I used heroin from 2004-2008, prior to that I dabbled with oxy and hydrocodone (it was possible back then to find shady online doctors to prescribe hydrocodone to you). I even had a mail order source for codeine tablets out of the UK.
Oxy and heroin were problems, but you didn't have the rampant overdose death and rapid decline of a generation of users in the same way. As someone else mentioned, people (generally) could hold down a job to some degree (though I only lasted so long before my use started to really interfere with employability). The population of users was less obvious, though still apparent if you knew what to look for - you didn't have quite the same issue with homelessness during that time, and if you wanted to get into treatment it was generally available.
Having worked through the rise in fentanyl within a suboxone program I can say that the biggest things I've noticed are the crippling addiction, the lack of enthusiasm for it's use, and its incompatibility with buprenorphine. Fentanyl analogues and metabolites linger far longer in the system than heroin did, so getting started on bupe sometimes takes several days of careful dosing before you can establish. I had plenty of times where I could start buprenorphine within 12-16 hours of doing heroin and be fine. I experienced precipitated withdrawals once but it was because I took a suboxone and then used heroin within an hour from that moment. Worst experience I've ever had.
You also have to look at a few additional factors that have contributed to the zombie-like masses that the modern street scene can resemble. Cost of housing has risen dramatically since then, and the ease of falling into homelessness has dramatically increased. Public health has been decimated by burnout over the past 20 years, with less and less people enthusiastic about wanting to go into addictions as a focus. Also, the rise of a number of various designer drugs with limited history of human use have further complicated things. Synthetic cannabinoids popped up around the same time as fentanyl, and had a huge market on the street due to how cheap it was. Some of the most difficult patients I've worked with were caught up with that stuff, suffering apparent neurological dysfunction, and a crippling addiction to the stuff. Meth also became far more prevalent throughout the US due changes to how it was manufactured, allowing for massive increases to production which could feed markets from coast to coast.
The problem is multivariate and crosses multiple systems - as best as I can tell, it started in 2006 with the first modern illicit fentanyl lab pumping it into the east coast supply (something that was discussed at the time on usenet groups, mentioned in the TV show 'The Wire', and noted by NFLIS reports published by the DEA). That lab lasted for about 6 months, serving as a likely beta test for the product, and was eventually busted late 2006 or early 2007 IIRC. We may never know why, but my sense is that Chinese organized crime approached the cartels with an offer to teach them how to move from organically produced heroin to synthetically produced fentanyl. The idea was eventually tested out in 2006, there was enough market saturation, and a successful operation was devised in the late 2000s early 2010s. Fentanyl started to really emerge in 2011/2012, then outpaced illicit opioid production in the years that followed. We even had to update our labs in the clinic because there came a time in 2013/2014 where our drug tests would detect no opioids present despite the person being obviously dopesick and begging for buprenorphine. We also adjusted our intake guidelines to work towards same-day dosing as many folks couldn't make it for a week or two until we could schedule their induction (which had been pretty standard when dealing with heroin).
Now I hear the stuff is drying up across the country - seems the cartels have finally agreed to stop supplying fentanyl (at least to some degree). The word on the street reminds me of the times when heroin would dry up and all of the product would get super weak. It has been a long time since I've heard of weak dope on the streets, but lately it's been mentioned quite a bit. Times they are a changin!
