In just 12 days, California’s Sacramento Valley has seen 42 opioid overdoses — resulting in 10 deaths. Even in a country that’s watched opioid addiction spread at an alarming pace, this kind of overdose rate isn’t normal.
At least, up until now.
These overdoses weren’t caused by the prescription painkiller the users were believed to have been taking, called Norco. Instead, they had taken a street pill disguised to look like Norco that contained a chemical 50 times more potent than heroin: fentanyl.
When you inject it, it hits before you’re even done giving the shot
Cheaper and easier to manufacture, fentanyl has quietly replaced other opioids in the illicit drug trade — whether addicts know it or not — and, in some states, is killing more people than heroin. In New Hampshire, fentanyl alone killed 158 people in 2015, while heroin only killed 32.
Fentanyl’s often unexpected high has become a major contributor to North America’s increasing opioid overdose rate. There’s little national data on fentanyl-specific overdoses, but in 2014, the Centers for Disease Control and Prevention (CDC) found that the sharpest increase in drug overdose deaths, 77 percent, was among people who overdosed on “other synthetic narcotics,” a category including fentanyl.
As law enforcement officials and public health workers link more and more overdoses to fentanyl, the answers to some of the foggier questions about the powerful drug are becoming clearer.
What is it?
Fentanyl is a pain medication, 100 times more potent than morphine, that’s only prescribed to a patient if their current opioid medication for pain management isn’t doing the job.
Like all opiates, fentanyl increases the dopamine levels in a person’s brain to produce a state of euphoria, a reaction only amplified when mixed with heroin, hydrocodone, or other illegally-sold prescription painkillers. Unlike other opiates, fentanyl is extremely fast-acting.
“You can’t move,” an unidentified woman told the New York Times. “When you inject it, it hits before you’re even done giving the shot.”
This is one of the reasons, she added, that many people who overdose on the synthetic drug are found with the needle still stuck in their arm.
Who is using it?
In 2014, doctors wrote 6.65 million fentanyl prescriptions for people dealing with severe chronic pain. Usually, these patients are suffering from chronic pain caused by cancer, but sometimes fentanyl is used as a anesthetic for people undergoing heart surgery. However, most overdoses are a result of illegally-manufactured fentanyl that don’t require a doctor’s sign-off.
Some users explicitly seek it out, in the search for a better high, knowing that it could easily be their last. Others, like those in Sacramento, believe they’re just buying a regular synthetic painkiller (like Norco) or straight heroin from a dealer, only to unknowingly purchase a drug cut with fentanyl. It’s the latter group that frightens public health experts the most. http://thinkprogress.org/health/2016/03/22/3762456/fda-update-labels-opioids/“There’s a sense of safety when you’re using a pharmaceutical. And that may not be warranted,” said Gantt Galloway, director at a California addiction treatment center. “It’s a measure of security that some people think they have with Vicodin, Norco, whatever — and it’s turning out to be an illusion, at least in the Sacramento area.”
But this isn’t limited to the West Coast. In fact, Sacramento’s overdose scare is one of the few major fentanyl-related cases outside of the Northeast, the area most affected by the recent opioid epidemic.
Why is it spreading now?
Fentanyl has only risen to popularity in the last five years. In 2012, the government seized and identified 668 illicit fentanyl-based drugs. By 2014, it found 3,344. This uptick can be easily linked to the moment Purdue Pharma altered the addictive painkiller Oxycodone in 2012, making it harder to mix with other opioids and far less addictive.
Fentanyl has replaced Oxycodone so seamlessly, it’s now common to find the new drug disguised as a pre-2012 Oxycodone pill. No one’s too surprised.
“This is not unpredictable,” Peter Selby, chief of the addictions program for Canada’s Centre for Addiction and Mental Health said in 2014. “[If you] just simply demonize OxyContin and keep all the other immediate-release, fast-acting or abuse-able forms on the market, then the population moves to that.”
Where does it come from?
For a while, most authorities believed fentanyl came from where illicit heroin and synthetic opioids often originate: Mexico. Which was, in part, accurate — Mexican cartels have been using chemicals sent from China to produce fentanyl for some time. However, authorities in Canada and the United States have recently intercepted packages also sent from China containing the raw materials needed to create fentanyl and pill production equipment.
There’s a sense of safety when you’re using a pharmaceutical. And that may not be warranted.
This discovery tells authorities that instead of relying on Mexican cartels to smuggle fentanyl up national corridors, people living in Canada and the U.S. are skipping the middle man — and getting the tools to mass-produce fentanyl delivered straight to their doorstep. This explains the recent spread of illegal fentanyl labs across the continent. From Syracuse, New York to British Columbia, small-scale production crews have been churning out the synthetic drug by the thousands. And when one is shut down, another seems to quickly take its place.
“We had a spike in 2007” of fentanyl-related deaths in the U.S., said Russell Baer, a spokesman for the federal Drug Enforcement Administration in an interview with STAT News. “We traced it to a single production lab in Mexico and the deaths went away. Now, it is not restricted to one site.”
Just like the smaller production operations they supply, if a Chinese package containing fentanyl is confiscated in route, companies will quickly send another batch.
What’s being done to stop it?
In November, China made it illegal to export fentanyl. But these growing shipments show leaks in regulation. In the U.S., the growing opioid addiction crisis has driven federal agencies to draft new regulations to control the amount of legal painkillers being prescribed by physicians and warn patients of the drugs’ addictive characteristics. The director of the U.S. Food and Drug Administration unveiled a “comprehensive action plan” to address opioid abuse in February, promising change. But many in the public health space say it’s not enough.
“It will probably only make a small difference,” Michael Carome, director of the Public Citizen Health Research Group, told Forbes. “This is just one small step of many steps that are going to need to be taken. It’s not going to suddenly solve all the problems.”
Following Sacramento’s rash of overdoses, California lawmakers advanced a state bill that would toughen prison sentences for fentanyl traffickers. However, it’s not necessarily geared toward those creating the drug in-state.
“We’re going after cartel-type organizations that are in it for the money and don’t care how many lives it costs,” Republican Senator Patricia Bates, who introduced the bill, told Reuters. But officials still aren’t certain this recent batch of fentanyl came from outside the U.S.
Democrats in the state Congress who’ve been working to shrink the state’s prison population oppose the bill’s approach.
Like other opioids, an overdose of fentanyl can be easily reversed with an injection of naloxone, a drug that President Obama pledged to double in distribution to private and public sectorslast October. Many major pharmacies, like CVS and Walgreens, now sell naloxone without a prescription in states that allow it — and pharmacy regulators are following suit. And law enforcement teams across the country are making sure their staff carry naloxone on them at all times. While this does little to stave off addiction in the first place, it’s a start.
“It’s not a solution to anything, other than saving people’s lives who don’t know any other way to live,” Chris Reed, a former heroin addict, told the Chicago Daily Herald in February, when the local Walgreens began selling naloxone prescription-free. “They’ve developed an addiction that’s so hard to beat. Everyone deserves an opportunity to recover. To me, that’s what naloxone does. It gives people another shot, no pun intended.”