A Fatal Cut: The Human Cost of Omaha’s Fentanyl Flood

Rite of Oblivion

-Due to the illicit nature of the following account, the source agreed to share his experiences under guarantee of anonymity, citing job security. He will be referred to as “Nathaniel Owens” in the following section.

“I did half of one, and next thing I knew, there’s a light in my face, and there’s a cop, just saying my name over and over again…‘Nate! Nate! Nate!’…‘Like, what? What’s going on?’” recalled Nathaniel Owens, a 29-year-old graduate of Omaha Westside High School and recovering opiate addict. “And the only reason…my head was out the window, and she saw me, I was turning blue, and she called 911. I woke up in the ambulance with the cop yelling above me.”

The “one” he’s referring to was, by all appearances, a prescription-grade oxycodone tablet. A round, powder-blue shell imprinted with the numeral 30 and the letter ‘M,’ ostensibly prescribed to treat severe pain. The “she” was a young woman, exiting a local bar. A complete stranger.

As his addiction so frequently demanded, Owens tossed back the familiar pill with guilty anticipation. Yet, it wasn’t the “little cloud, where your back doesn’t hurt anymore” cresting the horizon. On a cold February night in 2021, Owens found oblivion.

Face spilt over his driver’s side window, Owens’ lips rapidly drained blue; his automatic nervous system no longer signaled his body to breathe.

“With fentanyl…it’s so fast, you just go black,” he said. “It’s the scariest thing.”

At 50 times the relative potency of heroin, and 100 that of morphine, even a heavy opiate user—like Owens, at the time of his described overdose—is susceptible to what the Drug Enforcement Agency has determined fentanyl’s lethal threshold: an infinitesimal 2 milligrams (mg), the equivalent of 10-15 grains of table salt.

“It got to a real bad point where I was doing, like, 200 to 300 milligrams (mg) a day,” he said of his oxycodone consumption prior to seeking treatment. “I was drunk and called someone I shouldn’t have. They told me they [the pills] were real and clearly [in retrospect] they weren’t. A half one shouldn’t kill me, know what I mean?”

The other unknown that night—the woman who noticed Owens’ condition and promptly dialed emergency services—all but certainly saved his life.

“If she hadn’t happened to come out, I probably would’ve died,” he conceded.

Though Owens’ second fentanyl overdose a month later was arguably even more traumatic, lapsing out of consciousness while behind the wheel of his truck, it’s the funerals he’s attended that give him pause.

“I’ve had…six friends die from it now,” he said, weary of the number’s crushing fatalism. “Three within the past six to 18 months. The other three, over four or five years. Fentanyl is a whole different animal. It’s not even drugs, it’s pretty much Russian roulette,” he cautioned. “It’s murder.”

Breaking Waves

“Right now the biggest thing we’re seeing is fake, or counterfeit M30 pills,” said Lt. Steve Fornoff, who currently helms the Omaha Police Department’s narcotics unit. “The dealers have figured out that they can mimic this stuff, and they sell it per pill. It takes a very, very little amount of money to make them. Their profits are huge.”

Having spent 23 of his 29 years in law enforcement with the OPD, Fornoff is well acquainted with the various pockmarks and ulcers the city’s underbelly conceals. Still, the response he’s received from certain dealers hustling counterfeit pills reek particularly callous.

“Some of the dealers that we’ve talked to, that we’ve arrested, have told us when we’re telling them, ‘Hey, the possibility of overdosing on these drugs is pretty high, does that bother you at all, that you could potentially be killing people with this?’” Fornoff said. “The responses that we’re getting is that they understand the risk, but for every one person that does overdose, they get 10 more that become hooked. Their profit margins are going up, so they’re okay with that risk.”

According to figures collected by the Centers for Disease Control, the rate of synthetic opioid-related deaths jumped by a staggering 56% between 2019 and 2020 in the United States. Provisional data released by the CDC’s National Center for Health Statistics projected the death toll surged by 28.5% over a 12-month window through April, 2021—from 78,056 deaths to 100,306 deaths over the same time period tallied in 2020. In Nebraska, 46 more people succumbed to fatal overdoses in 2020 than in 2019.

