A man likely in his thirties buys $10 worth of cocaine from a Park Street dealer and then buys a bundle (ten 0.1 gram bags) of fentanyl from another for $15. He buys the fentanyl to keep withdrawal at bay and he buys the cocaine to give him the energy to collect enough cans and bottles to buy more fentanyl later in the day with a little left over for food.
Unknown to him, one of the bags of fentanyl contains a clump of fentanyl making the percentage of fentanyl in the bag not the expected 1% (1 milligram), but instead 12% (12 milligrams). He walks down a ravine in Pope Park and then goes through the thickets to a small clearing. He sits on a milk basket, puts the powder from two of the bags along with some of the cocaine into a small bottle capped sized cooker, squirts in some saline, heats it up with a lighter, then draws it up with a syringe through a tiny cotton ball to catch some of the impurities. He ties a blue tourniquet around his arm, finds a vein in the crook of his elbow. He draws back, sees a ribbon of blood, confirming he is in the vein, then pushes the plunger, injecting the concoction. He feels a great rush of euphoria and then nothing.
When we arrive, we find him collapsed forward in a frog position, his head resting on a rubber tire. The needle is still in his cold, riggored arm. I make note of the hundreds of torn wax bags scattered on the ground as I attach the electrodes to his chest and run off my six seconds of asystole (flatline) and call the time. I will hand an index card over to the responding policeman that will have the decedent’s name (John Doe), date of birth (unknown) and the time I pronounced him (11:14), as well as my name, my paramedic license and unit number. The officer will call the medical examiner’s office, who will come and take the body for an autopsy. Blood tests will reveal the patient had fentanyl, xylazine and cocaine in his system.
This man’s death counted as a fentanyl death, a cocaine death and a xylazine death. But it was fentanyl that killed him. Not cocaine or xylazine. Fentanyl stopped his breathing almost as soon as it hit his bloodstream.
Fentanyl was the culprit in 90.2% of all opioid deaths in Connecticut and likely the true cause of death in most of the 77.5% percent of cocaine deaths that also tested positive for fentanyl.
For all the fanfare about the fourth wave of the opioid epidemic, which represents opioids with stimulants, the driver behind most of the deaths continues to be fentanyl.