SPECIAL REPORT: Has America’s fentanyl crisis landed in the UK?

0:00Bite into a stacked sandwich made with Hero Bread. And the only thing you'll think is delicious. You won't think it has up to 19 grams protein, 11 to 32 grams of fiber, or just 0 to 5 grams net carbs. But it does. Hero Bread. No compromises. Just loaves, buns, tortillas, bagels, and noodles packed with flavor. Right now, get 10 % off at Hero.co with code IHEART. That's H-E-R-O dot C-O, code IHEART. All figures per serving of Hero Bread. See Nutrition Facts on Hero.co. This is a Global Player original podcast. The opioid crisis is a very American disease. Once you've found the right doctor and have told him or her about your pain, don't be afraid to take what they give you.

0:47Often, it will be an opioid medication. For 20 years, fentanyl, a painkiller, hundreds of times stronger than heroin, has gripped American life. it has claimed at least three quarters of a million American lives. It's shaped politics.

1:08With the opioid crisis or the drug epidemic we've had throughout the country, it's affected almost all of us. It was cocaine. You know, that was the drug of choice. Then heroin and meth made a comeback. And now it's fentanyl, it's Zizeline, it's carfentanil. Synthetic drugs are now the number one killer of Americans aged 18 to 45. It has led to the death of 70 ,000 Americans because of fentanyl. If the Bronx was its own state, it would have the second highest amount of opioid deaths in the United States. Fentanyl is the single largest cause of death among young Americans. So many millions of Americans hooked on opiates, hooked on painkillers.

1:52killers. No part of our society, not young or old, rich or poor, urban or rural, has been spared this plague, drug addiction, and this horrible, horrible situation that's taken place with opioids. It is a failure of politics, a failure of medicine, a failure of law, a darkness which is enveloped state after state and place after place. It shows no signs of stopping. It shows no sign of slowing. But if you think that this plague is something which happens over there, far away, think again. The opioid crisis is coming to the UK. In fact, it's already here. Welcome to this special episode of The News Agents.

2:46The newsagents Now Vegas is huge Yeah, huge Right, everybody thinks it's just the Strip No, it's really But this is like, you even got it into the rich areas Really? Yeah So whenever you see somebody panhandling There's generally a huge encampment somewhere around there What do you mean panhandling? Panhandling, like asking for money Oh, I see. Las Vegas is a city of lights. But those lights avert our gaze to the realities beneath. It is like so much of the American West, a city where fentanyl is everywhere. Fentanyl, originally a prescription painkiller, it has come to be routinely consumed by large parts of the local population in American cities before, in turn, consuming them.

3:38If you've ever been to any city on the Pacific coast, you know what I mean. Lost souls, ghosts, lighting up, injecting into any vein that's still left, wandering mindlessly from street to street, wandering from car to car, asking for money, any money, for the next hit, sometimes not moving at all, staring into space with whatever is left of their own being and consciousness. It is a dystopian sight. In this, the wealthiest, most advanced nation on earth. The land of the free, the home of those who crave. Because fennel's so cheap, you can get it for... The blues go for a dollar to two dollars a pill, which is, they call blue...

4:22Two dollars a pill? Yeah, yeah, yeah. Two dollars a pill is so cheap. Yeah. Sometimes a dollar a pill. That voice you heard is Giuseppe. He's our guide to Vegas. and Giuseppe is so Vegas. And I mean that in every way. Late 40s, ripped, sturdy, tight shirt, pensive brow, big garish glasses, thick set jewellery. And yet his movement, everything about him is so controlled, tightly bound, as if he were dreading something. He helps those who are addicted to the drug because he was once the same. His story, his descent into addiction, into opioids consuming his life is in some ways the story of American life in the 21st century.

5:07The story of accident and contingency and of heartbreak. How did you end up out here? What was your story with it? I got injured, back injury, and then started on tramadol, and then Loratab, then Percocet, then Oxycodone, all prescribed from a doctor. So it was all medical prescription, which is how this happens to a lot of Americans, right? This is a thing that maybe, particularly we Brits, because we don't really have the same experience. This actually comes from a doctor, ultimately. The opioid epidemic came from all from a doctor, yeah. Oxycontin and oxycodone. Painkillers. Painkillers. And then you got addicted to those.

