Recovering addict Phaedra Ward talks about an overdose last December that gave her the motivation to get help. (Lloyd Fox/Baltimore Sun video)
In a laboratory somewhere in China, a chemist is producing the fentanyl that will kill an opioid user in Maryland.
Within China's vast drug industry, which produces much of the global supply of pharmaceutical ingredients, laboratories are taking advantage of cheap labor and lax oversight from Beijing to churn out new versions of the cheap, powerful and often deadly synthetic opioid faster than U.S. authorities can identify, classify and ban them.
From China — the largest producer of fentanyl worldwide — the drug is sent daily by plane or ship to Mexico, where traffickers and truckers push it along well-worn paths of illicit narcotics north to the United States. In Baltimore and other cities, well-established gangs push the powder and pills to consumers.
This much is known by U.S. authorities. They're intercepting increasing amounts of fentanyl. But they've been unable to make much of a dent in the trade.
"It's kind of the new Wild West," said Katherine Tobin, a member of the U.S.-China Economic and Security Review Commission. The government panel helped outline the route for Congress earlier this year.
Deployed to stop the supply are more U.S. Food and Drug Administration inspectors, better customs technology and undercover Drug Enforcement Administration interference. There's also been some recent cooperation from Chinese authorities.
Still, no one knows how much gets by — until it lands in cities such as Baltimore, where record numbers of people are overdosing and dying. Fentanyl, often mixed with or mistaken for heroin, but 50 times more powerful, is now Baltimore's deadliest killer.
DEA Assistant Special Agent in Charge Don Hibbert talks about the rise of fentanyl in Baltimore. (Lloyd Fox, Baltimore Sun video)
Phaedra Ward was one of Baltimore's estimated 25,000 heroin users.
She stumbled from a West Baltimore rowhouse one morning last year, suffering painful withdrawal and looking for a hit.
She found a local dealer handing out testers. She took the free sample to a playground nearby, leaned against a fence and snorted it.
When she came to, she was looking up at an emergency responder. It had taken four doses of the overdose remedy naloxone to revive her. That's more than most city ambulances carry.
Ward, 54, entered treatment in January. She said she's since used naloxone to save two other drug users. But others have not been so fortunate. Fentanyl deaths outpaced homicides in Baltimore for the first time last year, and began outpacing heroin deaths this year.
Fentanyl deaths in Maryland leapt from 186 in 2014, when the drug began appearing here in volume, to more than 1,100 last year — one of the largest jumps in the nation.
Overdoses linked to fentanyl pushed overall drug- and alcohol-related deaths last year above 2,000 in Maryland and 60,000 across the country, making intoxication the leading cause of death for Americans under age 50.
Baltimore accounts for about a third of the overdose deaths in Maryland. But deaths are up in every region of the state, and among every age group, race and gender.
A federal review released earlier this year found Maryland had the nation's highest rate of hospitalizations for opioid use, a finding emergency doctors attributed in part to an enduring heroin culture. Hospitals have begun training users and others to administer naloxone and steer people to treatment.
Many try repeatedly to quit, but end up with the state medical examiner. Some 2,400 of the office's nearly 6,000 autopsies each year are drug related. The agency, overwhelmed, is at risk of losing its national accreditation.
Dr. David R. Fowler, chief medical examiner, said fentanyl not only threatens the quality of autopsies, but also complicates lab work.
As the Chinese labs develop new analogs of fentanyl, investigators resort to online chat rooms frequented by drug users to get a handle on what's circulating. When they're onto a new type of fentanyl, they contract with a DEA-approved lab to make samples to calibrate their machines, which can take months and cost thousands of dollars.
Baltimore health officials don't even know where the fentanyl lands in town until people begin overdosing.
The health department began collecting real-time data on overdose spikes from emergency responders and hospitals last fall. A spike is three or more fatal or non-fatal overdoses in 24 hours.
Baltimore suffered 95 such spikes from August 2016 to August 2017, city health department figures show. The west side logged the most, in neighborhoods largely familiar to treatment advocates: Sandtown-Windchester, Southwest Baltimore, Washington Village-Pigtown, Greater Rosemont and Upton-Druid Heights.
