As fentanyl use in Arkansas and the U.S. continues to rise, an emerging threat has law enforcement keeping a wary eye out for fentanyl analogs -- synthetic compounds that are manufactured to mimic the pharmacology of fentanyl but can be many times more potent -- as well as other additives that are making their way into the illicit drug pipeline.
Fentanyl is a potent synthetic opioid drug -- approximately 100 times stronger than morphine and 50 times more potent than heroin -- that is approved by the Food and Drug Administration for use as a painkiller and anesthetic. It was initially developed in 1959 and the following year was introduced as an intravenous anesthetic. In the 1980s, a transdermal fentanyl patch was developed to treat post-operative and breakthrough pain that other analgesics could not address.
Fentanyl is so potent, however, that as little as two milligrams of the drug can be fatal.
Assistant U.S. Attorney Chris Givens, criminal chief for the U.S. Attorney's office in Little Rock, said fentanyl presents something of a paradox because of its widespread use by medical professionals as a safe and effective anesthetic and to treat pain.
"In a hospital setting, fentanyl is perfectly safe," he said. "But on the street, fentanyl is the most dangerous drug around. ... The problem with illicit fentanyl continues to be that the person buying it on the street has no way of knowing what they are getting. They don't know if it's fentanyl or if it's a fentanyl analog. They don't know the potency of it, so how can you safely take a dose of fentanyl to get high? The answer is you can't."
In 2016, in addition to pharmaceutical fentanyl being diverted to the black market, law enforcement and medical professionals on the East Coast began running across clandestinely manufactured fentanyl and fentanyl analogs -- illicit alterations of fentanyl that mimicked the effects of the drug but oftentimes were much more potent. Drug overdose deaths involving illicit fentanyl began to climb as the drug gained a steadily increasing foothold among illicit drug users across the nation.
Clandestinely produced fentanyl -- most of which is mixed in Mexico with base chemicals imported from China -- is encountered either as a powder or in fake tablets and is sold alone or in combination with other drugs such as heroin, methamphetamine or cocaine. According to the U.S. Drug Enforcement Administration (DEA), counterfeit pills made with fentanyl are primarily manufactured by the Sinaloa and Jalisco (CJNG) Mexican drug cartels and are disguised to look like legitimate prescription drugs.
Jarad Harper, assistant special agent in charge of the Little Rock DEA office, said that in his experience in Arkansas, counterfeit Oxycodone tablets are the most prevalent form of fentanyl-based counterfeits, which are blue and stamped with the letter M inside a box on one side and the number 30 on the other.
"With the cartels there is no quality control," Harper said. "They import these precursor chemicals from China and mix them together in illegal labs in Mexico and there's no way of knowing how much fentanyl is in a given pill. Of the counterfeit pills the DEA has tested, 70% contained lethal amounts of fentanyl."
PURITY QUESTIONS
Additionally, Harper said, adulterants such as Xylazine, an animal tranquilizer commonly known as "tranq," and nitazines -- a group of compounds developed in the 1950s as opioid analgesics that were never approved to market -- are also showing up in various illicit drugs and counterfeit pills to increase the potency.
"One problem with Xylazine," Harper said, "is that it's not an opioid so Narcan won't reverse the effects of an overdose. What really surprised me is that 23% of fentanyl powder and 7% of the fentanyl pills have been f0und to contain Xylazine."
A big risk to people who use intravenous drugs containing Xylazine, Harper said, is the danger of developing severe wounds, including necrosis -- the rotting of human tissue -- that may lead to amputation.
Nitazenes have proven to be another threat, he said, making an already deadly drug even deadlier.
"Nitazenes have no approved medical use," Harper said. "They're abused like fentanyl for their opioid-like effect and they're often mixed with fentanyl, with stimulants and even with synthetic cannabinoids."
