager for Missouri's Opioid Response Project.

"So if you look at it from the economic perspective, it's cheap to get, and it's very potent in what it does," Brown says. "And if you're a person who's supplying drugs to individuals, it bolsters sales in many ways."

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