How fentanyl is pushing the opioid epidemic into new, more dangerous territory and why Kansas saw the nation’s second-highest increase in overdose deaths last year
It was the middle of last April when Shelby Wahl was found curled up at the bottom of a locked closet in a home that wasn’t hers.
She had been living with a man twice her age, the man who first introduced her to injecting heroin and fentanyl. She had already overdosed twice the morning she was found and was revived both times with Narcan.
At that point, Wahl had just turned twenty-four. She grew up in Wyandotte County and moved to the Missouri side after the third grade. She graduated from Oak Park High School in 2014 and began working as a waitress. As she was on the cusp of turning twenty, she moved into her own apartment and had a daughter.
Local police had been searching for Wahl for some time when they entered the home to find burnt spoons, needles and heroin littering the floor. Wahl—tucked away in a closet—was the last to be seen as officers searched the back bedroom. After finding her, arresting officers handcuffed her and walked her out of the home. “When we got to the car, they asked me if I wanted help,” Wahl says.
“That’s all I’d ever wanted. All I ever wanted was help.”
Last year, the state of Kansas saw the nation’s second-largest percentage increase in drug overdose deaths.
In 2020, there were four hundred and seventy-eight recorded drug overdose deaths in Kansas, and in 2021, six hundred and eighty. The CDC shows that overdose deaths in the state increased by forty-three percent last year alone. That spike is linked to the increase in fentanyl in the area.
While the Midwest’s fentanyl crisis is seeing a surge, America’s opioid epidemic at large is worse than ever before. In 2021, the nation logged a record-breaking 107,622 drug overdose deaths.
The evolution of the opioid crisis is often broken down into three categories: prescription pain pills, heroin and fentanyl. The U.S. witnessed a surge of overdose deaths from prescription drug abuse in the ’90s. By 2011, more than 115,000 Americans had died and many opioid users turned to heroin, a cheaper alternative to pills. Since 2013, fentanyl has overtaken prescription pills and heroin as the leading cause of overdose death among Americans.
Fentanyl is a synthetic and highly addictive opioid that is fifty times more potent than heroin. Experts say there’s no end to the crisis in sight as drug cartels continue to flood the country with shipments of fentanyl—often in the form of counterfeit pills made to look identical to prescription painkillers.
Two experts, Scott Higham and Sari Horwitz, Pulitzer-winning investigative reporters for The Washington Post, recently released American Cartel, a book exposing how some of the nation’s largest corporations created and perpetuated the initial phase of the nation’s opioid crisis in the ’90s. In recent interviews, Higham explains that the drug cartel has watched millions north of the border become addicted to opioids. Because fentanyl is such a cheap and easy drug to manufacture and smuggle, it has created an enormous and highly profitable market for the cartels.
As a teenager, Shelby Wahl suffered mild back pain from spinal stenosis, a condition that puts pressure on the spinal cord and nerves. While pregnant, Wahl sustained a fall. After giving birth, her back pain became increasingly worse.
When she sought treatment for her pain, she was given hydrocodone. She says her doctor did not give her any other treatment options. Typically, treatment for spinal stenosis involves physical therapy and sometimes surgery.
At first, Wahl says she was given a monthly prescription of one hundred and twenty tablets of ten-milligram hydrocodone. As she became dependent on the pills, her doctor increased the prescription to two hundred and forty tablets a month. At twenty-one years old, Wahl, a new mother, was prescribed and taking about eighty milligrams of hydrocodone daily. When the hydrocodone stopped cutting it, Wahl’s doctor prescribed her oxycodone on top of the hydrocodone.
“It got to the point where I was taking them throughout the day just to function,” Wahl says. “I took care of my child. I went to work, and she went to daycare. I made dinner and put my daughter’s dad’s lunch together before he went to work. When I tried to stop taking the pills, I would go into withdrawal.”
