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The Opioid Crisis Is Not Over

As fentanyl and synthetic opioids claim record numbers of lives, researchers and public health teams are racing to reverse the drugs’ deadly effects. Yet durable solutions are proving elusive.

Illustrations by Kellie Jaeger

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Madeleine Sweet’s fentanyl addiction started with an unexpected freebie. Already addicted to opioids and grappling with the sense that her life was going bottom-up as her student debts mounted, she was finding it difficult to access enough oxycodone and other opiates to satisfy her dependency.

So, in 2016, Sweet gravitated to the dark web. That’s where sellers were hawking designer drugs crafted to hijack the brain’s reward system, including mass-produced fentanyl, a synthetic opioid 50 times stronger than heroin. Sweet reached out to a seller for designer opiates and was sent a gram of fentanyl as a free sample with her purchase.

Soon, the sample arrived at her home in Monterey, California — a postage-stamp-sized bag of what looked like taupe-colored powdered sugar. Seconds after Sweet snorted the powder, an atomic-scale dopamine rush buried her in ecstasy. She came to a few minutes later with her head resting on her ...

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