Fatal Attraction

Fatal Attraction

Behind the rise of the deadly synthetic opioid Fentanyl.
Hayley Helmut

Fentanyl is a synthetic opioid which is becoming increasingly popular, despite its extreme lethality. In 2017, the Centers for Disease Control and Prevention estimated that drug overdoses caused 72,000 deaths in the United States. From that estimate, more than 49,000 were linked to opioids, and 30,000 of those were due to synthetic opioid use. [1] The opioid epidemic can be categorized in waves; the first wave was caused by the overprescribing of painkillers such as oxycodone and hydrocodone. The second wave saw an increase in heroin use, and the recent third wave is attributed to synthetics. [2]

The rising popularity of fentanyl is due to the drug’s potency. Fentanyl is 50 to 100 times more potent than morphine. Like most opioid drugs, fentanyl binds to the body’s opioid receptors. These receptors are located in the areas of the brain that control pain and emotions, which can drive up dopamine levels in the brain’s reward areas when altered by drugs, resulting in relaxation and euphoria. [3] The problem lies within the receptors’ location in the brain. The brain’s opioid receptors are also located in the region of the brain which controls breathing. Due to the high potency of the drug, the brain’s receptors can become overwhelmed, causing the user to stop breathing. [4] When prescribed, fentanyl is used to treat patients with severe pain, either chronic or postsurgery. Pharmaceutical fentanyl is generally administered by injection or transdermal patches, while recreational fentanyl is sold as powder, tablets, blotting papers, and often mixed or substituted for heroin. [3]

Analogs, commonly known as designer drugs, are designed to mimic the pharmacological effects of the original drug, but are used to avoid detection or classification as illegal in standard drug tests. Fentanyl analogs are the most dangerous forms of fentanyl, as they are developed by synthesizing the drug with other hard drugs such as heroin, cocaine, and methamphetamine. The lacing of heroin with fentanyl, or the disguise of fentanyl as highly-potent heroin, is what typically results in overdoses. From January-June 2017, the Drug Enforcement Administration’s National Forensic Laboratory Information System received an influx of reports from state and local forensic laboratories detecting fentanyl analogs. One extremely potent analog reported was carfentanil, the most potent opioid used commercially. Carfentanil is 10,000 times more potent than morphine, and 100 times that of pure fentanyl. The drug is so strong that it is traditionally used for the tranquilization of large animals such as elephants and hippos. While there is not yet extensive research on the impact of carfentanil, early reporting has already shown the drug as the cause for overdose deaths. [5]

The use of fentanyl, and subsequently overdoses linked to the drug, are primarily concentrated in the East and Midwest of the US. From July 2016-June 2017, the CDC conducted enhanced surveillance of opioid overdose deaths in ten states: Kentucky, Maine, Massachusetts, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, West Virginia, and Wisconsin. Seven of the ten states reported that 50% or more of opioid overdose deaths tested positive for fentanyl, while five out of ten states reported that 10% of overdose deaths tested positive for fentanyl analogs. [6] The high amount of fentanyl use in these states is believed to be connected to the geographic regions proximity to the Mississippi river. The white powder heroin market’s supply chain is predominately located east of the Mississippi, making it easy for fentanyl powder to be mixed with the heroin, or to be disguised as pure heroin. [5]

China is the lead distributor of fentanyl to the US. According to a Senate report released in January 2018, Chinese distributors illegally sold nearly $800 million worth of fentanyl pills to online customers. These distributors have taken advantage of internet anonymity and ecommerce such as Bitcoin. They even go so far as shipping the drugs through other countries to reduce the risk of seizure by customs officials. The Chinese have a large pharmaceutical industry, including thousands of illegal labs which manufacture counterfeit and illicit drugs. While commercial shippers such as UPS and FedEx are required by law to supply Customs and Border Protection (CBP) with names, addresses, and contents of packages in advance, the Postal Service does not provide such information. The Postal Service is not required to obtain the advanced data from foreign postal organizations, making it harder for CBP to detect opioids that are shipped. Distributors are also capitalizing on the high volume of international mail by sending smaller packages that go unnoticed. [7] In addition to the struggles of detecting these drugs as they enter the US, underground Chinese labs started altering the fentanyl molecule after the DEA persuaded China to add fentanyl and several analogs as controlled substances in 2015. This sparked the creation of more potent and unregulated variants. [8]
The US is working on legislation to address the growing opioid crisis. President Trump has declared the crisis as a public health emergency and has instructed federal agencies to increase efforts in stopping illegal drugs at the border. To this end, President Trump signed legislation giving CBP $9 million for additional screening devices and other tools for drug detection. [7]

In April of last year, the Department of Health and Human Services also devised their own five-step plan for addressing the issue. This included making access to treatment for opioid addiction available to all, creating a plan for realtime health response to those areas that struggle more than others, and researching new treatment methods for addiction rehab. [8] While all of these are steps forward for addressing the opioid crisis, the popularity of these drugs will continue as long as China can capitalize on the illicit market. [9] In order to have an effective and lasting impact against the production of fentanyl and other synthetic opioids, the US should increase pressure on China to crackdown on their underground labs. If China fails to enforce stricter regulations, the US should consider imposing sanctions until an agreement can be met.

  1. Centers for Disease Control and Prevention, “Provisional Drug Overdose Death Counts,” CDC, 09 September 2018, https:// www.cdc.gov/nchs/nvss/vsrr/drug-overdosedata.htm
  2. Nadia Kounang, “Fentanyl-related deaths double in six months; US government takes some action,” CNN, 12 July 2018. https:// www.cnn.com/2018/07/12/health/fentanylopioid-deaths/index.html
  3. National Institute on Drug Abuse, “Fentanyl,” NIH, June 2016, https:// www.drugabuse.gov/publications/drugfacts/ fentanyl
  4. Louise Stranger, “Fentanyl & Carfentanil: Inside the Deadly World of Synthetic Opioids,” The Huffington Post, 11 June 2017, https:// www.huffingtonpost.com/entry/fentanylcarfentanil-inside-the-deadly-worldof_us_593d6362e4b094fa859f196a
  5. PubChem, “Carfentanil,” National Institutes of Health, 15 September 2018, https:// pubchem.ncbi.nlm.nih.gov/compound/ carfentanil#section=Top
  6. Centers for Disease Control and Prevention, “Rising Numbers of Deaths Involving Fentanyl and Fentanyl Analogs, Including Carfentanil, and Increased Usage and Mixing with Nonopioids,” CDC, 11 July 2018, https:// emergency.cdc.gov/han/han00413.asp
  7. Ron Nixon, “Online Sales of Illegal Opioids from China Surge in U.S.,” The New York Times, 24 January 2018, https:// www.nytimes.com/2018/01/24/us/politics/ senate-investigation-china-mail-opioids.html
  8. Kathleen McLaughlin, “Underground labs in China are devising potent new opiates faster than authorities can respond,” Science Magazine, 29 March 2017, http:// www.sciencemag.org/news/2017/03/ underground-labs-china-are-devising-potentnew-opiates-faster-authorities-can-respond
  9. National Institute on Drug Abuse, “The Federal Response to the Opioid Crisis,” NIH, 05 October 2017, https://www.drugabuse.gov/ about-nida/legislative-activities/testimony-tocongress/2017/federal-response-to-opioidcrisis

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