Wahl was aware that she was developing an addiction. “I woke up one day and just didn’t want to do it anymore,” she says. “I didn’t want to take the pills.” But when she went to her doctor for help, he fired her as a patient. “He cut off all of my prescriptions and didn’t do anything to help me detox. At that point, I was probably taking three hundred and fifty hydrocodone a month. My body went into shock.”
A year ago, on September 27, 2021, the Drug Enforcement Administration in St. Louis released a public safety alert for the first time in six years. It warned against a sharp increase in fake prescription pills: “DEA warns that international and domestic criminal drug networks are flooding the United States with lethal counterfeit pills.”
The public safety alert noted that those pills, often made to look like hydrocodone and oxycodone, are “killing unsuspecting Americans at an unprecedented rate.”
In 2021, the DEA in St. Louis seized one hundred and seventy-nine kilograms of fentanyl, nearly as much as the previous two years combined, according to Todd Zimmerman, special agent in charge of the DEA St. Louis Division, which includes Missouri, Kansas and southern Illinois.
When asked why Kansas has seen such a sharp increase in overdose deaths related to fentanyl, Assistant Special Agent in Charge Rogeana Patterson-King says it’s because Kansas is “a trend shipment area and all of the major highways run through it.”
“We’ve seen that fentanyl and counterfeit pills are coming up through Kansas from Mexico, through El Paso and Houston,” Patterson-King says. “They’re also trickling in from the Southwest and West Coast. Ultimately, with so much being transported through Kansas, drugs are being dropped off and distributed in this area.”
Patterson-King is the head of the Kansas City District Office, which is part of the St. Louis Division of the DEA. She oversees DEA offices and activities in the state of Kansas. With more than twenty-three years of law enforcement experience, she has experience working on international conspiracy investigations targeting narcotics traffickers in Mexico, Pakistan, Canada, South America and the Eastern Caribbean. She has also engaged in multiple international and domestic undercover operations.
“We’re seeing it [fentanyl overdose] more and more among youth,” Patterson-King says. “High schoolers will think they’re taking an Adderall or something from a friend, but it’s actually a counterfeit pill laced with fentanyl.”
“Ultimately, with so much being transported through Kansas, drugs are being dropped off and distributed in this area.”
Cooper Davis was just sixteen when he and three friends decided to split two Percocet tablets one Sunday afternoon last September.
The boys had traveled from Shawnee to Missouri to purchase the pills, which they believed to be thirty-milligram Percocets—commonly referred to as “Perc 30s”. While it’s unclear what form of communication was used to buy the pills that Sunday, it is known that two of the boys had prior contact with the same dealer via Snapchat.
“Each boy took half a pill, and three boys survived that day,” Cooper’s mother, Libby Davis, says. “Cooper did not.”
This time last year, Cooper had just started his junior year at Mill Valley High School. “He was independent and very outgoing,” his mother says. “He certainly lived life like he was invincible. There wasn’t much that scared him, and he would try anything. He was just that kid.”
Three things were present in Cooper’s toxicology report: caffeine, Narcan and fentanyl. There was no evidence of legitimate, pharmaceutical-grade Percocet. The other three boys had no reaction to the fake pills. Even the one who took the other half of the same pill Cooper consumed had no response. None of the other boys required any medical attention.
The DEA uses the analogy of chocolate chip cookie batter to explain how one pill could have such dramatically different effects when taken. When making chocolate chip cookies, some of the cookies will end up with more chocolate chips than others.
“The cartels are not chemists, they’re not scientists, and there’s no quality control,” Libby says. “It only takes the equivalent of a few grains of salt to be considered a lethal dose of fentanyl. Those few grains of salt could be on one-quarter of a pill.”
Fentanyl is odorless and tasteless. Without laboratory analysis, it’s impossible to tell whether a single pill has been contaminated with fentanyl, let alone how much of it.