Givens said the emergence of fentanyl analogs such as fluorofentanyl, para-fluorofentanyl and carfentanyl have vastly increased the risks of an already dangerous drug as well. Carfentanyl is particularly dangerous because it is 100 times more potent than fentanyl, according to the Centers for Disease Control and Prevention.
According to the CDC, analogs like carfentanyl and adulterants like Xylazine have been showing up mixed with fentanyl with increasing frequency in recent years.
Prosecutions for fentanyl in Arkansas have risen steadily over the past three years.
Although fentanyl cases currently represent a fraction of the total cases, the danger the drug represents consumes a tremendous amount of attention from federal authorities. Of an average 300 to 400 criminal cases opened by the U.S. Attorney's office in Little Rock annually, Givens said the office opened approximately 27 fentanyl cases in 2021, 41 in 2022 and 55 in 2023, and he expects the numbers to continue to climb.
"These numbers represent what we believe to be cases involving only fentanyl," he said. "However, our office is investigating fentanyl that shows up in other drugs in a large number of cases and the percentage is rising every year."
He said cases of fentanyl distribution resulting in death are also increasing, with three cases opened in 2021, seven cases opened in 2022 and 13 cases opened in 2023.
The first person prosecuted in the Eastern District of Arkansas for fentanyl distribution resulting in death, 33-year-old Jemel Foster of Little Rock, was sentenced in January 2023 to 30 years in federal prison in connection with the fentanyl poisoning death of a Fayetteville woman. Foster was indicted in February 2021 and was found guilty in July 2022 after a two-day jury trial in Little Rock.
The first person prosecuted in Arkansas' Western District, 33-year-old Ethan Driskill of Farmington, was sentenced in September to 38 years in prison. Prosecutors said Driskill sold a Fayetteville man a fatal mixture of fentanyl-laced heroin in January 2022.
MONEY BEHIND THE DRUG
Driving the rapid increase in illicit fentanyl use is money and lots of it, Harper said. In his 19 years with the DEA, he said, the distribution and use of illicit fentanyl has surpassed almost anything he has seen since its emergence as a recognized enforcement problem in 2016.
"It's such a money-maker," he said. "And these cartels, their business model is relentless expansion at all costs and they don't care how many people die in the process. I think they are intentionally poisoning Americans to drive the addiction and achieve higher profits."
To combat the allure of drug profits from fentanyl, penalties are steep. Under federal law, conviction for fentanyl distribution resulting in death carries a mandatory 20-year prison term, which Givens and Harper said will hopefully provide a deterrent effect as word spreads about the harsh penalties.
"I think when people start seeing this, it's a whole new ballgame," Harper said. "I think that's a deterrent when someone thinks, 'holy cow, I could spend most of the rest of my life in prison for this now.'"
Givens said because fentanyl is so deadly, the U.S. Attorney's office takes a hard-line approach.
"We view a person dealing fentanyl as being no different than a person pointing a gun at someone and pulling the trigger," he said. "We treat fentanyl prosecutions with that level of seriousness."
NEW APPROACHES NEEDED
Harper said to truly address the problem will require a multi-faceted approach that views enforcement and prosecution as components of a solution that includes intensive addiction treatment.
"There's a huge recovery community in Arkansas and I really see that working," he said. "A lot are faith-based, not all but a lot, but at the end of the day it's those intense 12- to 18-month treatment programs that seem to be working. ... It's a multi-faceted approach, not a law enforcement problem, not a treatment problem, not an education problem, a medical problem or a recovery problem. It's everybody's problem. To defeat it, everybody -- law enforcement, social services, mental health -- everybody has to work together to defeat this animal. That's what it's going to take."
On the enforcement end, Harper said the DEA will continue to work with the U.S. Attorney and other entities to put drug traffickers behind bars.
"We're not going to stop," he said. "There's an accountability piece to this and the U.S. Attorney's office in Little Rock has been phenomenal. People are getting sentenced to 30 years, 38 years, even more and we're not going to stop. It's a priority for us and we're going to do our part of this multi-faceted wheel."