5:39And then if anybody doesn't know what being sick is, you know, your body withdraws. And it's like having the flu times a thousand, plus you can't sleep. And it's three days of brutal hell. So now you're just trying to get well every day. Yeah, you heard that right. So many people have ended up as drug addicts, on the streets, dead, lives destroyed, at the hands, fundamentally, of their doctors.

6:06Once you've found the right doctor and have told him or her about your pain, don't be afraid to take what they give you. Often, it will be an opioid medication. Some patients may be afraid of taking opioids because they're perceived as too strong or addictive. But that is far from actual fact. Less than 1 % of patients taking opioids actually become addicted. And any drowsiness that might occur when you start to take the medication will soon wear off in most patients. That was an ad from a pharmaceutical company from the late 90s, actively encouraging people to seek out opioids from their doctor and telling them that there would be no consequences.

6:55This was commonplace in the late 90s, with pharmaceutical companies heavily marketing opioid painkillers assuring doctors they were not addictive when used for pain. Prescriptions surged, addiction followed. Suddenly, whole communities, especially in small town rural America, which had largely been untouched by drugs before, seemed like they were being swallowed up huge spikes in overdoses deaths half dead people just lying on the streets that pushed the state and federal governments to tighten up prescription and regulation but by then the damage was done and it often left people who would become addicts with nothing to replace the thing to which they had become addicted pushing many to elicit drug taking with all that goes with it.

7:43So you ended up on the streets? I did. And what was that like day to day? What's it like living on the streets day to day? Oh, it's hell. You're just existing. You know, just one day blurs into the next, blurs into the next. You can't, you got no friends out here. And you got acquaintances, but they're only as good as what you can give them. And you know, you got to watch your stuff all the time. I mean, it's, it's rough. In Vegas, it isn't even living on the streets, but beneath them, away from the heat and the light and the eyes of the city above. Many addicts live in the city's flood tunnels.

8:16So Giuseppe, just tell us what these are. So there's one of the entrance flood tunnels in the city. They're all over the city. And so if you notice like the cuts in the gates. Yeah. Right here and right here. So then people go out there and they'll live under there, kind of hide out under there. So people who are addicted? is yeah drugs mostly yeah i just hide in the tunnels i don't know about hide but live live yeah you see how hot it is you know it's nice and cool down there yeah but man dark i mean secluded way of living nice way of living i mean it was not my thing yeah but i would go and pick up dope in there would you oh yeah it's not dangerous in there of course so this is basically it's a very long set of tunnels feet you know really really dark you only have to go in what like 20 paces before it's absolutely pitch black step step a little bit ahead of me and it's so far back and it's pitch black i can't see so these are the tunnels all underneath all underneath las vegas where hundreds and hundreds of homeless people addicts live on a regular basis and this is where people live people live in here in this pitch black they got lights lanterns you know flashlights bring batteries down for them water i mean and they just live to stay outside out of the heat feel much cooler it is and just get high down here get high you know work twiddle on your things depends on the drugs that you're on if you see all right here i mean that looks like it was all washed out right there that one goes down there this one goes for about probably another mile down that way and over because people can get washed out down here because they are used for floods oh yeah well look see everything comes right here so if it just rains a little bit they get washed out you're right and people drown yeah I have to say just happy like it is I mean it's pretty scary it was I mean I guess you're not thinking about there's more scarier things than living down here and surviving when you're just trying to get by every day well like being dope sick At least here you can kind of relax and kind of, you know, use away your problems.

10:32And you just sit down here, lie down here, get high, forget the world upstairs exists. Yeah, yeah. I mean, some of the other tunnels, they're huge. According to Tim, I guess they're going to start to clear out some of these tunnels, what they've been doing. And that's more for their safety, I think. And it's such like a, I mean, just have it, it's such a, I mean, what a contrast with the city above, right? Like the city of lights, like Sin City. The light. The city under the city. The luminescence, the thrills of all the people who flood in here every single day and week and year. And then in the other city, in a world that these people would never know about, there are people literally living, usually high.

11:11The world's just forgotten about. Yeah. Underneath the tunnels, and then any time you see a big wall by the highways, those are sound walls. In between there, there's all huge encampments as well. That's depressing, isn't it? I mean, I was out there, so yeah, it's depressing. You're just existing day to day. As we emerged from that tunnel, we were approached by someone who had lived there. His name was Tim. Were you living in there not long ago, Tim? Yeah, I was. How long were you living down there for? Off and on for the last two and a half years. Two and a half years? Yeah. Living in the tunnels?

