The poison and the antidote: A cry for help from ground zero of the fentanyl epidemic

Channing Velázquez slowly closed his eyes and began to stop seeing everything around him. “I remember sitting down to watch television and everything turned gray. Afterwards, I couldn’t move. I felt like my heart was beating very slowly. Everything started to shut down. It was like being inside a tunnel,” he recalls. Velázquez grew up in Nogales, Arizona, a city of just over 20,000 inhabitants on the border between Mexico and the United States. It’s separated by a wall from its sister city of Nogales, in the Mexican state of Sonora, which has 10 times the population.

As a young boy, he was restless and very active. One day, he was playing baseball with his neighborhood friends and it was his turn to bat. He hit the ball hard and reached first base with ease. He continued running, but had to slide to reach second. He got hurt in the process. He didn’t think it was anything serious, but his ankle hurt. He was subsequently prescribed Vicodin, a powerful painkiller. He was only 11 years old.

When he took the medication, his pain and his worries disappeared. He says it was like rising from the ground: the good was very good, while the bad didn’t matter. When his body developed a tolerance to Vicodin, he switched to OxyContin (oxycodone), another medicine for severe pain. Still, up to that point, he never saw himself as an addict. He was only doing what the doctors told him to do. Until, from one day to the next, they cut his dose.

By the age of 23, he was looking for drugs on the street for the first time. It was easy — everyone knew where to find them and who to ask. A pill of methamphetamine laced with fentanyl cost just 10 cents… much less than a piece of gum or a can of soda. He had a job, a family and a life ahead of him. However, by the age of 26 — when he experienced his first overdose — he had already lost everything. “At first, it scared me. But the saddest thing is that, at a certain point, you accept it and say to yourself, ‘I’m going to die. ‘”

But he didn’t die. Channing Velázquez woke up alone in his house, disoriented and with a pale face. He had managed to inject himself with naloxone, a substance that reverses the effects of fentanyl overdoses. It saved his life, unlike the 107,000 drug users who died last year in the United States, where the opioid epidemic killed one person every five minutes, according to official data.

Naloxone is an opioid antagonist: it attaches to the body’s receptors for synthetic drugs, blocking them and eliminating their effects. It makes those who have stopped breathing breathe; it returns consciousness to those who have collapsed because of exhaustion. It has become a sign of hope amidst a public health emergency for users, their family members and paramedics. Naloxone is also the main symbol that shows the contrast between the drug policies that are implemented on both sides of the border.

In the United States — where opioid use is skyrocketing, but is recognized as a public health crisis — naloxone is everywhere. Widely available, it’s key to harm reduction. In Mexico, however — where the consumption of fentanyl is a reality that is left out of official speeches and records — the medication is equally necessary, but its use is far more restricted. Finding it is a practically impossible mission. As a result, more and more Mexicans make the trip to the U.S. to bring it over, or have to depend on donations to get a dose. Poison crosses the border every day. The antidote, too… but in the opposite direction.

The lethality of fentanyl is a paradox. The body quickly generates tolerance to the drug, which means that people who have developed a dependence have to consume it more frequently, or in larger quantities. Yet, a single dose can be lethal: just two milligrams can kill you. And, when you’re dependent on it, not consuming fentanyl is a nightmare. Velázquez tells EL PAÍS that his withdrawal symptoms were so strong that he couldn’t stop. “You feel like your system shuts down. Your heart beats very fast, you feel like you’re sinking or drowning. It’s like your bones are being pierced by a nail, it’s horrible.”

He has no memories of his second overdose, nor any metaphors about his last brush with death. He only remembers the loneliness. At the peak of his addiction, he no longer had anyone around him. He crushed a handful of M-30 pills, one of the deadliest forms of fentanyl, and inhaled them, as usual. A family member found him unconscious and managed to give him naloxone. Shortly after this, he knew he had hit rock bottom and began a two-year-long battle to quit the drug. “The only thing you have left is to lower [your consumption] little by little, suffering day after day until you quit it cold turkey.”

Velázquez, 34, has been clean since 2020. At the beginning of last year, he began collaborating with Círculos de Paz, a civil society organization focused on supporting the Latino community, in Nogales, Arizona (95% of the municipality’s population), on issues such as restorative justice, gender-based violence and drug consumption. “I’m an addict helping other addicts,” Velázquez explains. He went through the association’s rehabilitation program and now makes a living helping those who are going through the same thing he went through.