Now when officials spot a spike, they notify treatment providers and others in the community. The tips about a "bad batch," heroin that likely contained fentanyl, go out the same day so others can be warned.
Users may download an app to get the warnings directly, though they are provided only general locations, lest they use specific information to locate the most potent drugs.
That's what Ward said she would have done.
"If someone OD'd on a certain drug," she said, "I wanted it."
Dr. Leana Wen, the city's health commissioner, said the new warning system provides "the opportunity to share what we see on the ground and save lives."
Others also are working to keep the fentanyl from arriving on local street corners in the first place. But the flow from China appears to be growing.
Drug Enforcement Administration teams that work in tandem with local law enforcement used to seize a couple of kilograms of fentanyl annually. Now they seize 30 or 40 kilograms at a time.
Three milligrams is enough to cause an overdose.
"Fentanyl has really replaced a lot of the drug market here in Baltimore, which is why we're seeing the increased rates of overdose," said Don Hibbert, the assistant special agent in charge of the DEA's Baltimore operation.
A task force created by Baltimore police in May has been working to build cases against fentanyl dealers.
The task force works at "putting patterns and trends together," Deputy Police Commissioner Dean Palmere said.
Members have learned, for example, that fentanyl from China is handled by long-established crime syndicates, which press pills or divide powder and distribute it via street-level pushers, sometimes with — but often without — disclaimers about the potency.
A hit of fentanyl can go for $10 on the street, a similar price as heroin, but with a far higher profit margin. Heroin wholesales for $50,000 to $60,000 a kilogram. A kilogram of fentanyl can be had for $2,500.
That profit potential has helped fuel the record surge in killing in Baltimore of the last three years.
Police and DEA declined to discuss the tactics they use to investigate traffickers and dealers. But court filings offer some clues about fentanyl's path in and around Baltimore, and how officials try to interrupt it.
In a case in which police recovered 30 kilograms of fentanyl and 15 kilograms of heroin, task force member Shane Lettau wrote that officers received confidential information about a drug deal and tracked a defendant through his phone to Jessup, 16 miles from Baltimore.
The officers reported watching men pull large bags from a tractor trailer behind a motel and put them in a car. When police stopped the car, they said, a police dog sniffed out fentanyl. Officials said they believed the drug came from the Southwest border and was bound for West Baltimore.
In a second case, federal officials using surveillance equipment charged a Baltimore man with running a heroin and fentanyl operation out of a luxury apartment in South Baltimore's Locust Point. They said they learned of the operation by tracking a co-conspirator and discovering the apartment was rented in a fake name using a fake driver's license and earning statements from a company that they couldn't confirm existed.
Detectives said they overheard Rodriguez Morgan, the defendant, discussing the drug operation on a phone they had wiretapped. They said they then found a large amount of drugs in his home in the city's Ednor Gardens Lakeside neighborhood.
Government prosecutors said in a recent court filing that the drugs were actually an "incredibly lethal amount" of carfentanil, a more potent version of fentanyl sometimes used as an elephant tranquilizer.
"Twenty-five percent of the amount of carfentanil that was recovered from the defendant's home could kill the entire population in the state of Maryland," prosecutors wrote. "Based on the items recovered from the defendant's home, it is clear that he was in the process of packaging an incredibly lethal product for distribution to customers who believed they were purchasing heroin."
Morgan's attorneys did not respond to request for comment.
In a third case, Maryland Transportation Authority Police Officer Thomas Davis sought permission to search two phones that belonged to a man awaiting trial on heroin and fentanyl distribution charges. Davis alleged Anthony Renard Wynn of Randallstown earned a $30,000 salary as a Port of Baltimore longshoreman but had placed and cashed out more than $15 million at casinos between 2016 and the present.
Davis said that was "consistent with drug traffickers attempting to conceal their drug cash as gambling winnings" or trying to "chip up" to exchange low-denomination bills for larger bills for "easier consolidation and transportation," such as mailing the currency.