11:43Yeah. Underneath Las Vegas? Absolutely. What's life like down there? Well, for me, it's normal anymore, you know. It's normal. Sounds crazy, you know. Some people have dogs they've got to feed every day and, you know, all that kind of stuff. I guess there's certain aspects that are somewhat normal, but it's really not, you know. So what is life like? It's normal, I know, but what... Just describe, yeah, what's the average day in the tunnels? Well, usually you just stay down there to do your drugs or whatever and sleep. And then when you get up, time to go out and do what you do to earn money. You know, so it's basically just a place to stay that's out of sight.

12:33Must be scary, right? Not really. Not even at first? No. If it wasn't for me, I don't know if it's that way for everyone. You know, some people think the tunnels are haunted and that sort of thing. You know, you do hear some strange noises, you know. How many people are normally down there with you in a typical tunnel? Uh, there was probably 20 of us in a group maybe about a year ago. And is there much like interaction between people? Oh yeah, absolutely. Yeah. The, uh, people, it's almost like having a neighbor that you go borrow sugar from, you know? Like, you know, except it tends to be a lot more drug related, you know?

13:12Like, you got a couple bucks I could borrow to, you know, only got X amount, you know, to pick up drugs. I need two more bucks to get to the next weight increment, you know. Or, I don't know, we need a dollar for a soda, you know. What sort of drugs are we talking, fentanyl? Fentanyl and crystal meth. Do you use those drugs? I do. Still now? Yeah. How regularly do you use them? Every day. Every day? Every day, yeah. Fentanyl most of all? Yeah, yeah. How often do you take it? Um, as often as possible, really. But usually every 12 hours, maybe. Every 12 hours? Yeah. And what effect does it have on your body?

14:00Are you able to walk, to talk? Yeah, like I smoked maybe an hour ago. So you're on it right now? Yeah, yeah. You seem reasonably with it, I would say. Yeah, yeah. Some people, I don't know how some people are different than me, but there's a few people out here that get, It's like they're possessed almost. It's crazy to see. I don't understand it. Will you take it again today? Yeah. In how long? Probably a couple of hours. A couple of hours' time? Yeah. Does it scare you, the potential effects? Because we know how lethal it is, how many people are dying from it. No, it seems as if once you build up a tolerance to it, that you seem to be pretty good because nobody's fallen out in our group in a long time.

14:48Would you like to stop taking it? Absolutely. You'd like to? You'd like to get clean from it? Yeah. Yep. And what stops you? That is a good question. See, that would be probably scarier than these tunnels, you know, honestly. What's stopping taking it? Right. You know, I've been using drugs for shit probably 20 years. You know, it'd be a big change in my life, you know. You can't imagine it? Well, I can imagine it, but, you know, the idea of it is scary, I suppose. You know? What's also very scary is that sometimes, often, people don't even know they're taking opioids. Dealers now mix them with more conventional drugs to make them more potent.

15:44Giuseppe's brother certainly had no idea. How old was he? When he died, 37. God, young. And not homeless, upstanding member of society, ran three methadone and suboxone clinics. Wow. Out in the Bay Area. He just got some cocaine one night, it had fentanyl in it, and that was it. Really? So he just... Wow. So he didn't even... Again, he didn't even realise he was taking it. It was just... He did not know he was taking it. No, no. No, no, he did not know he was taking it. The bill was still rolled in his hand. Well, it was instant. It shut his heart down. Yeah. My God. So my name is Michelle George and I work for Track B, which is the syringe service in Las Vegas.

16:24How big is Las Vegas' drug problem, would you say? Is it getting worse? It's worse. So in 2022, we lost 616 lives to overdose. This year we're looking at 796. 458 of those are due to fentanyl overdose. Due to fentanyl specifically? Fentanyl, yes. And why do you think that's getting worse, the fentanyl in particular? because all the drugs are cut with it. So on top of our syringe services, we are able to offer on-site drug testing so clients can bring in their works, they can bring in their supply, anything that has drug residue on it. We're able to test it in our storefront to see what's kind of in it.

17:08Like we can tell them if it's fentanyl, xylazine, and then we send that out to a lab and then it comes back and it tells everything that was in that drug. It's all hands on deck. It requires a community. It's our everyday people. That's the problem that I always face. We assume that it's our unhoused that have the problem. No, it's affecting our children because they're taking pills that they're buying off of Snapchat. Snapchat. Snapchat. What's the other one? WhatsApp. Instagram. So they're able to buy these drugs. They're not testing them. They're bringing them to school. So it starts from our kids all the way up to our elders.

