Tanya Niederman will never forget the phone call from her ex-husband, just about a year ago.
She was at a restaurant and initially ignored the call. But when he called again, she knew it had to be important.
"He said something happened to J.J. (their oldest child and only son)," Niederman recalled. "I thought he was in a car accident and was hurt, maybe at the hospital."
She was not prepared in any way for what she heard next.
"'J.J.'s gone,'" the 19-year-old's father said to his mother.
Another shock would come in just a few days: J.J., "a typical kid" who had a job and went to school, died from fentanyl poisoning.
"If you had asked me on Feb. 11 (2021, a day before J.J.'s death), 'Did J.J. do drugs?' I would have said, no, no, no. But I guess kids try stuff, right? I had no idea he had even tried cocaine."
Niederman and the rest of J.J.'s family believe he ingested what he thought was cocaine — but instead, he got a "hot shot" of mostly fentanyl, a synthetic opioid the U.S. Drug Enforcement Agency says is 80 to 100 times more potent than morphine.
Last month, Camden County officials unveiled an effort to raise awareness of fentanyl, which has found its way into a host of drugs: pills, cocaine, methamphetamine, heroin, among others. Cheap, potent, and readily available, fentanyl is used to lace marijuana, to cut drugs like cocaine to maximize profitability, or heroin to boost potency for users with a high tolerance.
"I want to make this absolutely clear: Every single life is equally precious," said Kaitlan Baston, MD, head of addiction medicine at Cooper University Hospital.
Fentanyl, she emphasized, poses a lethal danger to longtime users and people in active addiction because its ratio to heroin, for example, in a dose can be unpredictable. It can also be deadly to casual users because it has so completely infiltrated the supply of "party" drugs like ecstasy, cocaine, even pressed pills: "Anything you can buy on the street," Baston said.
'A fatal mistake'
Niederman, whose Mantua living room is filled with photos and mementoes from J.J., including one of his favorite sneakers, his hockey jerseys, his baby shoes and a baseball cap, said there were no signs her son was a regular drug user: No drugs or paraphernalia were found in his room or in his car, and his family and friends saw no signs that he had a problem.
"He was an average kid who made a fatal mistake," Niederman said.
Christmas was difficult for J.J.'s family; the 2019 Triton High School graduate lived with his father and grandparents but was close to his mother and two younger sisters, who miss their big brother's loving torments.
"People say he overdosed, but that's not really what happened," she said. "He had enough fentanyl in his system to kill 30 people — he would not have done that intentionally. There were only traces of cocaine and no alcohol. He thought he was taking one thing, but it was almost all fentanyl."
She's found herself part of a community no one ever wants to join, one that wants no new members.
"I've talked to other parents who lost children; their kids were sick, or they were addicted to drugs," said Niederman, a real estate agent. "This was so sudden. I didn't know how to react. I didn't believe it ... as a parent, it's your worst nightmare. I'm still shocked every single day that he's not here anymore."
Fentanyl highjacks the brain
Baston, the addiction specialist at Cooper, said public health officials have to take different approaches to fighting fentanyl for different populations.
"Some are using fentanyl knowingly," she said. Opioid addiction, she explained, rewires the brain. Dopamine receptors, usually associated with pleasure, also have an evolutionary component: They're stimulated by love and human connection, both of which are as necessary for human survival as food and water. Opioids hijack those receptors, convincing the brain that the opioid is necessary for survival.
"The survival part of the brain is in overdrive (during addiction)," said Baston, who holds a master's degree in neuroscience. "It's tied to a substance — it's just not the substance it should be. Your brain is telling you that you need this to survive, even more than food or water.
"It's not a case where people are using to feel good anymore."
A Nov. 29, 2021 NorthJersey.com story reported New Jersey was on pace to end 2021 with more than 3,200 overdose deaths, the most since 2012, when the state began tracking overdose deaths. Fentanyl, the story noted, was the leading cause of drug-related deaths in 2018 and 2019. (New Jersey does not break down drug types until its reports are confirmed, and data for 2020 and 2021 are preliminary, the story pointed out.)
The pandemic had an effect on drug use, too: Baston said many patients who'd been in recovery relapsed (though many returned for additional treatment, too), while people who'd been casual users developed full-blown substance use disorders.
"Isolation is one of the worst things for our mental health, and connection is one of the biggest components in recovery," she explained. "Connections combat shame; isolation brings shame and triggers pain centers, so people self-medicate."
People who use drugs alone are more likely to die from overdoses, with no one around to call for help, which, combined with the increasing prevalence of fentanyl she called "a confluence of terrible events."
'Bringing back the batch'
Fentanyl's newfound prevalence boils down to money, according to Sgt. Shane Morgan of the Camden County Prosecutor's Office Narcotics Unit. Because of its potency, traffickers are able to stretch batches of narcotics much more with the inclusion of the opioid.
"The difference between fentanyl and other cuts (is) other cuts will dilute the actual heroin or the drug you're using to cut it with," Morgan said. "Fentanyl, they call on the streets, will bring back the batch. So you can step on drugs three, four, five times to the point where the quality goes from a 9 (out of 10) to a 2. But fentanyl will actually bring back the batch to a 9.