Libby is a nurse and her husband, Randy Davis, Cooper’s father, is a nurse anesthetist. Both Libby and Randy have administered hospital-grade fentanyl throughout their careers. “My husband, ironically, provides fentanyl to his patients regularly because he’s an anesthetist,” Libby says. “In the hospital, fentanyl is administered in two forms, either as an IV or as a patch. There’s no such thing as a fentanyl pill in the medical world.”
“If you ask me, what happened to Cooper wasn’t an overdose,” Libby says. “These kids are being deceived to death. One Percocet wouldn’t have killed Cooper. Half a Percocet wouldn’t have touched him. These kids are getting fentanyl in what they believe to be Xanax, for instance, and they’re taking it because they are struggling with anxiety and just want to relax.”
“The cartels are not chemists, they’re not scientists, and there’s no quality control.”
What happened to Copper Davis is not uncommon. Contaminated pills—Perc 30s specifically— have been killing people in the Kansas City area frequently in recent years. Along with fake prescription pills, fentanyl is contaminating street drugs, too.
Those who are overprescribed opioids often turn to illicit drugs when they are cut off from their doctors, pharmacies and hospitals after becoming entirely dependent on prescription medications like oxycodone and hydrocodone.
When Shelby Wahl was cut off from her doctor without warning, she checked into a detox program at Research Medical Center, where she was given methadone. Methadone is a synthetic analgesic drug similar to morphine in its effects but longer-acting, and it’s often used in treating opioid addiction. Upon checking in, however, her daughter’s father called to tell her that he and her daughter would be gone if she stayed a week to detox.
“I couldn’t stay there, not with the thought of losing my daughter,” Wahl says. “So the center gave me my first dose of methadone and sent me on my way. But I knew I still needed help. I wanted help.”
After that, Wahl found a methadone clinic. For the first sixty days of treatment, she would drive forty-five minutes each way daily to be administered methadone. After two months, she’d make visits every other day, and then eventually, she’d make monthly trips where she’d receive methadone to take at home. Wahl actively sought treatment at the clinic for almost two years while being completely sober from prescription pills.
“It was great,” she says. “I was doing really well. It was costly, though—it cost me around $100 each week.”
Near the end of those two years, Wahl and her daughter’s father split up, and a few months later, methadone treatment became unaffordable. “I couldn’t afford to go anymore,” she says. “If you don’t pay, they just stop giving you the medication.”
During the months in between, Wahl had an ulcer rupture through her intestine from years of taking pain pills. In severe pain from the ruptured ulcer, Wahl sought medical attention at two different hospitals but says she was denied treatment. The ruptured ulcer caused her to become septic, and she required emergency surgery at a third hospital that finally accepted her. She was there for a few weeks, and she was started on fentanyl.
“They [the medical staff] knew about my methadone treatment but refused to give me methadone while I was in the hospital,” Wahl says. “All they would give me is fentanyl.”
When Wahl was discharged from the hospital, she was given a new prescription of hydrocodone for post-surgery pain. She only had a hundred milligrams left of methadone.
Dr. Daniel Warren, who runs a methadone clinic in Wichita, predicted this increase in fentanyl-related overdoses in the Midwest. Having completed a fellowship in addiction medicine in Portland, Oregon, he witnessed fentanyl become a burgeoning issue in western states before reaching the Midwest.
“Like anything else, fentanyl took longer to make its way to the Midwest,” Warren says. “Everywhere else, it was already exploding. I was here saying, ‘Something bad is going to happen.’ Then, it made its way to Kansas.”
About two and a half years ago, Warren started to see more positive test results for fentanyl at his clinic. He calls it a drug contamination crisis. “The amount of drug poisoning that’s happened because of fentanyl is remarkable,” he says, “and unfortunately, the drug treatment infrastructure in Kansas was not really prepared for that.
“You see these reports of high schoolers having overdosed,” Warren says. “Between 2019 and 2020, the number of fatal overdoses in Kansas for minors tripled.”