However, a countermeasure on the medical side has fatalities in a gradual, nonetheless encouraging, retreat. Naloxone, more commonly referred to by its trade name, NARCAN, is an opiate antagonist administered either intravenously or nasally that reverses the neurological misfires of an overdose within two to five minutes (for a duration of 30 to 90 minutes). Its greater availability, in Omaha and elsewhere, is saving lives.

“They may be literally seconds away from dying, you provide the NARCAN, and they can almost make a full recovery right then and there,” Fornoff said. “Just about everyone on the department has been able to get their hands on some NARCAN, and they take it with them during their shifts.”

An abundance of product, easy cash flow, and guaranteed repeat customers mean dealers needn’t discriminate. While deaths are down, overdoses continue to climb.

“We’re seeing young teenagers, all the way up to people in their 80s abusing it. We’re seeing all socio-economic groups; class doesn’t factor, race, area of town. We’re seeing all different types of people abusing it,” Fornoff said. “Methamphetamine is still our No. 1 drug in Omaha, but we’re seeing fentanyl is quickly rising.”

A huge bust in Omaha this past July by Fornoff’s colleagues at the Drug Enforcement Agency—the seizure of 32,000 counterfeit pills laced with fentanyl estimated to be worth between $96,000 and $160,000—underscores the drug’s strengthening grip on the community.

“This is not a metropolitan problem, this is not a small town problem, it’s not a rural country problem. It’s a nationwide problem,” echoed Justin King, special agent in charge of the DEA Omaha Field Division.

“The world’s never seen anything like it, something that in such a small amount can be so potent, and it continues to evolve,” King said. “If you look back at cocaine and how it evolved into crack cocaine, if you talked to someone at that time—they’d never seen anything like it. We had the same thing with the meteoric rise of methamphetamine.”

Statistics published by Washington, D.C.-headquartered Global Financial Integrity (GFI) in 2017, a research institute focused exclusively on the transnational exchange of illicit goods and services, estimated global drug trafficking lies somewhere between $426 billion and $652 billion in annual value—figures that don’t take into account the recent boon from fentanyl.

“What it really comes down to, they’re trying to make more money,” King said of fentanyl and other lab-made opiates. “It’s synthetic so they can produce unlimited amounts, whereas you talk about heroin or cocaine or marijuana, it’s something you have to grow. It takes a lot more time. They’ve streamlined that. They’ve made a more potent product.”

Drug dealers have also become more sophisticated in regard to distribution—the illicit market’s exponential growth accelerating the tactical and strategic arms race with law enforcement.

“The Sinaloa Cartel, the CGJN (Jalisco New Generation Cartel), are primarily the biggest ones who are producing fentanyl, these fake pills. They have supply networks where they get the precursors to make the fentanyl products out of China, and they’re making that into the product and pushing in through multiple various networks in the United States,” King explained. “But you know, it’s not a scientific process. These are clandestine labs where some pills may have more fentanyl in them, and that’s why we push our “One Pill Can Kill” campaign. That one pill can be the difference between life and death,” he warned. “We want to take it off the streets and hold those who are distributing it accountable, but we also want a multifaceted approach, to educate the public.”

“What I can tell, in each of these times you have to address the threat as aggressively as you can,” King continued, referencing the tidal quality of drug epidemics in the U.S. “You have to go after the dealer. You have to go after the distributor, the distribution network. You have to go after the supplier. Getting it off the street is so vitally important.

“We lose so much potential in our country because of drug addiction.”

Guiding Darkness

-Due to the illicit nature of the following account, the source agreed to share his experiences under guarantee of anonymity, citing fears of legal prosecution. The subject will be referred to as “Alan Campbell” in the following section.

“I’ve been in the market about six years now,” said Alan Campbell, a metro-area pot and cocaine dealer. “All of my friends were smoking a bunch of weed, and I wished I could make some money off them. Then, as I was selling to them, I was introduced to their friends and what they were into, and I just started picking up other things. Weed, Xanax, coke, Oxy…stuff like that.

“Yeah, I just kind of dabbled around,” he demurred.