He alleged Wynn used private carriers to ship drugs from California to Maryland and drug cash in the other direction. Davis said Wynn used a storage unit, multiple casinos, a fake business, UPS Store locations and his home to facilitate the operation. In one case, Davis alleged Wynn intercepted a package delivered to a local animal hospital and took it to a barber shop where he processed drugs.
Investigators say they found about a kilogram of suspected heroin in Wynn's car and three kilograms of suspected heroin and more than a kilogram of suspected fentanyl in a storage unit.
Wynn could not be reached for comment. His attorney declined to comment.
Hibbert said fentanyl dealers are running sophisticated operations, and taking precautions. Officials have seized latex gloves and filtration masks they use to protect themselves while handling the drug.
Police believe some street-level hustlers probably don't know what they're selling.
DEA issued guidelines this year warning emergency responders and police officers not to touch fentanyl, or any substance they suspect could be fentanyl.
All levels of law enforcement have been working to identify the routes fentanyl takes from China, interrupt the supplies and close loopholes.
A gaping hole is the nation's mail system, according to Tom Ridge, the nation's first Homeland Security secretary. He's been working on behalf of a group of logistics, trucking, pharmacy and other companies for passage of a law aimed at collecting more information from shippers about the contents of their packages.
The Synthetics Trafficking & Overdose Prevention Act was reintroduced in February by a bipartisan group of lawmakers to help stop fentanyl and other drugs from entering the country through the U.S. Postal Service.
The Postal Service isn't required to collect the same amount of electronic data as private shippers such as FedEx or UPS on where packages come from and where they go.
The information allows Customs and Border Protection to better flag packages for inspection. Officials look not only for illicit drugs but also for weapons, knock-off goods and counterfeit medications.
Ridge, a Republican former governor of Pennsylvania, says the STOP Act will not halt the flow of drugs. Fentanyl's huge profit margins motivate criminals. But it could "narrow the aperture of opportunity," he said.
Ridge warned of the urgency: "It's not hyperbole to say these drugs are a weapon of mass destruction."
Robert Cintron, vice president of the Postal Service for network operations, told Congress in May that officials are ramping up data collection. Officials now receive electronic information on 40 to 50 percent of incoming packages; two years ago, they had data on virtually none.
The Postal Service told The Baltimore Sun it "shares the concerns about America's opioid crisis, and works actively with Customs and Border Protection to help interdict the flow of illegal drugs entering the U.S."
UPS spokeswoman Kara Ross said the private shipper works "very closely with law enforcement on thwarting any dangerous and illegal goods. UPS has layered security measures to prevent unauthorized shipments from entering our system."
Ridge said there are no clear estimates of how much gets through. Several high-level government reports suggest a robust channel remains.
The U.S.-China Economic and Security Review Commission, a government advisory panel, reported this year that criminals take advantage of China's lagging regulatory environment, the United States' ineffective screening of raw drug materials at the border and the DEA's slow process for classifying new drug analogs as harmful.
The U.S. Food and Drug Administration has been increasing the number of inspectors and the pace of inspections of drugs from China, and U.S. officials have been seeking to hold companies accountable for their supply chains. But officials can inspect only the drugs they know are being shipped, said Tobin, the U.S.-China commissioner.
The growth of China's drug and chemical industry has outpaced government regulation, she said. But the industry is also a big money maker, and the country has not suffered the same levels of opioid addiction, which she said might be reducing the government's sense of urgency to act.
The Chinese government did ban four types of fentanyl, drawing praise from DEA and other U.S. officials. They say they continue to press the issue.
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Sen. Ben Cardin, the top Democrat on the Senate Foreign Relations Committee, said interrupting the flow of fentanyl will require new investment in technology at the ports and border, new tools to tackle financial crimes linked to drug trafficking, and an extension of discussions with Canada and especially Mexico begun under the administration of President Barack Obama.
"With China leading fentanyl production, Mexico serving as the main source of illicit heroin for American markets and the U.S. experiencing a nationwide opioid epidemic," the Maryland lawmaker said, "Baltimore and communities across the United States cannot resolve this crisis on our own."
Baltimore Sun reporter Justin Fenton contributed to this article.