On a crisp, sunny day in February 2025, a local nicknamed Sleepy, 44, stood across the street from the neat white house in West Baltimore where he had been raised by his grandmother. His parents had lived there, too, lost to heroin addiction.

As a boy, Sleepy vowed to become a police officer. (He asked not to use his full name to avoid police scrutiny.). But the streets called, and by his early teens he was selling crack and heroin. In 2007, just a few blocks from his childhood home, he fired a gun into a car carrying gang members whom he feared were hunting him. He went to prison on an attempted murder charge and was released in 2022.

In his absence, the drug world outside transformed — and for drug users, it has become far deadlier. Since the early 2000s, the number of fatal overdoses in the United States has soared. And the rate in Baltimore — 110 deaths per 100,000 residents, according to a recent analysis by the San Francisco Chronicle — is the highest among cities with a populations of a half-million or more.

The initial cause was prescription opioids, then heroin, and then, starting a decade ago, a new generation of synthetic opioids, mainly fentanyl. Now, new combinations of ultrapotent lab-made drugs reach the street almost daily, making the narcotics supply — in Baltimore and beyond — more dangerous, polluted and unpredictable than it has ever been.

After Sleepy came home from prison, his nephew pulled him aside in a park and put a fine point on it.

“He said, ‘Anybody tries to sell you heroin, don’t believe ’em,’” Sleepy recalled. “‘There’s no heroin in Baltimore City.’” The main ingredient is fentanyl or other synthetic opioids, typically mixed with multiple other psychoactive chemicals, which creates a more intense experience for users. “It’s all about potency,” Sleepy said.

“And they are steadily making more, with different names,” Sleepy added of the new compounds. “We don’t even know what it is until we hear it from the newspeople. Then, when the street dealers hear about it, they want to figure out where they can get it to make their stuff better like that.”

Because lab-made drugs are so easily mixed and altered, their effect is uncertain; few buyers know what they’re actually getting, and the possibilities are expanding dangerously. Last summer, several mass overdoses in Baltimore resulted when fentanyl was mixed with N-methylclonazepam, a powerful sedative. Across the country, 22 percent of drug samples contained five or more compounds, an increase from 8.8 percent in 2022, according to testing done by the National Institutes for Science and Technology.

Last February in Baltimore, Sleepy offered an insider’s perspective on the shifting street supply and the changing economics driving it. He was joined by his best friend from childhood, a woman nicknamed Boog, 40. Like Sleepy, she had spent her teenage years selling drugs. (She asked to not use her full name, to avoid police scrutiny.) She had defended her turf with a 9-millimeter handgun; she was arrested after using it in a robbery, and was incarcerated from 2008 to 2018.

“Everybody’s experimenting, that’s the problem,” Boog said. “That’s why so many people are dying.”

Potency and Profit

Baltimore has endured the worst of two drug eras: the one before synthetic opioids and the one since. In 2002, Maryland, particularly Baltimore, had one of the nation’s “most serious heroin abuse problems,” according to the National Drug Intelligence Center, a federal agency. With the ensuing drug war, captured in the HBO series “The Wire,” the city came to symbolize the futility of law enforcement efforts and a generation lost to drug trafficking.

The number of gang-related homicides in Baltimore has dropped sharply since 2019, but the drug trade has continued to thrive. One reason is the sharply falling cost of getting high. Two decades ago, Sleepy said, a gram of heroin might cost a dealer $40 or $50 wholesale; today, a gram of synthetic opioid might cost half as much.

Sleepy was driving now, the stereo playing in his black Ford S.U.V., in the direction of southwest Baltimore; Boog sat in the passenger seat.

“And you can stretch it more, and it’s going to be stronger than heroin,” Sleepy said of opioid. “The profit is bigger because it’s cheaper and you get to add more, different chemicals and cut it to make more money. You can turn a gram into seven or eight grams when you cut with a tranquilizer or whatever.”

The change reflects a transformation in how drugs are made and distributed. Traditionally, they came mainly from the land: heroin from poppies, cocaine from coca, marijuana from cannabis. Their production required acreage, labor and time, and interdiction involved destroying crops and interrupting the physical supply chains.