In 2021, drug overdose deaths increased again. In the first six months of 2021, at least three hundred and thirty-eight Kansas residents died of drug overdoses, according to data from the Kansas Department of Health. That number represents a fifty-four percent increase from the same six-month period in 2020. Nationally, the number of overdose deaths increased by about fifteen percent from 2020 to 2021, according to data from the CDC.
“I don’t think fentanyl is going to go away,” Warren says. “Economically, it’s more profitable, and that’s why it’s being mixed with all of these other substances.”
“Economically, it’s more profitable, and that’s why it’s being mixed with all of these other substances.”
Not long after having surgery, Shelby Wahl couldn’t afford to go to the methadone clinic for treatment anymore. During her stay in the hospital and just after, she wasn’t working—she wasn’t able to. She fell behind on payments at the clinic and couldn’t catch up.
When Wahl stopped taking methadone, she went into withdrawal. “People say coming down off methadone is worse than coming off heroin,” she says. “I felt like my bones were breaking.”
That’s when two other patients from the clinic offered to help Wahl detox. She believed the two would share some of their methadone with her because she couldn’t afford her own prescription anymore. But what they gave her wasn’t methadone—it was heroin mixed with cocaine. By this point, Wahl’s mother and grandmother had moved to Georgia. Her daughter’s father had taken their daughter and left.
“I had nobody,” Wahl says. “I didn’t know what to do. And the more I hurt, the more I started to use what I learned was heroin.”
Over the next few months, Wahl began stealing to support her addiction. She spent time in and out of jail, which eventually helped her get off of heroin for the time being. She also began making court appearances for her daughter to obtain visits. After a court hearing granting her daughter’s father custody, Wahl attempted to turn to the family she had left in the area and reached out to someone she says is like a stepmom to her.
“My stepmom said she’d take me to cheer me up after the court hearing,” Wahl says. “And I was devastated.” That’s when Wahl was introduced to meth and set up with a dealer who was twenty years older than her.
With no other place to go and out of work, Wahl moved in with the dealer.
At the methadone clinic, Dr. Daniel Warren sees patients from the ages of sixteen to seventy-nine. While opioid prescriptions have gone down per capita since 2021, the nation’s demand for opioids is still high among a wide range of people. Since supply-side solutions pushed by doctors haven’t been met with other solutions that would make treatment for opioid addiction accessible, people seeking opioids have been left with fentanyl.
“Supply reduction is not going to be a successful strategy,” Warren says. “We are going to do our best to take away the most potent and lethal of the pills, but if that’s not coupled with other interventions, it just makes the problem worse.”
Things like fentanyl test strips, Narcan and needle programs are tertiary prevention responses, but they’re not solutions to harm-reduction strategies. “With those tertiary prevention responses, we’re not trying to prevent the disease; we’re trying to prevent other stuff associated with the disease,” Warren says.
Still, he’s in favor of fentanyl test strips being readily available to those who need them. “I think harm reduction strategies would be helpful for Kansas,” he says. “There’s good evidence that needle exchange programs have substantial health benefits and that fentanyl test strips save lives and money. What’s important is that we communicate to people who use drugs that we’re willing to help, that we care.”
Currently, fentanyl test strips are not legal in Kansas and Missouri. They are considered drug paraphernalia. Kansas is also one of three states in the country that does not have a good samaritan law as it relates to drug overdoses. Such a law would protect someone who calls for help in the case of an overdose.
Warren also points to a narrative that’s been circulating since the early 2000s, near the origins of the opioid epidemic.
There’s been a whitewashing of the opioid epidemic, Warren notes. “You know, in the ’80s, crack killed, largely, people of color and those incarcerated,” he says. “Of course, everybody has been affected by drugs, but it’s still, even with the rise of fentanyl, been more predominant in lower-income communities.”
