Deep Dive: Fentanyl
What You Need To Know
This Deep Dive — a monthly feature sent to paid subscribers — is being made available to all readers to help raise attention to one of today’s greatest tragedies: the fentanyl crisis.
It remains poorly understood. It affects everyone and anyone. And instead of action being taken, countless lives are being taken — many of them young people.
At one point, perhaps, the fentanyl crisis was overlooked — ignored, really — considered just another chapter in our country’s decades-long drug epidemic that impacted poor or minority communities. That should have been reason enough to generate action.
So where do we go?
As a close friend — one who suddenly had to learn more about this than any person should have to — told me, “A couple of different themes, in my mind. All with underfunded and misdirected policy initiatives. Perhaps simplistic, but my rough view: How do we stop death rate (a practical approach)? How do we cut need (a mental health approach)? How do we curb supply (an enforcement issue)?”
Other points:
Fentanyl can be laced into anything: Adderall, marijuana, any black market item.
Drug access has exploded because of social media. Below are two pieces on Snapchat ... and suppliers also have been found on CraigsList and elsewhere.
Some remedies are around the corner — life-saving medication like Narcan spray that can be used to reverse or reduce opioid effects (see below) may clear the FDA next month. But it won't matter much without EDUCATION. People must learn how to protect themselves… and we all must learn how to protect each other.
Another problem is political. Too many politicians vote to restrict access to Narcan, fearing that access to Narcan will somehow encourage more drug use.
Of course, there is also the overseas production, cross-border smuggling, opioid addiction, and more.
The issues are myriad. This month’s Deep Dive seeks to highlight some of them.
Backgrounder
Why fentanyl is deadlier than heroin, in a single photo: It’s deadly because it’s so much stronger than heroin, as shown by the photograph above, which was taken at the New Hampshire State Police Forensic Laboratory. On the left is a lethal dose of heroin, equivalent to about 30 milligrams; on the right is a 3-milligram dose of fentanyl, enough to kill an average-sized adult male. (STAT News)
107,622 died of drug overdoses in the U.S. in 2021. Fentanyl was responsible for two-thirds of those deaths. The number of Americans killed by the drug has jumped 94 percent since 2019. On average, one person dies of a fentanyl overdose in the United States every seven minutes. Fentanyl kills more people than automobile accidents. Gunshots. Suicides. The Washington Post traced the synthetic-drug crisis from the back alleys of Tijuana, Mexico, to official Washington and from warehouses in northern Mexico to neighborhoods in Utah, Colorado and San Diego. (Washington Post)
Where are the 2022 statistics? Because drug death data is gathered slowly in the U.S., it won't be known for many months exactly how many people died from fatal overdoses in 2022, but the toll is expected to be grim. (NPR)
If fentanyl is so deadly, why do drug dealers use it to lace illicit drugs? Fentanyl is a synthetic opioid up to 100 times more potent than morphine. According to experts, there are many reasons fentanyl has become such a widely used illicit drug, despite its high overdose potential: (ABC News)
Fentanyl is not always a death sentence
Fentanyl is a cheap alternative to other opioids
Fentanyl production does not have tight quality control
Fentanyl seizures rise at U.S.-Mexico border — here's why: The spike in fentanyl-related overdose deaths in the U.S. has fueled a national conversation and a redoubling of the government's efforts to curb its smuggling. In 2021, 90% of some 80,000 opioid-related deaths involved fentanyl, federal statistics show. Most fentanyl is being smuggled into the U.S. along the southern border, often in vehicles driven by American citizens, as cartels and other criminal groups in Mexico have turned the production of the synthetic opioid into a clandestine industry that has become the primary source of fentanyl in the U.S. (CBS News)
In late December, the DEA said it had seized over 379 million potentially lethal doses of illegal fentanyl in 2022. Fentanyl is also flooding the illicit drug supply, which means that people may use drugs like cocaine without being aware that it’s been laced with fentanyl. While the rate of deaths involving synthetic opioids like fentanyl climbed 22% between 2020 and 2021, the rate of deaths involving heroin declined by 32% in the same period. Heroin is “being replaced with fentanyl … because that’s all [people] can get,” Shoshana Aronowitz, an assistant professor of family and community health at the University of Pennsylvania School of Nursing, told STAT via email. “As heroin is less potent … we’d be seeing less overdose deaths if more folks were using heroin rather than fentanyl.” (STAT News)
