Fentanyl is a potent, lab-produced opioid pain medication with a very fast acting response, and short-lasting effects. It is estimated to be 50 to 100 times more potent than morphine, and is now emerging as the newest opiate addiction concern in the United States.

Its original prescription is for patients who are already on long lasting opiates, but who experience “breakthrough pain”, or pain that breaks the opiate barrier. In prescriptions, it is often given in hard-to-misuse forms, such as an extremely slow dissolving fentanyl lollipop (Actiq), or 24h to 72h patches (Duragesic), due the ease of overdose.

Shocking overdose numbers

In Cincinnati, within six days, 174 people overdosed on opioids. In Huntington, West Virginia, within a span of just four hours, 26 people overdosed. Even in America, a country accustomed to frequent drug misuse reports, these numbers were startling.

However, for drug experts and enforcement agents (DEA) familiar with fentanyl and other opioid equivalents, these numbers were not shocking; fentanyl was linked to the drug overdose epidemic as far back as 2005, but its widespread misuse has just begun.

The DEA issued a nationwide alert against the use of fentanyl in March 2015, after fentanyl-linked overdose deaths surpassed the 700 mark. To date in 2016, fentanyl and its related opioids have claimed twelve lives, amongst 53 overdoses.

The Centre for Disease Control and Prevention (CDC) released a report with a shocking revelation of more than 420% increase in confiscations of synthetic opioids by the police in 2013 and 2014, and also noted a 72% increment of fatal drug overdoses in 27 states.

Additionally, it found that many coroners and labs in America are not equipped to test for, and do not routinely test for, fentanyl and its related opioids, hampering the data collection process of these synthetic drug overdoses, and confirmation of overdoses in Cincinnati and Huntington (as mentioned above). However, DEA and CDC has indicated that these drugs could be the cause.

In Singapore, according to the latest drug abuse data furnished by Central Narcotics Bureau (CNB), heroin and methamphetamine, continues to be the two leading commonly abused drugs and accounts for 93% of all drug abuses.

There were a total of 3,343 drug abusers in 2015, an increase of 6% from 2014 and repeat offenders comprised of more than 60% of drug abuses. The street value of drugs seized by the CNB amounted to almost S$ 9 million.

Fentanyl often disguised as other common painkillers

Researcher and lead author R. Matthey Gladden hypothesised that the death rate was alarming due to many street users consuming fentanyl unknowingly, as it is frequently disguised as oxycontin and other painkiller brands, and mixed together with a more expensive drug, heroin. The findings tally with DEA on how such synthetic drugs has flooded the black market.

The core reason for such tactics is the maximisation of profit as 1kg of fentanyl costs S$4,750 to produce, while 1kg of heroin can fetch more than S$80,000. Thus, the dilution of fentanyl with heroin would net several hundreds of thousands of dollars. Pressing it into pills would potentially fetch almost S$ 13 million, and would broaden the customer base.

"That one kilo of fentanyl can produce between 16 and 24 kilos [of drug product], ultimately yielding profits of $1.3 million after it's sold on the streets. It's more lucrative than heroin,” says Russ Baer, a DEA spokesman.

The sheer profit of fentanyl has lured several Mexican cartels to increase sales of fentanyl, by sourcing it from both illicit and legitimate pharmaceuticals corporations, and buying the raw materials and producing it themselves from China.

As pills are sold in mass quantities, and past many layers of pushers, sellers and buyers often have no idea these pills contain fentanyl, and this substantially increases the risk of overdosing. The sales of these pills are so lucrative that “independent” manufacturing operations in apartments have popped up in New York and Los Angeles.

Alternative synthetic drugs rapidly on the rise

Fentanyl has been tightly controlled in America, and Chinese labs have promptly responded by altering the molecular structure, to formulate drugs that have yet to be declared illegal in America and China, and these have proven to be stronger than fentanyl.

A prime example is carfentanil, which is already regulated in the US and was originally used as a tranquilizer for elephants. It has been detected mixed in with heroin seized in Cincinnati and the DEA suspects carfentanil is linked to 230 and 20 drug poisonings and deaths respectively in various states.

As America and Chinese work in tandem to reduce fentanyl, drug experts reiterated that to curb drug overdoses, the only way is to stem the demand through drug rehabilitation and national education programs.

Paradox of supply - side strategy

Leo Beletsky, associate professor of law and health sciences at Northeastern University, explained that the current opioid crisis is caused by cracking down on pill prescriptions, while failing to ensure addicted individuals are entered into rehabilitations. “That’s one of the paradoxes of doing supply-side strategy. You could be fuelling the problem you're trying to address,” he says.

The number of fatalities is also appalling, as "more than 40 Americans die each day from overdoses involving prescription opioids. Families and communities continue to be devastated by the epidemic of prescription opioid overdoses. The rising cost of the epidemic is also a tremendous burden for the health care system," according to CDC director Tom Frieden.

The DEA agrees and contends that while it is nearly impossible to stem the flow of fentanyl from China and Mexico, it is a serious issue that needs to be stopped fast. Opioid addiction in the US is estimated to cost the economy almost S$ 109 billion, with the majority of costs attributed to healthcare, public insurance programs, substance abuse treatments, and legal costs. MIMS


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