Findings from Families Against Fentanyl, collected directly from CDC reports from 2020 and 2021, show that Black Americans are more likely to die from fentanyl poisoning than any other racial demographic. While the total number of fentanyl deaths is highest among white people, the per capita rate of fentanyl deaths revealed that a higher percentage of Black people were killed by fentanyl. Data from FAF also indicates, as Warren points out, that teen deaths from fentanyl have more than tripled since 2019 and increased more than five-fold among Black teens. Among multiracial and white Americans ages eighteen to forty-five, fentanyl is the number one cause of death. Among Black and indigenous Americans of the same age group, it is the number two cause of death, surpassed only by homicide and liver disease, respectively.
“I don’t know how to make people care,” Warren says.
Rogeana Patterson-King of the DEA says she does what she does because, as a kid, she was affected by the
crack epidemic. “I had family members that became addicted to crack cocaine,” Patterson-King says. “I always wanted
In 2020 the DEA’s Kansas City District Office seized seven kilograms of fentanyl and around thirty thousand counterfeit pills in Kansas alone. In 2021 they seized forty-two kilograms and about seventy-seven thousand counterfeit pills. From January to April 2022, they seized twenty-five kilograms of fentanyl and fifty thousand counterfeit pills in the state of Kansas.
Even for the DEA, it is difficult to determine whether a pill is counterfeit or not. “They [counterfeit pills] look just like the real deal,” Patterson-King says. “We are at the point now where we just send what we seize directly to the lab.”
Patterson-King says that fentanyl is contaminating every street drug, too. This February, there was a mass overdose in St. Louis in which seven people died using crack cocaine that had been contaminated with fentanyl. There were others among the group who overdosed but did not die.
The recorded number of overdose deaths related to fentanyl only accounts for cases in which a toxicology report has determined the presence of fentanyl. Sometimes, however, as the DEA points out, fentanyl isn’t always tested for in toxicology reports if other drugs are present. There are also instances of overdose where first responders, for instance, may arrive on the scene to revive a person. Those overdoses that don’t lead to death often go unreported.
Let’s face it: Until recently, a lot of overdose cases were treated like, ‘Oh, it’s just another doper who overdosed,’” says Sergeant Gary Blackwell. “But the fact is that’s somebody’s child, somebody’s mother, somebody’s father, brother, sister.”
Blackwell is the sergeant of the Clay County Drug Task Force, which investigates narcotics in western Missouri. The drug task force works against crime in Jackson, Platte, Caldwell and Clay counties. Some of Blackwell’s investigations bleed over into eastern Kansas, where the drug task force partners with the DEA, FBI and Homeland Security to investigate narcotics. Lately, those investigations have included a large number of cases involving overdose deaths from fentanyl.
“We are in a triage situation right now,” Blackwell says. “We are seeing so many kids die of fentanyl overdoses.”
Before his time on the Clay County Drug Task Force, Blackwell served in Iraq—he is a veteran who hunted IEDs. “I have seen some horrific stuff in my life,” he says. “I’ve been to two wars. But the pain in a parent’s face when they’re told their child had died, it’s heavier than all that other stuff.”
He also describes one of his close friends who was shot twice in the line of duty in Iraq. “He told me, ‘Weaning my body off of opioids was the single hardest thing I’ve ever done in my life,’” Blackwell says, “That’s when it clicked for me. That’s when I knew how powerful this stuff is.”
Blackwell began on the drug task force in 2011. Then, he says, most of his narcotic investigations dealt with methamphetamine. From 2012 to 2013, heroin started surfacing again within the county, and opioid use began surpassing methamphetamine use. He first came across fentanyl on the drug task force in 2016, which was rare in the area then.
Now, he says, he deals with fentanyl cases daily. Perc 30s are common, he says, and he has seen more counterfeit Xanax circulating, especially among local high schoolers.
“I have to direct as much of my attention toward fentanyl as I can because it’s the largest killer of Americans between fifteen and twenty-five—and that’s above car wrecks, cancer, suicide,” he says.
According to Blackwell, the fentanyl “hubs” in Kansas include Wyandotte County and Sedgwick County. He says that Wichita also draws a lot of narcotic activity. “Straight up I-35—you’ve got I-70 too—Kansas Highway Patrol intercepts a lot of drugs,” he says. “The drug trafficways follow the interstate.
