“If anything can be likened to a weapon of mass destruction in what it can do to a community, it’s fentanyl. It’s manufactured death.” ~ Special Agent-in-Charge Michael Ferguson, New England Drug Enforcement Administration According to an article in the New York Times, drug overdose deaths in America are continuing to rise at a record pace. After compiling estimates from medical examiners, county coroners, and state health departments across the country, the numbers are staggering. There were approximately 64,000 fatal overdoses in the United States in 2016. This far exceeded 2015’s total of 52,404, which was at the time the greatest number of drug deaths ever recorded in a single year. This represents a one-year increase of over 22% – the largest jump ever. To put that number in perspective, drug overdoses kill more Americans than:
- The Vietnam War – 58,200
- AIDS (peak year 1995) – 50,628
- Gun Deaths and Injuries COMBINED (2016) – 45,699
- Suicides (2015) – 44,193
- Automobile wrecks (2016) – 40,200
- Homicides (peak year 1991) – 24,703
And it’s not over – early estimates are predicting that there will be 71,600 drug overdose deaths in America in 2017.
The Cause? Opioids. The Effect? Deaths.
Here’s the thing – the public health crisis of drug overdose deaths is driven by the opioid epidemic – up to 67% of drug deaths involve prescription painkillers or heroin. That’s almost 43,000 deaths. In fact, up until 2015, heroin was considered the biggest single opioid threat, because the number of heroin-related overdose deaths continues to climb. In 2002, there were 2089 heroin deaths in America, but by 2016, that number has skyrocketed to 15,446. That is an increase of 739%. But a new threat has overtaken heroin as the largest drug threat in the United States – fentanyl. In 2016, there were 21,405 deaths involving fentanyl and its analogues. That is more than double 2015’s total of 9945, and nearly seven times the number of deaths in 2013. Some specific locations were hit even harder. In Cook County, Illinois, home of Chicago, fentanyl-related overdoses mushroomed 2700% between 2014 and 2016. In some areas, 70% of all opioid deaths involve fentanyl.
First Things First – What Is Fentanyl?
Fentanyl is a powerful synthetic opioid medication. It is typically prescribed as a surgical anesthetic, or for people in chronic or severe pain. In some instances, it is useful for people with life-limiting illnesses or who are in hospice care. Since it was first created in 1960, fentanyl has a long history of medical use. When very carefully monitored, fentanyl is considered to be a safe and extremely effective pain management medication. In fact, it is the most widely-used synthetic opioid medicine in the world. Medically, fentanyl is produced in several formulations:
- Intravenous
- Intranasal
- Sublingual
- Transdermal patches
- Lozenges
Brand-name medications containing fentanyl include Subsys, Onsolis, Lazanda, Fentora, Duragesic, Actiq, and Abstral. The World Health Organization lists fentanyl patches among its “Essential Medicines”.
How Strong Is Fentanyl?
Fentanyl is far stronger than other more familiar opioids:
- Up to 100 times more powerful than morphine, Vicodin, or Lortab.
- 60%–70% more potent than OxyContin.
- 50 times stronger than 100% pure, laboratory-grade heroin.
At this strength, a dose of just 2 milligrams of fentanyl is enough to kill a 200-pound man. That’s about the size of six grains of salt. Compared to morphine, analogues of fentanyl also dangerously potent:
- acetyl-fentanyl – 15 times stronger
- butyrfentanyl – 30 times stronger
- carfentanil – 10,000 times stronger
Micrograms of carfentanil can kill a human, because it’s not even made for human consumption. Carfentanil is intended for veterinary use, as a tranquilizer for large animals – elephants, rhinos, hippos, etc.
Fentanyl as a Popular Drug of Abuse
Like many other opioids, fentanyl is often diverted for recreational misuse. When abused, fentanyl produces a profound feeling or well-being and a euphoric high. And because fentanyl is so potent, its effects – both good and bad – are much greater than other opioids. Among opioids, fentanyl is particularly fat-soluble, allowing it to quickly enter and affect the brain. This means that there is a rapid onset of effects, thereby making the drug even more desirable to opioid addicts. Some abusers will extract the fentanyl from their transdermal patches and then smoke or ingest the drug.