Now, drugs come largely from clandestine labs, which require far less land and labor. In Mexico, where much of the fentanyl supply in the United States originates, one gram of fentanyl costs a few dollars at most to produce. In China, where the precursor chemicals for Mexico’s operation are made in enormous batches, the ingredients for one gram of fentanyl can be produced for around 83 cents, according to a person who works at one of the Chinese labs.

This translates to plummeting costs for street buyers. Accounting for inflation, a person spending $10 for a dose — the same price, or lower, for a heroin dose years ago — today is buying greater potency for far less. An analysis by The Times found that the cost of an opioid high has fallen 93 percent since 2007. (An opioid high results when certain drugs — either plant-derived drugs, like heroin, or lab-made ones, like fentanyl, nitazenes or orphines — attach to opiate receptors in the brain. This mechanism prompts the release of dopamine and produces a sense of euphoria but can also lead to severe addiction.) The same $10 buys a higher high, and more of it, than two decades ago.

The dramatic drop in cost has allowed more people to afford and access drugs, and helps explain the soaring death rate, experts said. Two decades ago, when Boog and Sleepy worked on the streets, 30,000 people died in the United States each year from fatal overdoses. By 2024, the figure had grown to 80,000, more Americans than died in the Vietnam War.

In southwest Baltimore, on Washington Boulevard, Sleepy drove past a fire station. “I watch them handle nothing but OD’s all day,” Sleepy said. His own sister was currently in drug rehab, he said.

In theory, the threat of an overdose or death should deter users. But, Boog said, a dealer whose product causes an overdose can actually attract customers; it indicates a strong batch. She added that unscrupulous dealers sometimes deliberately sell a few capsules that they know are potent enough to cause an overdose — to invite more business.

“They call ’em ‘death packs,’” Boog said.

Tester

Sleepy parked behind a bar in the Morrell Park neighborhood, a small commercial strip amid residential blocks of red brick rowhouses, where drug transactions take place. On foot, half a block on, Sleepy and Boog flagged down a gray-haired man in a long, worn coat who stood in the doorway of a small grocery. They introduced him as Pops.

Pops was what is known in South Baltimore as an “old head,” a longtime functional substance abuser — a survivor. He sold drugs, mostly to support his own habit. He was also a “tester,” the term for someone who received free samples in exchange for his assessment of them: Was the drug mixture strong enough? Did it leave him feeling weird?

Testers like Pops are the street’s response to an increasingly adulterated and unpredictable drug supply. The labs, where the drug mixtures are made and packaged, can be as small as a one-person operation in an apartment. “Basement, kitchen table, wherever you do it, that’s your lab,” Pops said.

Sleepy agreed: “That’s your lab!” The supply is so potent that simply touching it unprotected can result in addiction.

“You can get a table habit like that,” Boog said.

Once a product is approved by testers, it is then sold to regular users. They represent the bottom of the food chain, where desperation meets the adulterated supply. A few blocks away from where Pops was working, Sleepy introduced a young man he called Berto, who had been aimlessly walking the streets.

Berto wore a collage of unkempt layers: green and blue sweatpants, a black hoodie, a dark blue velvet robe that hung off the left side of his body, a black jacket slung over his right shoulder, gold-and-black basketball sneakers. He smoked a cigarette with hands darkened by grime. He looked middle-aged.

“I’m 25,” he said. “I’ve been doing this for four years.”

How did he know what drugs he was getting?

“You really don’t,” he said. “You try to taste and smell it and see if it’s raw heroin.”

Sleepy jumped in: “Hang on a second, are you telling him you buy heroin?”

“No,” Berto said. He slurred slightly and worked to get out his thoughts. He meant synthetic opiates, typically fentanyl. Heroin is gone, but the word lives on as a kind of metaphor.

“When we say ‘heroin,’ we’re basically talking about fentanyl,” Sleepy said, and it was typically “scrambled” with other drugs. The scrambling and the increased potency of the supply raised Berto’s drug tolerance such that he could not last long without a dose, so he looked to score more often: “every one to two hours, if it’s garbage, and every five hours, if it’s good,” Berto said.

When he was unable to score, he said, “I get rashes, hot and cold sweats, racing thoughts, can’t sleep.” When it’s particularly bad, he soiled himself. He overdosed eight times, he said, and has been revived six times with Narcan. As for the other two, he said, “by the grace of God, I woke up.”