The autumn sun beats down on the Sonoran and Arizona desert. The streets of the American Nogales are practically empty. Velázquez suggests going to visit the park that surrounds the city library, a site away from onlookers and police officers, where people gather to consume substances. The worst drug crisis that has hit the United States emerges to the surface in a stark way: it’s in the photos that parents keep of a child who overdosed, in a desk that was left empty, in lives that were extinguished without warning. But sometimes, the trail is much more subtle, as imperceptible as the litter in a park.

In an abandoned alley between the library and a branch of the Salvation Army, Velázquez patiently collects small pieces of aluminum foil, where the pulverized pills are placed and burned, so as to inhale the smoke with straws or pens. Among the weeds are empty syringes and burnt bits of plastic. Along with bottles of alcohol and empty cigarette packs, there are also cans of compressed air, which is a legal, cheap and increasingly common alternative to getting high.

On the purchase receipts for each bottle, which sells for $5 in a pharmacy, it states that the customer received a discount because he’s a veteran. This offers clues about the crisis and of topics that have become taboo. All kinds of people suffer from opioid addiction, but nobody wants to talk about it. The double stigma is evident in the Latino community and among other racialized minorities. Half of the people who die from overdoses in Arizona are non-white, according to official figures. “The stigma has never changed and it won’t change: this is a small city and everyone knows each other,” Velázquez affirms.

Not only is consumption riddled with stigma, but so is the fight against overdoses. Arizona declared a state of emergency in June of 2017 due to the high number of deaths caused by opioids and, since then, naloxone has been distributed by the state government for free. Still, many people don’t seek help, because they don’t want to be seen as addicted, or because they’re afraid of what people will say.

Blanca Acosta, director of Círculos de Paz, tells EL PAÍS that the organization identified that opioids were beginning to be a problem in Nogales as far back as 2012. This phenomenon was first driven by the medications that doctors prescribed and, later, by the pirated versions of these drugs, many of which were laced with fentanyl. These substances flooded the streets, reaching the initial users as well as their family members. “The problem overtook us little by little,” Acosta explains. “If you look at the news, every day, there’s a drug [bust], every day there’s an overdose, every day someone is arrested for aggressive behavior due to drugs.”

For a long time, the poison was everywhere, but the cure was not. Over the years, Círculos de Paz realized that more people were willing to accept help if it was offered anonymously. Earlier this year, the organization went a step further and pushed for street-based first aid kits — known as NaloxBoxes — to be installed, so that fentanyl users could access naloxone without having to answer questions or explain themselves. The antidote was placed in areas where it was urgently needed, such as in the library park mentioned earlier. On a white brick wall, the words “opioid rescue kit” can be read. Each box has two packages of Narcan, the brand name of the drug, and an instruction manual for emergency use, in English and Spanish. These have been placed in 18 points in Santa Cruz County, where Nogales is located. It’s the only jurisdiction in Arizona where these kits are readily available.

The war on drugs is also being fought in forgotten corners. In empty parking lots, beside train tracks, or behind fruit and vegetable packing plants, where workers use substances to endure the long days… and where bosses have stopped asking questions. In the open fields, you can see makeshift houses, back seats of trucks and tarps that become shelters in the middle of the desert.

Javier once lived in such conditions. A big man who ended up on the streets, he’s now part of a rehabilitation group led by Velázquez. “They kicked me out of my house and I spent 14 years wandering around, until I got tired of all that and couldn’t take it anymore. I’ve been clean for a year-and-a-half,” he opens up, describing the hell he went through in front of his peers. They sit in a circle during the session.

At his side is Alberto Cortinas, a musician who started using opioids 10 years ago, after being injured in a car accident. The doctor prescribed Percocet, a painkiller that combines oxycodone with paracetamol. “[The doctor] didn’t just prescribe it to me, [it was prescribed] to my brother and my wife, because we were all in the car. Apart from that, [the doctors] had already prescribed it to my father. They prescribed it to my grandmother, my aunt and my cousin. There were seven of us in the family. We all became addicts, except my brother,” he explains.

Official records indicate that, in 2013 — the year that Cortinas suffered his accident — more than 17 million Percocet prescriptions were issued in the United States, despite the fact that the authorities had already been investigating its role in hundreds of overdose deaths for at least four years. The 43-year-old musician, who once toured the United States and Europe, also ended up on the streets. He claims to have lost more than $100,000 to drugs. After receiving Percocet for six years, he was suddenly taken off the medication, but the grip was so strong that he couldn’t stop. And that’s where fentanyl came in. “I consider myself to be a victim of this system,” he shrugs. “Nogales is a place invaded by drugs. You realize that you’re not the only one. We all know someone who consumes, sells, or has died because of this.”