“In a case that we are prosecuting right now, two girls drove over to the Missouri side from Olathe and split one pill,” Blackwell says. “Both smoked each half of the pill, and one died while the other had no effects.” He also uses the chocolate chip cookie metaphor to describe the inconsistencies with counterfeit pills made
“These [counterfeit] pills are just acetaminophen and fentanyl,” Blackwell says. “We’ve had a lot more fentanyl-related overdoses than people realize. We found that overdose toxicology reports didn’t include testing for all analogs of fentanyl. So deaths that were in fact fentanyl overdoses weren’t reported as such.” Until recently, it wasn’t routine for autopsy investigations to include testing for different analogs for fentanyl. Only within the last year or two has it become more common.
Blackwell says there has also been a recent emergence of a substance called carfentanil, which is a hundred times more potent than fentanyl. The drug task force has seen it in liquid form in Clay County. “Carfentanil hasn’t become prevalent yet, but a potentially lethal dose of fentanyl is five to seven grains of table salt,” he says. “You wouldn’t be able to see a potentially lethal dose of carfentanil. If carfentanil hits, you’re going to be walking past dead people on the streets.”
Regarding fentanyl investigations, the Clay County Drug Task Force is starting to see more and more powdered fentanyl in addition to counterfeit pills. Blackwell suggests that people assume injecting fentanyl may give more dosing control than consuming counterfeit pills.
“I’ll tell you one thing: If I were trying to overthrow a country,” Blackwell says, “I’d do it with fentanyl.”
I had always told myself I would never shoot up,” Shelby Wahl says. But after moving in with her drug dealer, she discovered that he used heroin intravenously. “He was so happy when he was high,” Wahl says. “I wanted to be like that. I wanted to not feel pain.”
It wasn’t long before she found herself back on opioids. This time, Wahl was shooting up. “It got to the point where, on the streets, it wasn’t heroin anymore,” she says. “It was fentanyl, and you never really knew what you were getting until you shot up. If it killed you and you had to have Narcan, then it wasn’t heroin. I died five times that year.”
By April 15, 2021, Wahl had seven active warrants for arrest, including two felony warrants, across multiple counties. “I wanted to get clean,” she says, “but at that point, it [addiction] had completely consumed me. I wasn’t the same person anymore. I was exhausted.”
That April day, the arresting officers who found Wahl in the closet took her into custody, where she detoxed from fentanyl in a county jail cell under twenty-four-hour lockdown.
After being released from jail and with no place to go, Wahl moved back in with her dealer. However, with the support of a counselor and suboxone treatment, she remained sober after detoxing in county jail, despite being around people who were still using.
Wahl, newly sober last summer, quickly found a job waitressing again. “I was severely depressed, but working helped me stay sober,” she says. “It gave me purpose. But it was hard. All the emotions I had numbed while using were hitting me when I got sober. I realized I didn’t have my daughter, and that was my fault. I was living with a man who was forty-seven years old. I didn’t want to be there. I stayed until I couldn’t take it anymore.”
When the man she was living with became physically violent, Wahl packed a small bag and left. She’s been sober for a year and a half since, and she’s earned supervised weekly visits with her daughter.
Every Sunday, Wahl gets to see her daughter for two hours. She pays $40 an hour to spend time with her daughter, on top of whatever she has planned for them to do. She also says she pays over $700 in child support a month. During the time she was using, one judge backdated her child support. Because of that, Wahl says she is $20,000 behind, despite paying monthly. Currently, she is twenty-five and lives in transitional housing at Hillcrest Hope, where she completed a ninety-day sobriety program on July 1. She’ll have to move out in January, and she hopes to rent an apartment of her own.
“Right now, my focus is on getting to spend more time with my daughter,” Wahl says. “I still beat myself up over our time apart. There for a while, I was a terrible person, but I didn’t want to be a terrible person.”