Feb 3, 2023: Four arrested after authorities seize 20 pounds of fentanyl in San Francisco, Oakland. (San Francisco Chronicle)
Issues & Politics
Stories on China, Mexico, and social media:
US warns overdose crisis will spread overseas without action from China: Washington is increasing pressure on Beijing to crack down on illegal supplies of raw materials used to make the synthetic drug fentanyl, warning the deadly overdose crisis sweeping the US could soon spread to Europe and Asia. Dr Rahul Gupta, the White House drugs tsar, told the Financial Times it is only a matter of time before criminal cartels in China and Mexico expand their highly profitable trade in the drug, which is 50 times stronger than heroin. He said the illicit manufacture of cheap and easily transportable synthetic drugs such as fentanyl and methamphetamine are transforming the drug market, posing a risk to global security. Only co-ordinated, international action involving China, which is a major source of the precursor chemicals used to make synthetic drugs, could thwart criminal cartels, he added. “You can divide the world up into three categories,” said Gupta, who is the first medical doctor to hold the post of director of the Office of National Drug Control Policy. “One, you have a fentanyl or meth problem and you know it. Second, you have a fentanyl or meth problem and you don’t know it . . . And the third, it is coming to a shore near you very soon.” (Financial Times)
Some pharmacies in Mexico passing off fentanyl, meth as legitimate pharmaceuticals: A Los Angeles Times investigation has found that pharmacies in several northwestern Mexican cities are selling counterfeit prescription pills laced with stronger and deadlier drugs and passing them off as legitimate pharmaceuticals. In Tijuana, reporters found that pills sold as oxycodone tested positive for fentanyl, while pills sold as Adderall tested positive for methamphetamine. In total, the Times investigation found that 71% of the 17 pills tested came up positive for more powerful drugs. A team led by UCLA researchers recorded similar results. The new findings could represent a dangerous shift in the fentanyl crisis. (Los Angeles Times)
Read the UCLA study here.
FBI Examines Snapchat’s Role in Fentanyl Poisoning Deaths: Social media under scrutiny as fentanyl crisis spikes in US Lawyers say Snap’s disappearing messages appeal to dealers. Federal agencies are questioning Snapchat’s role in the spread and sale of fentanyl-laced pills in the US as part of a broader probe into the deadly counterfeit drugs crisis. FBI agents and DOJ attorneys are zeroing in on fentanyl poisoning cases where the sales were arranged via Snapchat, according to people familiar with the matter who requested anonymity. The agents have interviewed parents of children who died and are working to access their social media accounts to trace the suppliers of the lethal drugs, according to the people. (Bloomberg)
Snapchat’s role in fentanyl crisis probed during House roundtable: ‘It’s a Snap-specific problem’. (CNBC)
People & Families
A mother tried to save her daughter from fentanyl’s grip. Here’s what happened next. (San Francisco Chronicle)
Learn about BirdieLight: BirdieLight saves lives by educating young people about the danger of unintentional fentanyl ingestion, and by empowering them with tools to detect fentanyl before they ingest. The organization launched after “Eli Weinstock collapsed and died at his home in Washington D.C. [in 2021]. He was twenty years old, a sophomore at American University, an intern at the Spanish Education Development Center, and an aficionado of hip-hop, snowboarding, and Quentin Tarantino films.” (BirdieLight)
What’s Next
Fentanyl test strips help prevent overdoses, why are they still controversial? With much of the nation’s illicit drug supply contaminated by fentanyl, test strips that detect the dangerous synthetic opioid can help people who use drugs prevent a deadly overdose. These tests are inexpensive and effective, but they remain inaccessible for many people in the U.S. and are illegal in many states. In this video, learn about how fentanyl test strips work, how they can reduce harm from drug use, and why they are controversial around the country. (STAT News)
Deaths did not rise with wider access to buprenorphine during the pandemic: Treating substance use disorder with buprenorphine is a complicated story. An opioid itself, it’s regulated as a controlled substance. When Covid-19 emerged in early 2020, emergency policies allowed doctors to issue new buprenorphine prescriptions via telemedicine, making it far easier for patients in rural areas or without transportation to get it. While embraced by most doctors and health officials, some of of these experts voiced concerns that increasing buprenorphine access could have unintended consequences, including overdoses. Now, a new study in JAMA Network Open shows that despite the medication’s wider availability, deaths involving buprenorphine still constitute a small fraction of overall drug mortality. While deaths involving buprenorphine did tick upward in the months following the policy changes, they increased at a significantly lower rate than overall drug deaths. Between July 2019 and June 2021, the share of opioid-related deaths involving buprenorphine dropped from 3.6% to 2.1%. (STAT News)
