From the theft of fentanyl in a hospital in Rome to the streets of San Francisco, where the synthetic opioid has caused one of the most serious health emergencies in recent years. A journey to the place where the phenomenon became reality.
The theft of 80 vials of fentanyl – suitable for preparing approximately 20,000 doses to be introduced into the clandestine market – which occurred in recent days at the Israeli hospital in Rome has brought back into the spotlight a drug which, in Italy, continues to be used almost exclusively in the healthcare sector and which is subjected to rigorous controls. The episode has reignited attention on a substance which on the other side of the Atlantic has already caused one of the most serious health and social emergencies of recent decades. In the United States the fentanyl it is not only a powerful analgesic used in hospitals. It became the drug that supplanted heroin, cocaine and crack, transforming entire neighborhoods of big cities into scenarios reminiscent of a post-apocalyptic film. TO San Francisco thousands of people wander the streets with slow movements and an absent gaze, so much so that they are nicknamed the “zombies” of the fentanyl. Drug synthetic opioid one hundred times more powerful than morphine, it is used in medicine as an anesthetic or for the treatment of severe pain, especially in cancer patients. But on the illegal American market it has become the most sought after substance for its psychotropic effects.
San Francisco, the city overwhelmed by the fentanyl crisis
They move like zombies The Walking Deadand die on the streets of San Francisco hundreds of them, as if they had been struck by a mysterious epidemic. Instead they are terribly real, they are drug addicts fentanyl. Drug synthetic opioidone hundred times more powerful than morphine, used in hospitals as an anesthetic or for intense pain especially in terminal cancer patients, it is highly sought after in the United States for getting high, so much so that it has supplanted heroin, cocaine, crack and any other drug. It caused, in 2023, nearly 700 deaths in San Francisco aloneenough to make us forget the charm of a city that was once first and foremost the icon of the Californian dolce vita. Today, when sunset approaches and the shops close, the streets empty and they come out: the living dead.
The city boasts the highest number of homeless people (over 8 thousand) in the entire USA, while more and more residents, especially of the middle-upper classes, prefer to move to other states considered safer, preferably Texas: tourists who initially plan a week in San Francisco (even Italians, currently facilitated in their travel by a series of direct air connections from our country) after a few days ask – a travel agent of an important tour operator in our country confides to us – to shorten their stay in the city, disturbed by excessive delinquency and from the risk you run on the streets.
At 8pm on a weekday, in Market Street – one of the most elegant shopping streets – at the terminus of the most important cable car line (the iconic wooden trams that climb the vertically rising streets) we meet Alex, who works in a bank in the area. He doesn’t trust leaving two young Mexican tourists alone waiting for the tram. A few meters away a group of addicts inject Fentanyl – called fetty by consumers – in a small square adorned with Chinese lanterns, in front of the magnificent Victorian-style buildings in the city centre.
«Until before the pandemic, San Francisco wasn’t so dangerous» Alex tells us as he compulsively tries to understand, on the public transport app, how much time is left until the vehicle arrives. «Now going around in the evening is very risky, for everyone, not just for tourists. The addicts of Fentanyl they lose their inhibitions, they chase you, they scream, they undress, they threaten with knives: luckily they are slow, just like zombies. And there isn’t a morning without a couple of overdose deaths on the street. This is San Francisco today.”
If only a couple of years ago the problems were quite limited to certain more marginal neighbourhoods, starting from the Tenderloin where already in 2021 Mayor London Breed had declared a state of emergency (now literally off limits), now involves the entire city.
In addition to violence, there is the problem of urban decay, because the streets become tent cities in the evening and residents get busy as they can: a few years ago – we are still a stone’s throw from Silicon Valley – an app called SnapCrap was developed, available in the San Francisco area, which allows citizens to report streets full of human excrement so that the Municipality can clean it up.
Why fentanyl is so dangerous
The Fentanyl it has spread so quickly also thanks to its multiple “bonuses”, which make it easily available and easy to use: it costs little – not even 10 dollars a gram – it is versatile, in the sense that it can be taken orally, by injection, inhaling or smoking it, and being very powerful, very little is needed to have macroscopic high effects. And this also makes it concealable and easy to hide, import and pass off. “It is often used to cut cocaine or methamphetamine,” explains JM, working in a vigilante agency. «This allows organized crime higher profit margins: many have started to use Fentanyl for the impossibility of finding heroin, as well as for the similar effects at much lower costs. Unfortunately, others have fallen victim to it after starting to use the drug for chronic or post-operative pain: then ending up drug addicts and finally homeless because they are isolated from their families. Living with a drug addict Fentanyl it’s impossible.” Today US government data observes a decline in the number of deaths per overdosebut they warn of another type of risk: addicts have started to abandon syringes (also due to the impossibility of finding the veins after infinite “holes”) and prefer to smoke the drug using mainly aluminum foil, as well as glass bubbles and bongs. This has opened up new scenarios, also investigated by a study carried out by a team of researchers from University of Californialed by the professor Daniel Ciccarone: sharing smoking equipment, and residues Fentanyl left on foil then used by other people, they can induce overdose especially in those who do not regularly use the drug. The reason? A small amount of product is enough to kill a person: death occurs due to excessive sedation, up to loss of consciousness and respiratory arrest. «Individuals who use it recreationally seek the typical effects of opioids – euphoria and sedation – to feel more relaxed and reduce anxiety, stress and worries” he says Luca Pasinahead of the Clinical Pharmacology and Prescriptive Appropriateness Laboratory at the Mario Negri Institute. «The brain quickly adapts to these stimuli, requiring repeated and higher doses to maintain the same effects. Thus, prolonged intake can cause changes in physical and mental appearance: people appear confused, stagger, have muscle stiffness and they make movements that seem slow and poorly coordinated.” Here’s the term explained «zombie drug». Furthermore, repeated injections into the veins, especially when the fentanyl is cut with the xylazinean anesthetic muscle relaxant present on the illegal market, cause those who use it to have ulcers and bleeding lesions on their arms, hands and feet which often become infected with serious side effects.
Meanwhile, evening falls, while the police also inspect the streets of the tourist area of Fisherman’s Wharfwhere Italian fishermen arrived in the mid-19th century and where even today 9 out of 10 places have Campanian, Sicilian and Apulian names. The luxurious driverless Waymo robotaxis of which the city is teeming, white Jaguars transformed into technical jewels full of sensors that have almost replaced the classic taxis and even Uber, proceed along the streets of the neighborhood hurrying to take the – few – tourists back to the hotels, or towards the restaurants in the centre. It will be dark soon. We need to hurry: a San Francisco It’s zombie time.