Why Is Fentanyl So Dangerous?
All opioids are dangerous because they trigger respiratory depression. Overdose victims die, because they simply stop breathing. This is especially true when opioids are used in combination with each other, alcohol, or benzodiazepine tranquilizers such as Xanax, Valium,or Klonopin. Fentanyl does this to an even greater degree, resulting in more profound and prolonged breeding suppression. There are three reasons why this is the case:
- First, its unique fat solubility. This means that abusers who have a profound lack of body fat are more at risk of overdose. Of special relevance, two of the most common side effects of fentanyl abuse are weight loss and anorexia.
- Second, fentanyl causes the user to retain carbon dioxide, which causes the blood vessels to dilate, thereby releasing more fentanyl.
- Third, retain carbon dioxide can trigger acidosis, thereby impairing inhibitory protein bonding of fentanyl. This releases even more fentanyl.
Fentanyl and its related analogues also cause less sedation than other opioids – an early warning sign of overdose. This means that a fentanyl abuser won’t feel as sleepy or sedated as they would after taking heroin or other opioids. They could mistakenly think that they could safely take more, easily leading to a fatal overdose.
More Powerful Than Narcan
Fentanyl and its analogues are so powerful that it can take multiple doses of Narcan, the life-saving anti-opioid-overdose emergency medication to revive victims. Scott Lukas, who serves as the Director of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital, located in Belmont, Massachusetts, says, “In a fentanyl overdose, you may not be able to totally revive the person with the Narcan dose you have. Naloxone easily knocks morphine off of the receptor, but does that less so to fentanyl.” Even worse, when fentanyl is mixed with or substituted for other drugs, emergency personnel have no expedient way to tell the difference. For example, if they think the person is overdosing on Xanax, they won’t even administer Narcan. And that can be the difference between life and death. By the time fentanyl is discovered as the true cause of the overdose, it may be too late.
Fentanyl Puts First Responders at Risk
The Centers for Disease Control and Prevention have issued guidelines to protect workers who could possibly be exposed to fentanyl during the performance of their duties.
- Emergency Medical Personnel
- Fire departments
- Law enforcement officers
- Hospital workers
- Investigators
- Evidence handlers
- Forensic lab technicians
- Hazardous waste handlers
- Staff at homeless shelters, methadone clinics, and fentanyl rehab programs
- Funeral directors
Exposure could occur in the number of ways – needle sticks, contact with mucous membranes, accidental ingestion, inhalation, and even skin contact. This is a real concern, as evidenced by the following instance – During a 2016 drug raid in Hartford, Connecticut, SWAT officers attempted a tactical entry by using a flash-bang grenade to stun occupants within the house. However, when the grenade went off, powdered fentanyl on a table was aerosolized. Within minutes members of the team began to feel dizzy and began vomiting. They all had to receive emergency treatment for fentanyl poisoning. As little as 3 mg of fentanyl is enough to send someone to the emergency room. The dangerous possibility of fentanyl exposure is of such concern that many law enforcement agencies are requiring officers to wear respirators, eye protection, gloves, and even Tyvek suits if they suspect the presence of fentanyl or other synthetic opioids. Because the simple action of scooping out a sample is so dangerous, many police departments no longer have officers conduct tests on-site. Instead, officers are told to forward any still-sealed drug packages to the crime lab for analysis.
