Why Denver Heroin Users Are Switching to Fentanyl

This is the second in a series of stories on fentanyl and overdoses in Colorado. Click to read part one, "Fentanyl and Other Drugs Killing the Most Coloradans."

A decade ago, heroin was widely viewed as the most dangerous street drug not just in Denver, but in Colorado as a whole. But the latest statistics from the Colorado Department of Public Health and Environment reveal that overdose deaths from heroin have been falling in recent years, while those related to the synthetic drug fentanyl have been heading in the opposite direction.

The CDPHE recorded 229 heroin overdose deaths in 2018, 215 in 2019, 220 in 2020 and 176 in 2021 (those figures are not yet firm). In contrast, the department counted 102 overdoses connected to fentanyl in 2018, 222 in 2019, 540 in 2020 and 803 in 2021 (final numbers are pending).

Lisa Raville, executive director of the Harm Reduction Action Center, whose mission is to "educate, empower, and advocate for the health and dignity of Denver's people who inject drugs, in accordance with harm reduction principles," reveals a surprising factor in this shift: climate change. She says that climatic conditions have led to a larger decrease in poppy production than did decades of interdiction efforts, and as a result, "heroin is transitioning out of Colorado. That's why we're seeing more synthetics like fentanyl. They're easy to make in a lab, and they're cheap."

She adds: "Prohibition and the criminalization of the drug market have brought us fentanyl. During Prohibition in the 1920s, people weren't brewing beer. They were making cheap hard liquor in bathtubs" — and fentanyl is the modern equivalent, she suggests.

Because many longtime heroin users in Denver and beyond are having trouble obtaining their previous drug of choice, they're changing over to fentanyl — and Raville acknowledges that users she's met through HRAC "are pumped, because they don't have to inject anymore. Injecting is difficult to do quickly, but fentanyl comes in blue pills that they can grind up and smoke."

Still, this switch has had consequences. "Smoking fentanyl is a shorter-acting high," she points out. "If I'm a maintenance heroin user, I don't have to use for four to six hours. With fentanyl, it's like an hour or an hour and a half, and that's it." For this reason, many former heroin users will choose to smoke fentanyl more often, thereby increasing the odds of something going wrong.

There are also risks for people Raville refers to as "pill poppers" — folks who have grown accustomed to using opioids such as oxycodone for fun. Because such opioids were federally regulated, their dosages were reliable; as a result, individuals taking them at least had a sense of their strength. In contrast, fentanyl pills are completely unregulated, with the amount of the drug they contain varying widely from tablet to tablet, and there's no way for the average person to know how powerful they are in advance.

Now, of course, oxycodone and its pharmaceutical cousins aren't flooding the market as they once did — so users "are taking the blue fentanyl pills thinking they're out of a medicine cabinet, that they're from a safe supply of drugs," Raville contends. "But FDA-approved pills were low-hanging fruit for the legislature to go after physicians" whose penchant for overprescribing fueled the opioid crisis. "And the blue pills are definitely not the kind of safe supply people who've been pill poppers for years got used to."

Raville stresses that "I'm talking about non-chaotic, recreational users who might drink and take a pill on the weekend, which was very popular in colleges. I think some of them assume that the blue fentanyl pills are fine because the pills they used to take were fine. But this is a very different situation."

And, as in the case of five people who died in the same Commerce City house last month after using cocaine that turned out to be laced with fentanyl, the results can be tragic.