How Drug-Soaked Paper Caused Deaths in US Prisons

Poisoning Cases Linked to Drug-Soaked Paper

I was talking with a friend recently who wondered aloud why the US takes drugs so seriously — why it’s pressuring China over fentanyl-related regulations. This friend’s exposure to drugs was limited to marijuana and what shows up in movies and TV dramas, plus whatever gets mentioned in the news. But someone else in the conversation had actually seen people in California addicted to fentanyl and other synthetic drugs, and the gap between their two reactions to the issue was striking. So I went looking through news coverage and international reports on the subject.

One piece that caught my eye was a New York Times investigation into US prisons. It traced deaths at Cook County Jail connected to paper soaked in drugs. The core problem was that items were getting smuggled in whose contents couldn’t be identified just by looking at them.

Paper that looks like an ordinary letter or document can contain any number of different drugs, and there’s no easy way to immediately determine what someone was exposed to after using it. This is both a smuggling-interdiction problem and a clinical one — diagnosing and treating patients who show symptoms of poisoning.

Testing for a single drug can miss the bigger picture

The danger of drug-soaked paper has also been confirmed in medical research. A separate study published in JAMA Network Open in 2024 analyzed 18 patients who came to hospitals after suspected exposure to this kind of paper inside a correctional facility in Atlanta. Symptoms included decreased consciousness and slowed pulse, and one patient died. The paper and blood samples mainly tested positive for synthetic cannabinoid compounds.¹

Multiple substances were detected together in the paper samples analyzed in this study. But not every substance found on the paper also showed up in the patients’ blood. Pinning down exactly what substance was present, in what amount, and what the person was actually exposed to is essential for accurately identifying the cause of poisoning.

The Cook County reporting and the Atlanta study are separate cases. Death counts and test results from different regions shouldn’t be lumped together as if they were a single incident. What they do share is a common lesson: substances beyond the ones originally suspected can be mixed in, and even the person using the drug often has no idea what’s actually in it.

The scope of testing matters too. Standard drug screening panels don’t catch every new synthetic substance. When suspected symptoms don’t match the test results, more precise analysis may be needed. That’s not to say detection is impossible — the researchers used specialized analytical equipment to identify the compounds present in both the paper and the blood samples.

688 New Psychoactive Substances Were Reported in 2024, 101 of Them for the First Time

Plant-derived drugs like opium, cocaine, and cannabis have long been the source of trouble. But that doesn’t mean synthetic drugs are a recent phenomenon. As established drugs circulate alongside a growing array of synthetic compounds, telling substances apart and assessing their risks has only gotten harder.

In an October 2025 release, the UNODC reported that 688 distinct new psychoactive substances (NPS)² were logged over the course of 2024. Of those, 101 were reported for the first time that year. This doesn’t mean all 688 were newly created in 2024 — as of October 10, 2025, cumulative reports stood at 1,396 substances across 153 countries and territories.

As more newly reported compounds pile up, analytical agencies face a growing burden: identifying what each substance actually is, and confirming its toxicity and how it’s being distributed. The label “NPS” alone tells you nothing about whether a substance is legal domestically. International classifications and each country’s legal scope differ, and some substances are managed only through temporary scheduling.

One family that deserves particular attention is nitazenes.³ Developed in the 1950s but never approved as clinical medications, these synthetic opioids have been linked to illegal distribution and deaths since 2019. Some compounds in this class produce strong effects at extremely small doses, but potency varies by specific compound and test conditions, so no single multiplier can be applied across the entire family.

Introducing a 2025 review, researchers at Vanderbilt explained that nitazenes are sometimes mixed into other drugs without the user’s knowledge, and that standard toxicology screens can miss them entirely. Detection technology alone isn’t enough — it’s equally important for medical staff and public health agencies to share new information as it emerges.

As the variety of substances multiplies and online distribution channels compound the problem, any response built on the assumption that we already know which compounds are out there runs into real limits. Still, it would be wrong to assume every new substance is automatically stronger, or that regulation always lags behind distribution. What’s needed is gathering real detection and poisoning data to catch dangerous shifts quickly.

The same caution applies to screening items smuggled into correctional facilities: appearances — who supposedly sent a package, how it’s wrapped — aren’t enough to judge safety. Investigators need to separate what’s merely suspected from what’s actually been confirmed in terms of shipping and delivery, and back it up with test results.

Border Seizures and Domestic Arrest Statistics Need to Be Read Separately

South Korea has also seen cases of new psychoactive substances being distributed and disguised as ordinary products. To gauge the scale of the problem, the first step is figuring out which agency counted what.

According to January 2026 reporting on figures from the Korea Customs Service, drug seizures at the border in 2025 totaled 1,256 cases and 3,318kg. That’s a 46% increase in case count and a 321% increase in weight over the previous year — both record highs. A few large cocaine seizures drove much of the weight increase. These numbers can’t be read as a proxy for domestic consumption or for growth in synthetic drugs specifically.

Separately, arrest statistics released by the Korean National Police Agency in February 2026 show that the share of online drug offenders rose from 21.4% in 2020 to 39.9% in 2025. Among drug offenders police arrested in 2025, those in their teens through 30s made up 63.5%. Border seizure volumes and police arrest counts are measuring different things entirely.