The Connection between Prescription Painkillers, Marijuana, Heroin, and Fentanyl
As states enact stricter opioid prescribing guidelines, this makes legitimate painkillers harder and harder to obtain. And, for people who are already dependent on or addicted to their prescriptions, it makes purchasing them illicitly much more expensive. For example, an 80 mg OxyContin tablet can easily cost $75 when purchased on the street. On the other hand, a dose of low-grade black tar heroin can be had for as little as $5. This could be why 80% of heroin addicts started out by misusing prescription painkillers. It also explains why 94% of opioid rehab patients switched to heroin, because prescription opioids were “far more expensive and harder to obtain.” At the same time, more and more US states are legalizing marijuana for medical and recreational use. This drastically reduced the American demand for Mexican marijuana. In 2016, seizures along the southern border were barely one-third what they were in 2009. In addition, because marijuana from Mexico or the Caribbean is viewed as inferior to American strains, the price has also plummeted. A kilo of cannabis cost between $60 and $90 in 2011, but by 2014, the asking price had dropped to as low as $30. In response, many of the Mexican drug cartels switched to planting opium poppies, instead of marijuana plants. Between 2010 and 2015, heroin seizures increased by 243%. It is now estimated that 94% of the heroin that enters the United States comes from Mexico. But producing heroin takes considerable resources – land and the manpower to plant, tend, cultivate, and process the plants. Fentanyl, on the other hand, only needs a laboratory and someone with a knowledge of chemistry. In June 2017, the San Diego DEA confiscated nearly 100 pounds of fentanyl during a raid – 14 MILLION lethal doses. It was the largest fentanyl seizure in history.
Deadly Disguised Drugs
“…you don’t know what you’re taking. You’re injecting yourself with a loaded gun.” ~ Tim Pifer, Director of New Hampshire’s State Police Forensic Laboratory Because Mexican heroin is of extremely low quality, cartels and dealers often mix fentanyl in with their product to increase potency. Sometimes, they even substitute fentanyl completely. Heroin and fentanyl are identical in appearance. All of this is done without the user’s knowledge. A heroin addict expecting their normal dose and potency will instead take far-deadlier fentanyl. And if a customer dies, the suppliers don’t care—it seems there is ALWAYS another crop of addicts. In fact, an overdose only serves as advertising that they are putting out superior product. Counterfeit pills are also becoming more common. Increasingly, autopsies and post-mortem toxicology screens are finding that the drugs found next to overdose victims aren’t what they appear to be. For example:
- When musical legend Prince died in April 2016, counterfeit pills were found at his home. Although they were marked as hydrocodone, these pills instead contained fentanyl, lidocaine, and U-4770. U-4770 is another synthetic opioid eight times more potent than morphine.
- In October 2015, men in Santa Cruz, California died after taking what they thought were Xanax tablets. Instead, these fakes contained fatal doses of fentanyl.
CNN reports that pill presses are being seized by US Customs and Border Protection at a rate that is 19 times higher than it was in 2011. Not coincidentally, 2011 was also the year that fentanyl first became a problem in the United States, per the American Association of Poison Control Centers. Also not coincidentally, most of these presses are coming from China, the leading world’s leading exporter of illicit synthetic drugs. Some of these machines are capable of producing 170,000 pills per minute.
What’s the Bottom Line about Fentanyl?
Part of the reason for the explosion of fentanyl deaths in America is the fact that it is so available. Most illicit fentanyl is imported from Asia or South America through large ports. Customs officials and law enforcements face a Herculean task if they are to intercept enough drug shipments to make any real impact. Fentanyl is also easily found online. In August 2017, Lester Holt and an NBC News investigative team were easily able to find an online supplier who was willing to sell them a bulk order of fentanyl powder. The search to about five minutes, starting with the broad term “buy fentanyl”. Addressing those two issues won’t be an easy or quick fix, so what is a person supposed to do in the meantime? There should be two main takeaways from all of this information, with one possible call to action, moving forward. First, it is frightening how fast recreational painkiller misuse turns into a desperate opioid addiction. As the disease progresses, at some point, ANY opioid will do—prescription medication, heroin, or illicit synthetics, including fentanyl. Second, overdosing after exposure to fentanyl isn’t merely a possibility, it’s a PROBABILITY. In 2016, there were over 21,000 deaths that clearly demonstrate just how likely that eventuality is. So, here’s the call to action—if you or someone you care about is struggling with opioid addiction, the time to get professional help is NOW, before it is too late.