"People are not even interested in drugs unless it's cut with fentanyl."
Fentanyl, which is commonly used in hospitals to manage pain during cancer treatment, typically makes its way onto the street from illegal manufacturing in Mexico. As a depressant that slows breathing, it's extremely dangerous to use in any dosage.
"That's why fentanyl should only be used in hospital or other kinds of emergency settings. When people are using on the streets and they're using it in a fashion where they don't know how much of it they're taking, how much of it they've ingested, there's nobody there to help you if your breathing gets to the point where you can no longer survive or you need emergency treatment," said Nevan Soumilas, Camden County assistant prosecutor and section chief of the Major Crimes Unit.
In a logical world, drug users would steer clear of a particular seller if word got out their batches resulted in a number of deaths; but in the world of addiction, it just becomes another selling point because death equates with a better high.
Different sellers and different cuts of a drug are identified by stamps on the bag as a sort of branding, Morgan said. When people hear about a death related to a specific stamp, users flock to it.
"It's the complete opposite of anything that would make sense," Morgan said. "The closer you are to death's door, the more that drug is going to bring a profit."
Making matters worse is how fentanyl is finding its way into just about every kind of drug. That, coupled with the glorification of prescription pills in popular culture, is a concerning prospect as officials try to stem the use of the opioid.
One of the most notable offenders, Morgan said, is the song "Mask Off" by the rapper Future.
"What's he repeating? 'Percocet, Molly, Percocet,'" Morgan said. "This is a song that's wildly popular and he's glamorizing the use of the Percocet. So now, who's listening to the music? Is it just adults in their 20, 30s, 40s? No, who's really listening to this music? We're talking about teenagers, people in elementary school, in high school. They hear Future in this wildly popular music video talking about Percocet.
"Someone wants to buy Percocet on the street, or (Oxycontin), and they're buying fentanyl without even knowing it. So their first introduction to this prescription pill underworld is through music. They go to take something because it's being glamorized and now next thing you know, they're ingesting fentanyl and they have no idea."
'People spreading this poison'
Camden County officials said a recent review of overdose deaths found 70 percent of victims had fentanyl in their system; 93 percent had opioids. Though the county is in many ways the epicenter of South Jersey's opioid crisis, it's hardly the only place where the problem exists.
The regional High Intensity Drug Task Force in September seized 66 kilos (145 pounds) of fentanyl from a home in Pennsauken — fentanyl with a street value of about $2 million, and bound for towns all over South Jersey, according to Camden County Police Chief Gabriel Rodriguez.
"The stuff is popping up everywhere," said Rodriguez. "It's leading to an alarming number of overdoses. It's a cheaper product being made purer and more potent by 'street pharmacists'," people who "don't know chemistry, but they do know business. These people are spreading this poison."
Rodriguez has spent most of his law enforcement career in Camden, and knows well how intractable the addiction problem is.
Baston advocates for harm reduction measures like fentanyl test strips and wide availability of Narcan, the opioid overdose antidote, as well as reducing the stigma of addiction and drug use and raising awareness.
"It's not a thing we can arrest our way out of," said Rodriguez, who like Baston is concerned about the danger to casual and habitual users alike. Education and intervention, he believes, are crucial.
"It's the person injecting it into their veins, but it's also high school kids, college kids," he said. "We need to educate them and even instill some fear: The first time you take (a drug) could be the last time."
'Just didn't know'
A year later, Niederman is still reeling from her son's death. Nothing, she said, feels the same and she knows it never will. She's had days where she wants to stay in bed all day and cry, but she knows she has to keep going, for the sake of her two daughters and, in some way, for J.J.
"I don't know how to come back from any of this, except to try to help," she said. "If me talking about this helps one kid, if just one kid can relate to J.J. and say, this kid was just like me and he died ..."
She worries for her daughters, and for J.J.'s friends, even for young people she doesn't know and the parents they might leave behind.
"You're never supposed to do this. Parents aren't supposed to outlive their kids," she said. "I think he might even be mad at himself for doing this, but he just didn't know."
Fentanyl wasn't something she'd even thought about before J.J.'s death, let alone something she spoke to her children about.
"As a mom, I would look at it like, I don't even want you to try (drugs), let alone experiment with (cocaine), I don't even want you to touch it, let alone take it. He was a regular kid who had no idea that something he put into his body would kill him."
Getting help for drug addiction
Phaedra Trethan has been a reporter and editor in South Jersey since 2007 and has covered Camden and surrounding areas since 2015, concentrating on issues relating to quality of life and social justice for the Courier-Post, Burlington County Times and The Daily Journal. She's called South Jersey home since 1971. Contact her with feedback, news tips or questions at firstname.lastname@example.org, on Twitter @By_Phaedra, or by phone at 856.486-2417.
Ahmad Austin Jr. is a lifelong South Jersey resident telling stories within the healthcare and cannabis industries for Burlington County Times, Courier-Post and The Daily Journal. For story tips, reach out at email@example.com.
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This article originally appeared on Cherry Hill Courier-Post: What is fentanyl and why is it found in so many street drugs