The mayor, Jorge Maldonado, assured the media this year that Nogales was the city with the highest number of fentanyl seizures along the entire border. Between October of 2022 and September of 2023, the United States seized 12.2 tons of the substance, according to data from the CBP. Six tons were seized in southern Arizona alone, almost more than all border regions combined and more than in the San Diego-Tijuana metropolitan area, which has almost 5.5 million residents.

A hidden crisis

“We don’t produce and we don’t consume fentanyl,” was a statement made by Mexican President Andrés Manuel López Obrador this past March, amid calls from Washington for his administration to act against drug-trafficking. On the ground, however, the story is different. Drugs not only cross the border, they also stay. The old drug-trafficking panorama between both countries — with Mexico as a producer and transit country and the United States as the major consumer — is collapsing, while the demand for fentanyl is growing at an alarming pace south of the border. This reality is recognized by the local authorities in both countries.

“There’s a really complicated situation surrounding fentanyl… we know that [sales of the drug] are increasing,” acknowledges Nicole Salazar, the director of Municipal Health in the city of Nogales, Sonora. This institution is aware of overdose cases on the Mexican side of the border, although it doesn’t have the authorization to make the figures public. Such a problem extends throughout Mexico, where the figures that are known are few, imprecise and outdated. The last national addiction survey was published seven years ago.

Salazar adds, however, that consumption is increasingly widespread and no longer follows defined patterns of gender, age, or income. “[All of this] increases the work we have to do to identify where the problem is. The moment we have the life of any person in our hands, we have the responsibility to save them.” For months, health authorities have been undertaking prevention and awareness campaigns about the devastating effects of the drug, which is increasingly stronger, cheaper and easier to traffic.

In the absence of statistics, other indicators show the size of the problem in Mexican territory. Nogales made headlines last May, when a 10-month-old baby had to be admitted to a public hospital for fentanyl poisoning. The boy suffered cardiorespiratory arrest and doctors had to administer naloxone to save him. Health authorities disclosed that they found blue pills in his diaper.

Along this same border, the consumption of fentanyl was identified back in 2016 by the local press. This is also where, last year, the so-called “rainbow fentanyl” — a candy-like variety — began to be talked about for the first time in Mexico. Sometimes, the drug emerges in unpredictable ways: hidden in tamales, in toilets, or in party decorations, ready to make the leap to the United States. Other times, its path is barely visible in the lost gaze of people who wander the streets. Emergency calls are more frequent, while more and more users and family members are testifying and asking for help.

“I’ve been struggling with fentanyl for a year, but this drug is very addictive, you have to use it all the time, because the effect wears off very quickly,” says Martín Rentería, a 37-year-old man admitted to the Center of Integration for Addicts and Alcoholics in Recovery (Ciaar). Rentería started using drugs at the age of 16, taking heroin, crystal meth and cocaine. He eventually managed to rehabilitate himself and find a job, but he had to cover 16-hour-long shifts in a kitchen. A friend who worked at a gas station gave him a taste of fentanyl a year ago and he hasn’t been able to stop since, even though “consumption is very self-punishing.”

“The boys are more afraid of hitmen than of drugs,” says José Luis Quihuis, the director of Ciaar. This past October, amid binational tensions over the fentanyl crisis, Los Chapitos and other factions of the Sinaloa Cartel announced an alleged ban on the purchase and sale of fentanyl in several cities in northern Mexico. But the substance is still common in some bars along the border, or in the areas known for drug sales, which are scattered throughout the most conflictive neighborhoods of the city and watched by the hawks of organized crime.

“There have always been a lot of drugs here, but most [users] come for fentanyl. It damages them a lot more than other drugs,” Quihuis explains, in reference to how users lose muscle strength and bend over when they’re suffering from a drug overdose. The body also loses the ability to breathe; the skin loses its typical color and the patient loses consciousness due to the risk of cardiac or respiratory arrest, which can be fatal.

The director of Ciaar says that the police and drug traffickers often bring people to him, so that they can be admitted to the rehabilitation center. “They’re good at dropping them off… but who supports us? If there’s something that can save their lives, the government doesn’t care. Here, naloxone [isn’t even available] in hospitals. The doctors and the [people from the Red Cross], they do what they can,” Quihuis sighs. He’s upset, but also visibly sad. Humberto, a young man who was being treated in the center, died from a fentanyl overdose four days ago. He consumed a pill a few hours after he was discharged. “He was about 34, he left a daughter.”