Contemporary media depictions of drug dealers often portray a lavish lifestyle, wherein fine jewelry, luxury vehicles, and crisp c-notes are flaunted through a lens of ‘untouchable’ excess. Campbell, however, maintains a low profile. That’s because under Nebraska state law, ‘possession with intent to deliver’ of any Schedule I substance—whether marijuana or prescription pills, counterfeit or otherwise—constitutes an automatic Class IIA Felony, which carries a maximum sentence of 20 years upon conviction.

Campbell is conscientious in other ways, too. He ceased selling pills altogether when the deleterious effects that fentanyl was having on the underground economy became apparent.

“I’ve had two buddies’ girlfriends die after parties, just because some guy was outside selling fake Percocet, and it was laced with fentanyl,” he recalled. “Just an hour later they died. I was like, ‘I don’t want to do that. I don’t want to kill somebody on accident.’”

Still, Campbell isn’t ignorant to the fact that many dealers are cutting their wares with fentanyl regardless of the type of high advertised. A rash of overdoses related to fentanyl-laced cocaine occurred in Omaha and Lincoln last summer, and the trend continues with cases related to spiked cocaine, heroin, and methamphetamine increasingly commonplace. Not even marijuana’s relatively benign reputation has gone untarnished.

“They’re putting [fentanyl] on weed, because I guess it looks more ‘crystally’ that way,” he said. “They’ll sprinkle it in with just about anything.”

Campbell also highlighted that, although cities near the coasts and southern border may have greater quantities of narcotics flowing through them overall, purity becomes a greater concern the further inland contraband travels.

“I mean, it could touch like 20 people before it gets here, depending who their supplier is,” Campbell said, “and even if they’re getting it straight from, say Texas, and it’s coming to Omaha, maybe just a couple of people have touched it. But once it’s here, it’s probably going through five or so plugs before it gets to a consumer, all cutting it in their own way.

“You’re not getting pure Molly (MDMA), you’re not getting pure coke, you’re not getting pure Oxy, you’re not getting anything pure unless it comes straight from the pharmacy,” he concluded.

Campbell offered the following advice to those seduced by curiosity or peer pressure:

“Don’t be so quick to just take whatever someone’s giving you, ask questions and test your drugs,” he advised. “On a moral standpoint, [fentanyl] doesn’t make any sense, it’s evil. But it’s not going to stop. They just don’t really give a shit that they’re hurting people.

“Crush it up, break it down, and test it,” he said. “A test kit costs a lot less than your life.”

Still, abstinence is the only definitive way to avoid overdosing—a truism at the core of Coalition Rx, a nonprofit that aims to intercept addiction via education, preventive care, and policy advocacy.

“Do you realize we’ve lost 107,000 across the country?” posed Coalition co-founder and executive director Carey Pomykata, referencing the final estimate of lethal fentanyl overdoses for 2021 as reported by the CDC. “That’s enough people to fill the football stadium (Lincoln’s Memorial Stadium). Think about that, all those people dead.”

While Pomykata noted that senior citizens represent another cohort disproportionately affected by the crisis, it’s the emergence of ‘rainbow fentanyl’—brightly colored, innocuous-looking tablets specifically designed to appear ‘fun’—that’s renewed her anxiety toward Omaha’s youth, including children.

“They look like sidewalk chalk or like the marshmallows in the Lucky Charms boxes. And I thought, ‘If any little kids see that, they’re going to pick that up,’” Pokmykata recalled with dismay. “And if you figure that four out of every 10 pills contains [potentially] lethal does of fentanyl, when young people start testing these things out, we’re going to lose a lot of youth. Parents cannot afford to be lax nowadays—it’s critical they’re part of the conversation.”

Based out of University of Nebraska at Omaha’s Barbara Weitz Community Engagement Center, Coalition Rx also works closely with the university to curb on-campus drug abuse, and just as prevalent, prescription drug theft between students—partnering with Justin King and the Omaha DEA to distribute medication lock-boxes this past October.

“The time you really see Adderall issues is around test time, right? I’m beginning to realize that pretty much any prescription drug that you overdo and overtake is going to do damage,” she noted. “You never want to take drugs that don’t have your name on it.”

