2023-11-19 06:21:00
An image showing several injection pills and bottles with fentanyls
Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, counterfeit drugs or pills purchased in non-medical settings can contain potentially deadly amounts of fentanyl.
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Doctors like me have seen an increase in unintentional fentanyl use by people who purchase prescription opioids and other drugs laced or adulterated with fentanyl. Heroin users in my Massachusetts community realized that fentanyl had entered the drug supply when overdose numbers skyrocketed. In 2016, my colleagues and I discovered that patients who came to the emergency department reporting a heroin overdose often only had fentanyl present in their drug test results.
As Chief of Medical Toxicology at the University of Massachusetts Chan School of Medicine, I have studied fentanyl and its analogs for years. As fentanyl has become ubiquitous in the United States, it has transformed the illicit drug market and increased the risk of overdose.
Fentanyl is a synthetic opioid that was originally developed as an analgesic (or analgesic) for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.
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For example, carfentanil, a fentanyl analogue formed by replacing one chemical group with another, is 100 times more potent than its original structure. Another analogue, acetylfentanyl, is about three times less potent than fentanyl, but has still caused clusters of overdoses in several states.
Despite the number and diversity of its analogues, fentanyl itself continues to dominate the illicit opioid supply. Milligram for milligram, fentanyl is approximately 50 times more potent than heroin and 100 times more potent than morphine.
Drug traffickers have used fentanyl analogues as an adulterant in the illicit drug supply since 1979, and fentanyl-related overdoses have been clustered in individual cities.
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The modern epidemic of fentanyl adulteration is much broader in its geographic distribution, production and number of deaths. Overdose deaths approximately quadrupled, rising from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, more than 100,000 Americans died from drug overdoses, and more than 64% of these deaths were due to synthetic opioids such as fentanyl and its analogues.
Illicitly manufactured fentanyl is synthesized internationally in China, Mexico and India and then exported to the United States in powder or pressed pill form. China also exports many of the precursor chemicals needed to synthesize fentanyl.
A bag of fentanyl seized in a drug raid is displayed at the US Drug Enforcement Administration (DEA) laboratory in Sterling, Virginia. (AP Photo/Cliff Owen, File)
Additionally, the rise of the dark web, an encrypted, anonymous corner of the Internet that is a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through traditional delivery services, including the United States Postal Service. .
During the 2023 Asia-Pacific Economic Cooperation summit, US President Joe Biden and Chinese President Xi Jinping reached an agreement to combat fentanyl trafficking.
Fentanyl is sold alone and is often used as an adulterant because its high potency allows traffickers to traffic smaller quantities but maintains the effects of the drug that buyers expect. Manufacturers can also add bulking agents, such as flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to reduce a kilogram of fentanyl than a kilogram of heroin.
Unfortunately, the high potency of fentanyl also means that even a small amount can be deadly. If the end user does not know that the medication he purchased has been adulterated, this could easily lead to an overdose.
As an emergency physician, I use fentanyl as an analgesic or analgesic to relieve severe pain in an intensive care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery.
But even under the controlled conditions of a hospital, there is still a risk that fentanyl use could reduce respiratory rates to dangerously low levels, the leading cause of opioid overdose deaths. For those taking fentanyl in non-medical settings, there is no medical equipment available to monitor a person’s breathing rate in real time to ensure their safety.
One measure to prevent a fentanyl overdose is to distribute naloxone to bystanders. Naloxone can reverse an overdose just as it occurs by blocking the effects of opioids.
Another measure is to increase the availability of opioid agonists such as methadone and buprenorphine, which reduce withdrawal symptoms and opioid cravings, helping people stay in treatment and decrease illicit drug use. Despite the track record of these life-saving medications, their availability is limited by restrictions on where and how they can be used and by an inadequate number of prescribers.
Other strategies to prevent overdose deaths include lowering the barrier to entry into addiction treatment, fentanyl test strips, supervised consumption sites, and even prescription diamorphine (heroin).
However, despite the evidence supporting these measures, local politics and funding priorities often limit the ability of communities to try them. Bold strategies are needed to disrupt the rising number of fentanyl-related deaths.
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