EXPLORATION // A Tale of Two Cities
A Tale of Two Cities
A journalist in Seattle and a photographer in Philadelphia on the frontlines of the opioid crisis
Words by Julia Wald
Photography by Suzanne Stein
EXCERPT //
In 2022, there were more than 76,000 deaths from fentanyl overdoses in the United States. To contextualize how dangerous street fentanyl can be; according to a 2021 Delaware State Department of Toxicology report, a fentanyl concentration of less than 3 ng/ml is enough to cause death in an otherwise healthy adult. To emphasize how small of an amount of fentanyl this is, three nanograms per milliliter is the visual equivalent of holding three tiny grains of sand in your palm.
In 2023, there were more than 74,000 deaths from fentanyl use. While this may sound like an improvement, certain researchers speculate that the reason the overdose rate is declining is because so many overdoses have been lethal—the population of white fentanyl users has shrunk, but unfortunately the number of black and native American users is rising. In any case, waiting for fentanyl users to die so overdoses go down isn’t a solution to this public health crisis, or a way to counter the efforts of national security threats from China and the Sinaloa cartel.
We’re in the middle of what may constitute a reverse opium war—instead of Western powers flooding Chinese markets with opium in the middle of the 19th century and ravaging their population, the U.S. is now awash with opioids and associated drugs that have their origins in Chinese factories and Latin American drug cartel laboratories.
It started when cheap heroin from Afghanistan flooded the market in 2002—the Taliban used opium sales to fund opposition to the U.S. occupation—and people addicted to expensive prescription drugs such as oxycodone started buying on the street. The street drugs started to be cut with synthetic drugs, including fentanyl, which is 75 times more potent than oxycodone.
Then came tranq, which causes skin to rot at the injection site. //
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