Sanctioned Drug-Use Sites Reach a Crossroads as Funding Runs Out: Biden administration’s silence on the approach is slowing the movement nationally. Medical assistant Alsane Mezon placed cotton balls into metal cups, creating “cookers” for heating illicit drugs. Her colleague Rayce Samuelson spoke with a woman struggling to find an unscarred vein to receive the injection of fentanyl she was holding. “Arms, hands, legs, feet—that’s the rotation,” Mr. Samuelson told her. It was all in a day’s work for the staff of a supervised drug-use site in East Harlem, one of two that have made New York the first city in the country to allow open use of illicit substances including the fentanyl that has driven a surge of more than one million overdose deaths over the past decade. (Wall Street Journal)
Teen overdose deaths lead California schools to stock reversal drug: With overdoses near record highs because of the prevalence of fentanyl, Gov. Gavin Newsom called in his recent budget proposal for $3.5 million to supply middle and high schools with naloxone — even as a potential deficit looms and some programs face cuts. “This is a top priority,” the Democratic governor said last month. “There’s not a parent out there that doesn’t understand the significance of this fentanyl crisis.” The second-largest school district in the country isn’t waiting. Los Angeles Unified placed naloxone in each of its schools last fall. And Superintendent Alberto Carvalho announced this week that the district will allow students to carry the overdose antidote to stem the “devastating epidemic” brought on by fentanyl. “We remain committed to expanding access, education and training for this life-saving emergency medication,” Carvalho wrote in a memo to parents. (Politico)
New York City public schools aren't stocked with Narcan, officials say, despite spike in youth opioid overdoses. (CBS New York)
Listen, Watch, Read
Listen: Painkiller: America's Fentanyl Crisis. VICE News reporter Keegan Hamilton tracks the third wave of the opioid crisis. In episode one, a small-town fisherman becomes a dark web fentanyl dealer after an accident leads him down the path to addiction. (Vice Media)
Watch: Documentary: The ‘fourth wave’ of the overdose crisis. Initially driven by the over-prescription of pharmaceutical opioids such as OxyContin, a “second wave” of addiction deaths began as people transitioned from prescription opioids to heroin, a much riskier drug. The so-called “third wave” was marked by the proliferation of potent synthetic opioids such as fentanyl. The overdose epidemic has evolved into a new phase that experts are referring to as the “fourth wave.” (STAT News)
Read: “The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth”, by Sam Quinones. “Quinones explores the more recent shifts in drug markets: from poppy-based heroin to the much stronger laboratory-based fentanyl, and from ephedrine-based methamphetamine to a mass-producible P2P version. It no longer required a cartel. Instead, anyone with a laptop and an Internet connection could order large quantities of pure, highly potent fentanyl from what were essentially mom-and-pop operations, first in China, then in Mexico. “With a minuscule investment of learning and money,” Quinones explains of fentanyl, “anyone — even someone in boxer shorts in his mother’s basement, without education nor connection to mafias or traffickers — could now make a killing. And beginning in about 2015, they did.” (Washington Post)
Smart Links & Resources
Top U.S. addiction researcher calls for broad deregulation of methadone. (STAT News)
What led to the opioid crisis—and how to fix it. (Harvard T.H. Chan School of Public Health)
Venture capital is investing little in new treatment for addiction, report finds. (STAT News)
A major drugmaker plans to sell overdose-reversal nasal spray Narcan over the counter. (NPR)
NYC launches drug checking program to spot fentanyl before people overdose. (Gothamist)
Resources:
DEA Fentanyl Awareness: https://www.dea.gov/fentanylawareness
National Institute on Drug Abuse: https://nida.nih.gov/research-topics/fentanyl
CDC: https://www.cdc.gov/opioids/basics/fentanyl.html
SAMHSA Opioid Overdose Prevention Toolkit: https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf
Narcan: https://www.narcan.com
For local resources: Search for your city/state + fentanyl… resources will appear in the search results.
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