So when interpreting a rise in detections, you need to look at shifts in distribution channels, shifts in enforcement intensity, and the impact of a handful of large busts — all at once. The fact that seizure weight went up doesn’t mean the domestic user population grew by the same proportion.

The police agency’s data includes cases distributed in the form of e-cigarette liquid and food products. There’s also a case of GBL — a temporarily controlled substance disguised as eyelash-glue remover — being smuggled out of the country. Not all of these are cases of drugs being smuggled into Korea. Since the physical form alone can make a substance look like an ordinary consumer product, confirming its actual composition and tracing its distribution route are essential.

Oswarld’s Lens

As I read through these materials, I felt that keeping information updated is what matters most when responding to new distribution methods. Even when I’ve built go-to-market strategies, I’ve seen cases where market participants’ behavior diverged from existing rules or assumptions. Drug enforcement isn’t the same kind of problem, but it shares this: you have to spot what’s changed on the ground, and fast.

Strengthening enforcement methods and identifying what substances are actually circulating need to happen together. Analysis results on suspicious substances shouldn’t stay locked inside investigative agencies — they need to reach medical and public health institutions too, so they can be cross-checked against patients’ symptoms. Conversely, unusual reactions observed in hospitals can themselves signal a new risk.

We should also look at the statistics showing that overdose deaths in the US have declined. The CDC’s provisional estimate, released in May 2025, put 2024 deaths at roughly 80,000 — down 26.9% from the previous year. That decline is a meaningful shift, but the number alone can’t isolate the effect of any specific enforcement policy. The claim that nitazenes have simply filled the gap left by declining fentanyl also needs separate evidence to support it.

Rather than saying we lack the capacity to respond, I think it’s more useful to know precisely what any given test can and cannot detect. Domestically, Korea’s Customs Service announced a crackdown on novel synthetic drugs in February 2025. In February 2026, the National Police Agency unveiled measures including an inter-agency council for responding to new drugs. While acknowledging the crackdowns and responses already underway, we need to examine how quickly analysis and information-sharing can be improved.

Closing

The starting point for this piece was a conversation with friends. Hearing the same news, people who had actually witnessed addiction problems firsthand felt a different level of risk than those who hadn’t.

After going through the research, I felt that simply saying “this new drug is scary” wasn’t enough. You need to separate out what compounds were actually detected, what harms were actually reported, and how far current testing and response capabilities can go. Understanding those distinctions is what lets you talk about the necessary response without exaggerating the danger.

UNODC’s NPS data and announcements from Korea’s Customs Service and National Police Agency can serve as a starting point for tracking these shifts. It helps to read them by separating out what each one actually tells you: the types of substances, the actual harm caused, and the enforcement statistics.

References & Further Reading

• New York Times, “No Pills or Needles, Just Paper: How Deadly Drugs Are Changing” 2026. : This is the U.S. prison-system report that sparked this piece.
• UNODC, The Challenge of New Psychoactive Substances — A Technical Update 2024, June 2024. : A technical report laying out the chemical classification and market evolution of new psychoactive substances.
• UNODC Early Warning Advisory, “Record high of 688 individual NPS reported worldwide in 2024,” October 2025. : A tally of NPS reports for 2024, compiled as of October 2025.
• CDC, “U.S. Overdose Deaths Decrease Almost 27% in 2024,” NCHS, May 2025. : Provisional 2024 estimates released in May 2025.
• Vanderbilt University Medical Center, “Forgotten opioid has resurfaced as lethal street drug” Pain Medicine review, September 2025. : Vanderbilt’s coverage of a review paper on nitazenes.
• JAMA Network, “Identification and Health Risks of an Emerging Means of Drug Use in Correctional Facilities,” December 2024. : A case series and substance-analysis study on drug-laced paper in U.S. correctional facilities.
• Herald Corp (Korea), “Korea Customs Service seizes 1,256 cases, 3,318 kg of narcotics in 2025,” January 21, 2026. : A report on Korea Customs Service’s border-enforcement statistics.
• Korean National Police Agency, Special Countermeasures to Curb the Spread of “New Psychoactive Substances”, February 11, 2026. : Arrest statistics, major case studies, and the response plans of relevant agencies.

The author is Oswarld (Kwangseob Ahn). Current roles: Adjunct Professor at Sejong University, Strategy Consultant at INLEVEL9. Career, research, books, and recent work are kept current on the About page. Latest · July 2026: HEMA-2: A Consolidation-Aware Tri-Memory Architecture with Multi-Channel Scheduling for Lifelong Conversational AI.

Footnotes

1. Synthetic cannabinoids: a family of synthetic substances that act on the same receptors as THC, the active compound in cannabis. Effects and risks vary by substance, and some can cause severe intoxication or death. ↩

2. NPS (New Psychoactive Substances): a term for substances not covered by international drug-control conventions that nonetheless pose public-health risks. “New” doesn’t necessarily mean recently invented, nor does it imply anything about a substance’s domestic legal status or safety. ↩

3. Nitazenes: a general term for benzimidazole-class synthetic opioids. Some compounds are highly potent and can be missed by routine screening, though dedicated tests and specialized analysis can detect them. ↩