Local drug market experts believe fentanyl, a potent opioid, is behind the mass overdose in the Penn North neighborhood of Baltimore that hospitalized at least 27 people over a 24-hour period.
And they say the particular blend of drug involved is likely still out there. Bill Brooks, CEO of Penn North Recovery Center, which assisted in the medical response, said Friday he suspects the area will see more overdoses before long.
“I don’t want to say that this is anything other than fentanyl … but it’s probably just a much more pure fentanyl,” Brooks said.
In the heydays of the cocaine and heroin epidemics, drugs often traveled south along the I-95 corridor. First, they’d hit New York City. Then, Philadelphia. Next, Wilmington. Finally, they’d land in Baltimore, before moving further south to Washington, D.C., and beyond.
But now, experts say, fentanyl, a cheap, synthetic opiate originally dreamed up to treat pain for people with end-of-life cancer, is either smuggled in across the U.S. southern border by Americans, where it connects with the cartel’s footprint and spreads north and east, or, more rarely, it is something you can make at home from “precursor” components purchased online.
A fentanyl shortage in the U.S., driven by crackdowns abroad
Last year, the U.S. saw a dip in opioid overdoses, which experts in drug markets tied to increased oversight in China and Mexico of the chemicals needed to make fentanyl, leading to a shortage and a resurgence in heroin use.
“There’s been recent talk about major interruptions in that supply and surprisingly effective crackdowns by the Mexican government,” said David Kennedy, a professor at the John Jay School of Criminal Justice and the chair of the National Network for Safe Communities.
“The crooks are scared and going underground and coming up with new formulations,” he said. “The stuff that’s coming across is even more unpredictable.”
Given the decrease in fentanyl imported into the U.S. last year, too, people may be even more sensitive to fentanyl now, said Keith Humphreys, a Stanford-based psychologist and professor who works on the science of addiction and drug markets, and a former Bush, Obama and Biden White House drug policy advisor.
In rarer cases, home chemists mix and cook fentanyl up from chemicals they import from China or Mexico.
Humphreys said he believed China had better monitored its distribution of these chemicals the previous year, further cutting the fentanyl supply in the U.S.
While some of the traditional distribution routes still exist, some simply “have these [chemicals] sent by FedEx to their house,” Brooks said. There, they turn it into powders and pills, he said, and distribute or sell it.
That’s made it harder to track import and production, drug experts say, preventing cities from looking to their neighbor to the north to prepare for new, incoming blends of drugs.
And these can be dangerous — or deadly.
It’s typical for drug dealers across Baltimore to hand out what are called “testers” in the morning, said Brooks. “People are just so well aware of this, they line up and wait an hour or two for the testers to come out.”
They get the information from a runner, head over to the pick-up site, which is often inside an alley, hidden from public view, and pick up a clear capsule with a white powder, he said. That, they can break open in order to sniff the powder contained inside off a piece of paper.
“What they’re trying to do is really give people a flavor for what they’re going to be selling throughout the day, so that they get a lot of repeat customers,” he said, “So they generally give out anywhere between 40 to 50 of these testers.
“Nobody knew that virtually every one of these testers was a lethal dose in and of itself.”
Combating new drugs, improving harm reduction
One drug market expert says the U.S. should invest in wastewater monitoring, like many municipalities did during the coronavirus pandemic, and as Australia and many European countries still do.
“[Currently,] we find out about a new drug from autopsies, and it’s the worst possible way to find out,” Humphreys said.
“The best possible way is in the water,” he said. “People excrete metabolites very quickly and you can know quite quickly when something new is there. It was a real failure of Biden’s [Centers for Disease Control] not to do this.
Kennedy said the Biden administration refused to test the water for drugs for fear of giving police another reason to target Black and brown communities.
A few counties and at least one state already test the water, he said, but “it should really just be national policy. It’s so inexpensive … and you can just look and see what [drugs are] in the water.”
Brooks said while his center doesn’t look to other cities around the U.S. to predict what will hit the streets of Penn North next, they do look to them for intervention or harm reduction strategies, citing drop-in centers, picking up dirty needles from sidewalks, and so on.
“I think the next big thing is going to be the safe injection site, or overdose prevention site,” he said.
Times BCFD administered naloxone by ZIP code, 2022-24
Note: While the boundaries representing some ZIP codes extend into Baltimore County, only Baltimore City data is reflected.
Source: Open Baltimore
Penn North neighborhood ranks highest in overdose responses
Data from Open Baltimore shows that the 21217 ZIP code, which encompasses the Penn North neighborhood where Thursday’s overdoses took place, was by far the leader from 2022 to 2024.
During that time, Baltimore City fire personnel administered naloxone subsequent to an overdose 1,149 times.
In total, the city’s firefighters administered naloxone 7,699 times in response to overdoses across 28 Baltimore ZIP codes, data shows, with administration spiking in the spring and summer months.
The number of opioid-related deaths in Baltimore dropped by more than 25% in 2024 to 703, after four years of annual fatal opioid overdoses in the city hovering around 1,000, according to state health department data.
While the database only shows deaths through the end of May this year, the average monthly opioid overdose deaths in Baltimore decreased by more than 30% from 2024. Nationally, opioid deaths have declined, as well.
Thursday, Penn North “was chaos,” Brooks said. “There was a whole bunch of top city officials and everyone else, standing in the middle of a closed-down, taped-off street with our mouths open, wondering what to do.”
By Friday, he said, the scene in the neighborhood was much calmer, more organized.
The city had sourced more naloxone, a lifesaving drug that reverses the effects of opioid overdoses, there were check-in areas for workers, and his center had organized people to search for any other overdose victims hidden out of sight in vacants or alleyways, turning up “two or three” more people, he said.
Importantly, he added, none of his staff had found anyone who had died from the drug.
Mat Schumer and Steve Early contributed to this article. Kate Cimini is an investigative editor with The Baltimore Sun. Contact her at 443-842-2621 or kcimini@baltsun.com.