“But now, with fentanyl, there’s a good chance it could kill you,” she said.

Photo by BiIl Sitzmann

The Pain Paradox

The genesis and socio-historical apparatus that sustains the ‘opioid epidemic’ as coined in the 21st century has achieved general consensus among addiction scholars:

An initial wave, characterized by the overprescription of OxyContin in the 1990s, owed largely to intentional mislabeling by its manufacturer, Purdue Pharma, and the “panacea” reputation it initially excited in physicians.

The second wave occurred in the 2010s, when a confluence of updated research, more stringent protocols, and a sentiment of contrition by the medical community led to a sharp decrease in the prescription rate of semi-synthetic opiates; consequently, this left a large segment of the population turning to street-curated heroin to fend off withdrawal.

Presently, the third wave—generated by the mass influx of fentanyl—is crashing over the United States with unprecedented virulence.

“There were huge pushes in the medical community about the overprescription of opiates,” noted OneWorld Community Health Center psychiatrist Dr. Shannon Kinnan. “There’s been a major cutback over the last few years.”

University of Nebraska Medical Center addiction medicine fellow Dr. Abraham Farhat has observed much the same.

“For a long time, opiates were being marketed really heavily and overprescribed. It’s gone the other direction; now people are reluctant to prescribe any opioids,” Farhat noted. “So we have a patient base that has a physical dependency. That puts patients in a tough spot, because they do develop a very significant withdrawal syndrome…so if you develop dependency in a patient and don’t sort of taper them off, they may just be seeking other ways to not feel sick.”

Physicians have encountered and attempted to solve this medical paradox for centuries: no drug in nature or science comes close to the pain relief offered by the specific arrangement of alkaloid compounds extracted from the seeds of Papaver somniferum, more commonly known as the opium poppy. Nor has any drug caused such prolonged, recurrent suffering throughout the course of human history.

“It’s hard to be in a rational place when you’re just vomiting and having diarrhea and feeling really terrible; your whole body starts to ache,” Farhat explained. “It’s a phenomenon called hyperalgesia, which happens because your body’s meant to feel pain, and if you’re covering up your pain sensors, it creates more of them. Then when the medicine is taken away, you have more pain receptors that are now active, not being covered up by anything. So, you actually have increased pain from when you started.”

Just as the potency of fentanyl is magnitudes greater than that of oxycodone, Kinnan has noticed the ravages of withdrawal are commensurately intense.

“We’re using the same as we would for any other opioid disorder, but it is harder. It’s harder to get them started on the medicine,” she said of opiate replacement therapy (ORT), in which the illicit and more harmful narcotic is initially substituted with an FDA-approved substitute, such as methadone or buprenorphine, as a transitional step toward recovery. “The detox and replacement time is trickier. It’s more difficult to treat.”

As with previous waves, the medical community is examining how to best adapt. Until the tide recedes, doctors like Kinnan and Farhat are performing triage in its wake.

“Right now, I think where we’re at, we’re really dealing with a disaster management sort of thing, where we’re just trying to keep people from dying. It’s analogous to CPR,” Farhat said.

“There’s definitely families everywhere that can identify with the issue, and not be able to do much,” he continued. “It puts them in this weird, hard situation between helping someone who needs a lot of help, versus saying no to someone because they’re making bad choices, and how to find that balance. You say a family member can’t live with you anymore because of their problems. But then, their living on the street poses an equally difficult situation.”

“It puts many families in a very tough spot.”

Eulogy

“Michael was born July 5, 1984, to parents Gary and Paula Glissman in Omaha, NE. Survived by his parents; grandmother, Joan (Glissman) Pistillo; aunt, Lisa Jensen and uncle, Mark Armstrong; aunt, Cindy Glissman; loving family, Chris and Sarah Short and children, and Kelly Warner and children. Preceded in death by both grandfathers, Henry Glissman and Kenneth Jensen; grandmother, Edith Jensen; and his beloved cat and dog, Maynard and Max.