17:47So the kids are taking fencing? Yes. How young are we talking? About three years ago, we had a junior high where a little girl brought five pills to school. Two of the five kids that took the pills overdosed and died. And three of them didn't take the pills. They put them in their pocket. So we're seeing it all the way down. How old would that be? 11, 12. 11? 11, 12 years old. from fentanyl at the age of 11 because they're buying it on snapchat yep and they're not that's horrifying it's terrible and i have kids i raise my kids out here and i have to tell them all the time like don't even don't take anything anybody gets so dealers are selling to kids absolutely absolutely there's no age money is money right so there's no remorse like hey let me not sell to this part nope it goes out to everyone how quickly can this take hold would you say if it isn't controlled or if authorities kind of lose track of it before we get started, how quickly can it take hold?

18:43Well it's gone from being a minimal problem in 2019 to now being an epidemic out here. So in five years? Five years. If you think kids being dealt fentanyl on snapchat is scary then get this. So that's a recovery high school so if you're trying to get sober and you're a kid in high school it's fully under the school district you can go there and specialize two kids struggling with alcohol and drugs. So it's a high school, a secondary school? High school. Specifically for? Alcohol and drugs. Kids who are addicts? Uh-huh, yeah. Whole school? Whole school. It's pretty amazing. And they've got outstanding results with it.

19:20And how young are the kids? So freshmen to seniors. So how old is that? 13 to 18. You might have some that are in there that are 19. 13, as young as 13? Mm-hmm.

19:36750 ,000 Americans are estimated to have died in this epidemic. That's depressing enough. What's disturbing for us is that maybe this isn't just an American story after all. This is a story which might be coming for Britain. Stay with us.

20:03your social media feed delivers plenty of advice but it doesn't know you it doesn't ask questions it doesn't give physical exams or order tests doctors do at the american medical association we believe the best care starts with a real conversation with someone who understands the science and your unique health. So stay curious, ask questions, but when it's time to make decisions, make them with a doctor. Learn more at amahealthvshype.org. That's amahealthvshype.org. This is The News Agents.

20:40So we're a long way now from the west coast of America where so much of this epidemic is centered. We're in Camden in North London. It's just off the main high street, tucked away behind a Turkish restaurant, a drugs treatment center. And we've come because we've heard that recently centers like this in London and elsewhere in the country as well, literally in the last 12 months or so, have started to notice something very disturbing. Fentanyl, and more specifically, nitazines, the family of synthetic opioids, chemically different to fentanyl, but maybe three, four, five times stronger than fentanyl and 250 times stronger than heroin, well, they've started to be detected in the UK.

21:26I'm Molly Howden. I'm the cluster lead nurse at CGL Camden. Opiate-related problems. It's something we hear about in the US a lot. Fentanyl, obviously, has become a huge problem over there. How big a problem in terms of the substance abuse with relation to those substances, is that in the UK? I think it's become a bigger issue within the last year or two, especially here. The synthetic opiates, there seems to be more of those coming in now. That's something you've noticed here? Yeah. The majority of people aren't aware that they're purchasing the synthetic opiates and that tends to mean that they're trying to buy heroin but then they might end up using a synthetic opiate.

22:07So people think that they're buying heroin, something they're familiar with. Yeah. So there's mitazines, xylozines, fentanyl, all different types of synthetic opiates. The majority of people are aiming to buy heroin. Some people actively seek out the synthetic opiates because generally they're a lot stronger than heroin. But on mass really overall, I think people are aiming to buy heroin and are unaware that they've got synthetic opiates in them. It can be up to 100 times stronger than heroin, but then the next time it could be 200 times stronger. So it's really difficult for us to advise people how much stronger it is.

22:49They were never made for human consumption. Obviously there's fentanyl, which is used in hospitals and like general opiates but these netizens are have been reintroduced after they were found too strong for for people to take and are only illicit the effects on the body are presumably profound yeah and it makes the danger of overdose presumably much more profound the people have overdosed on netizens what they thought was heroin and they might have a quite high tolerance to opiates they've been taking heroin for 20 years and they'll they'll overdose once on netizens because it's so much stronger we had a period of time in march where there was 31 non-fatal overdoses in camden in a week because of netizens so just in camden just in camden one week yeah all the drugs were tested and they all had netizens in them or netizen compounds in them Because of that, we had to sort of change the way that we were delivering our service.