“It was a heartbreaking case,” says one of the paramedics, who attended that emergency. The family called Humberto to eat, but when they opened the door to his room, they found him rigid. “His parents screamed and shouted, they asked us to do something, but there was nothing to be done. Just one pill, can you imagine?” he shakes his head. Three years ago, the Red Cross in Nogales treated an overdose case every month, while only having to answer calls sporadically on the Mexican side. But now, they have up to three emergency calls each week. “We’ve run out of naloxone,” the paramedic adds.

In Mexico, naloxone is classified as a “psychotropic substance” according to federal healthcare legislation. Hence, access to it is highly restricted. The legislation makes the antidote practically prohibited. Its sale requires a medical prescription, which prevents it from being applied in emergency situations. This is despite the fact that it’s not addictive. And, while on one side of the border it’s omnipresent, on the other side, in Mexico, it’s practically impossible to obtain outside of the main public health institutions and a couple of private clinics. In one of them, a single vial sells for more than 2,000 pesos ($117), a prohibitive price in a municipality where almost seven out of every 10 inhabitants lives in poverty, according to data from the federal government.

“It’s the difference between life and death,” affirms Guadalupe González Bucio, coordinator of the Red Cross in Nogales (Sonora). “It makes a real difference: with naloxone, a case of overdose can be reversed in three minutes. The patient regains consciousness, can sit up and talk as if nothing had happened. But you can’t find it. You can have all the money in the world and you can’t find it. We really miss it,” she laments. “More than an exhortation, this is a request for help, so that we can continue doing our work.”

A bill has been stalled for almost two years in the Senate of Mexico to remove naloxone from the list of restricted substances. This past April, the project was approved in committee, but it was never discussed during the regular sessions of 2023, which concluded this past week.

The proposal has faced resistance, under the argument that facilitating access to the antidote only opens the door for people to continue using fentanyl. This is part of a prejudice that was built in the shadow of the war on drugs. “What has to be made clear is that guaranteeing access to naloxone is protecting the human right to health and the human right to life,” says Senator Olga Sánchez Cordero, author of the initiative. She hopes that the project can be discussed starting in February, when the 2024 legislative session begins.

The urgency to combat a hidden but increasingly visible crisis in northern Mexico, where fentanyl consumption is concentrated, has led doctors, first responders and activists to cross the border and seek doses of naloxone themselves. While the poison is fueling the public health crisis that’s devastating the US, the cure — travelling in the opposite direction of the drug-trafficking routes — arrives in Mexico in trickles. While drug cartels receive unusual attention, those who are most vulnerable to drug abuse in Mexico remain in the shadows.

In Arizona, where the crisis is still more widespread (but at least acknowledged), five people die every day from opioid consumption, although 10 overdoses a day are successfully treated, according to official figures. Three out of four non-fatal cases are treated with naloxone.

Since 2021, in collaboration with the authorities of both countries and as part of a coalition of associations and institutions that make up the Binational Health Council, the Círculos de Paz organization has been using a legal mechanism to donate around 1,200 doses of the medicine to Mexico. The last transfer was 75 doses for the Red Cross, which were delivered this past week by the Municipal Health Directorate of Nogales (Sonora).

“It hurt us to see what was happening, because we’re part of the same community, we have family, we grew up in Mexico, we speak Spanish and part of our team lives on the Mexican side [of the border],” Acosta says. There’s still a need to work on a registry to record how each dose is used, who benefits and that each patient receives follow-up appointments. Still, donations of naloxone are a silver lining, as well as the main source of access for Mexican health agencies. This effort is also one of the most determined attempts by actors in both countries to seek joint solutions to a shared crisis, in which the diagnosis of the problem, the dynamics of consumption and the impact on the population follow diametrically different logics.

“We’re never going to win the war against substance use, that [reality] has already been accepted. But the war against death is going better,” Channing Velázquez notes. Two days after the interview, the library park in Nogales, Arizona has, once again, been filled with empty needles and burnt bits of plastic. Two homeless people — former classmates hooked on opioids — greet Velázquez. One of them asks him if he has Narcan (naloxone). He hands it over and they say goodbye, before wandering aimlessly again through the deserted streets of the border city. The epidemic is rising to the surface again, but there’s also one less dose of naloxone in the park’s medicine cabinet. Someone was saved. Someone got help.

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