“Michael was a proud Eagle Scout and a graduate of Brownell Talbot, Class of 2002, and had an associate degree from Metro Tech. He struggled with addiction most of his adult life but was currently on a much better path, living at home with his parents and searching for inner peace. He was a kind and gentle soul and will be greatly missed by all of his friends and family.”

So reads the obituary of Michael Glissman, whose life ended with a fatal dose of fentanyl. As written, by Michael Glissman.

“We had made it clear he couldn’t be using and staying at home, but I also begged him not to do it alone,” Michael’s father, Gary Glissman, recalled. “He probably just didn’t have any place to go, so just stayed in his truck, and was probably dead within five minutes. He stopped breathing, and no one was there to revive him this time.”

“One of the things we found in his truck—with his registration and stuff—he had handwritten his own obituary, so he knew he was probably done,” Gary continued, “he was probably high, sitting in his truck, nothing to do…and so wrote out his own obituary. We tried everything we could conceivably think of, on the positive side of stuff, but it’s a precarious situation when they continue to relapse…”

Michael grew up in Omaha’s Bryn Mawr neighborhood, the only child of Gary and his wife, Paula. He enjoyed detailing cars, showed a talent for sculpture, and earned his Eagle Scout badge, anchored by a stable, prosperous household. However, Michael displayed behavioral issues—initially attributed to ADHD—which grew more pronounced and frequent with age. A genetics test in 2009 revealed the actual root of Michael’s worsening conduct: a late diagnosis Klinefelter’s Syndrome, in which a male is born with an extra copy of the X chromosome (47, XXY). The condition underlies an array of developmental complications, both physical and behavioral. This led Michael to self-treat with alcohol and preempted other, more serious health complications.

“He developed something called acute pancreatitis [in 2010] that ended up putting him in the ICU for 42 days hooked to kidney transfusion and a ventilator,” Gary said. “They kept him in a semi-coma existence and got him extremely addicted to painkillers, just dismissing him with painkillers despite his addiction profile. And that is eventually, you know…what killed him.”

“It’s like this perfect storm,” he continued, “I was actually the one that caught him doctor shopping all over the area and five counties in Nebraska, and I just went ballistic when I found out doctors are required to report prescriptions for all medications, but they are not required to utilize that database before they prescribe. He had 10 doctors he was getting medication from and none of them were checking the state database.”

As his addiction mounted, so too did Michael’s rap sheet of petty crimes—culminating in a felony possesion charge, proceeded by a six-month jail sentence in 2021. Gary believes Michael’s incarceration all but sealed his son’s fate.

“Our son was developmentally delayed with a lifelong genetic condition and various medical issues, and during his time at DCC (Douglas County Corrections) he received inadequate medical and mental health services,” Gary wrote in an essay he titled “Broken Prison System.” “I am convinced it was a contributing cause of his death […] He died on June 23, 2022, just a few days before his 38th birthday. We bought him a headstone for that birthday.”

Gary continues to rally against what he points to as egregious failures by the medical and penitentiary systems and breaches in the social contract—including the proliferation of ever deadlier street drugs in the community—that combined to tear the Glissman family apart.

“He was being told [he was being sold] oxycodone, but I would say at least 80% of the time, it was almost always laced with fentanyl, because he would take it and lose consciousness and stop breathing” Gary said. “Fentanyl is so damn cheap. It’s so damn accessible. People are dying from this. This is 100,000 people dead. And nobody’s got a handle on it.”

Recovery

Both Nathaniel Owens and Michael Glissman suffered lethal fentanyl overdoses in their vehicles. One man is alive today. The other, buried by his family. The critical difference—someone was there. In Owens’ case, it was a matter of sheer luck. However, outside of abstaining from drug use entirely, the most important factors in the face of the fentanyl crisis are: utilizing test kits/strips, keeping NARCAN within reach, and perhaps most importantly, having someone else nearby who isn’t using (or using at the same time, at least) to administer aid and call for help. It’s important to remember that under Nebraska’s “Good Samaritan” statute, those who report an overdose in good faith are exempt from both civil and criminal liability. Recovery is a process. The following resources are available in Omaha:

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-4357