23:51So we opened at the weekend. We went to, you know, went to do outreach. We contacted like over 300 people that hadn't been contacted recently. And it's obviously not just happening here. It's happening in other boroughs and all over the country. You've talked about a time frame of a year, two years. You talk about March and it seems to be getting worse. Does anyone have any idea as to why suddenly this is becoming a bigger problem so quickly? It's probably cost, it's probably much cheaper. Unfortunately, drugs that are being sold as other things as well, nobody really knows. So even party drugs like MDMA have been found to have netizens in for people that don't have a tolerance whatsoever that might take netizens accidentally.

24:36But it's hard to say. I think it's generally just a cost thing and it's much cheaper. These netizens are terrifying. They're coming in from China mainly. They're completely deadly, even in trace amounts. People don't know they're on them. And it seems like dealers are literally experimenting to see how much they can put in. My name is Vicky Markovich and I'm an executive director for Change Go Live. and Change Grow Live is the largest of the third sector providers of drug and alcohol services, treatment services in the UK. Is the worry that this is just the beginning of something? I mean, presumably, obviously this is a murky world, right?

25:21The gangs, criminals, there must be advantage for them in so doing and therefore that this could grow as a problem, this could become more and more common. It's the tip of the iceberg. Well, there's an advantage to them in some ways that it's cheaper But it's a disadvantage if you're killing the people who are bringing you the income. So when there was a big spike a number about 18 months ago and then things sort of settled down a little bit, the kind of intelligence that we have and that we've kind of garnered is that the drug dealing networks and the gangs that are creating these drugs are testing out how much netazine you would use that wouldn't necessarily kill somebody but would give you a similar effect to heroin or any other kind of drug.

26:02A live experiment. Yeah, so it's almost like live experiments. Now, it's not brand new, it is emerging. We are very concerned as a drug treatment sector about the impact on the people who use drugs. As the levels, I suppose, become balanced, this could become the norm. It could become the drugs that are available on the street. So we as a sector need to really think about what kind of treatment are we offering? How quickly can we get people in? How can we almost be more successful at engaging people than the drug dealers so that they're getting the drugs that they want from the drug treatment services so that they're safe and they're not putting themselves at harm?

26:40Because I suppose that the risk that you're describing is that right now, this has been quite nascent. And as you say, one of the very unfortunate effects, obviously morally, but also commercially for these people is that they've been killing their customers. But if they were to get a kind of, for want of a better expression, a Goldilocks kind of level, which provides the hit that people want, whilst not killing them, that you do get a fentanyl type crisis in the UK, that you get something, in fact, could be worse, because as you say, it is worse. As it stands and the numbers are increasing. So we know as a society, there are lots of people out there that are using opioids, heroin as one of the opioids that people are using.

27:17And really what we want to do is get those people into treatment. We know that drug use is a reality. It's a reality of society. It goes on every single day. and by kind of almost, I suppose, de-stigmatising that people use drugs, trying to encourage people to access help, ensuring that they're able to access treatment easily, quickly, in a way that isn't, you know, increasing stigma, is really the only success story that we have. At least 400 people have died in the UK from overdoses involving litigines over the 18 months to January of this year. Authorities, the police, they're just waking up to the scale of the threat they now pose.

27:56They can be, remember, four to five times stronger than fentanyl and up to 250 times as potent as heroin. One leading drugs charity has warned that this is probably the biggest public health crisis for people who use drugs in the UK since the AIDS crisis in the 1980s. Alistair, who we met at the clinic, has already lived it. So you were homeless for six years? Yeah, I'm still homeless now in temporary housing, just in different hostels, but I was street homeless when I first came to the agencies. And how long have you been street homeless on the streets for? Roughly five, six years. I had a major problem, about 21, with heroin and cocaine injecting, and I sort of did a prison sentence seven years for a robbery, so it got pretty serious.

28:43I stopped working and then became institutionalised from the prison. Have you ever been or were you aware of the increasing use of opioid drugs? Yeah, definitely. Yeah, yeah. I stopped and had an abstinent time for about two and a half years. And in that time, the fentanyl got really strong. Quite a lot of people used it, as opposed to no one was really aware of it at one point. So you're using fentanyl? We were all, everybody used it. Yeah. And at the end of the time, before I had an abstinent phase, a lot of people were overdosing on it. It's one of the things that overdosed a lot of people.