Las Vegas Sun

March 29, 2024

5-MINUTE EXPERT:

Overdose epidemic: Fentanyl is a growing threat to public health and safety

Carfentanil

Royal Canadian Mounted Police via AP

In this June 27, 2016, photo, a member of the RCMP opens a printer ink bottle containing the opioid carfentanil imported from China, in Vancouver. Drug dealers have been cutting carfentanil and its weaker cousin, fentanyl, into heroin and other illicit drugs to boost profit margins.

Fentanyl is a drug so deadly, a tiny fleck equal to three grains of salt could kill a healthy adult.

Last year, the U.S. Drug Enforcement Agency issued a nationwide alert, calling fentanyl a threat to health and public safety. During the past two years, the narcotic has been linked to an unprecedented epidemic of overdose deaths, which are increasing at an alarming rate.

Law enforcement officials say it’s only a matter of time until fentanyl use becomes as rampant in Nevada as it has in other parts of the country.

Where it comes from

Fentanyl first was synthesized in Belgium in the late 1950s and was introduced into medical practice in the 1960s.

• Non-pharmaceutical fentanyl is produced primarily in Mexico in illicit drug labs.

• Acetyl fentanyl, a fentanyl analog, is made primarily in China.

In July 2015, the DEA used its emergency scheduling authority to temporarily place acetyl fentanyl into Schedule I of the Controlled Substances Act.

• Another analog made in China, furanyl fentanyl, has been linked to 128 deaths in five U.S. states in less than two years.

Furanyl fentanyl is slated to be placed temporarily on the Schedule I list of controlled substances this year.

• Carfentanil, also sold as Wildnil, is a fentanyl analog that’s 10,000 times more potent than morphine. It is used by veterinarians to immobilize large animals.

The schedule of a drug determines how much of it is allowed to be produced in the U.S., as well as the penalties for being involved with the illegal distribution or sale of said drug.

Schedule II: Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence; considered dangerous.

Schedule I: drugs with no currently accepted medical use and a high potential for abuse. Carries the highest penalties for trafficking.

What it is

Fentanyl is a Schedule II prescription drug used to treat severe pain or manage pain after surgery. It also can be used to treat patients with chronic pain who have built up a tolerance to other opioids. It’s most commonly prescribed to cancer patients.

Drug type: Synthetic opioid analgesic

Prescription brand names: Actiq, Duragesic, Sublimaze

Street names (for fentanyl or fentanyl-laced heroin): Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, Tango and Cash

Musician Prince died from an accidental overdose of fentanyl earlier this year, according to the Midwest Medical Examiner’s Office. The pills were found to be mislabeled as hydrocodone, but it was unclear whether or not the pills were produced illegally.

How it’s used

People can swallow, snort or inject fentanyl. The difference between a therapeutic dose and a fatal dose is very small.

Doctors administer fentanyl by injection or transdermal patch, or in lozenges or lollipops.

Nonpharmaceutical fentanyl, produced in clandestine laboratories, is sold as a powder, spiked on blotter paper, mixed with or substituted for heroin, or pressed into tablets.

Possible effects

• Drowsiness

• Euphoria

• Lethargy

• Nausea

• Confusion

• Itchiness

• Hallucinations

• Sweating

• Shaking

• Respiratory arrest

• Unconsciousness

• Coma

• Death

How it works

1. Fentanyl binds to the body’s opioid receptors, found in areas of the brain that control pain and emotions.

2. The drug drives up dopamine levels in the brain’s reward areas, producing a feeling of euphoria and relaxation.

3. Fentanyl users quickly build a tolerance to high doses, so a dose that initially is adequate likely won’t create the same high even a few days later.

Police also have found fentanyl disguised as hydrocodone or oxycodone tablets.

Addiction

Fentanyl’s high potency greatly increases the risk of overdose, especially if the user is unaware that the drug he or she is taking contains fentanyl. Because illicit fentanyl is very cheap to produce, drug dealers often mix it with heroin or cocaine, which significantly amplifies its potency, or market it as a different drug entirely, increasing its potential dangers.

Signs of addiction include:

• Compulsion to seek drugs by any means necessary, such as doctor-shopping for prescriptions

• Impaired personal relationships

• Prioritizing drugs over family, work and friends

• Changes in physical appearance and hygiene

• Rapidly changing moods

• Financial problems from spending money on drugs

• Increased tolerance to drugs

• Withdrawal symptoms when not using, which may include runny nose, sweating, decreased appetite, irritability, anxiety, stomach cramps, diarrhea and body aches

More people died from drug overdoses in the United States in 2014 than during any previous year on record.

Deaths

Overdose deaths attributed to opioids have quadrupled in the United States since 1999.

In 2014, opioids were involved in at least 28,647 deaths, or 61 percent of all fatal drug overdoses.

And experts say the death toll is likely even higher than that. Deaths caused by fentanyl specifically aren’t reported in national data.

Only six states — Florida, Maine, Maryland, Massachusetts, New Hampshire and Ohio — track fatal fentanyl overdoses.

In those states, the rate of deaths linked to fentanyl increased 80 percent from 2013 to 2014, the most recent years for which data are available.

What’s being done

Public health agencies, law enforcement, medical examiners and coroners are working collaboratively to improve investigation and testing techniques to better detect outbreaks of fentanyl-associated overdoses.

• Part of the effort includes reporting and monitoring specific drugs.

• The DEA also is working to stiffen regulations on synthetic opioids and their analogs.

• The DEA in June urged law enforcement officers to stop field testing drugs because of the proliferation of fentanyl. DEA officials instead advise officers to take confiscated drugs immediately to a laboratory, where they can be handled and tested safely.

Getting help

Fentanyl withdrawal can be intense as the brain struggles to restore balance, so most experts recommend detoxification and treatment in a specialized center. Several facilities in the Las Vegas Valley offer treatment specifically for fentanyl addiction, and many accept insurance.

• Nevada Prevention Resource Center: Based at UNR, the NPRC serves those struggling with addiction statewide through partners in the RADAR (Regional Alcohol and Drug Awareness Resource) network dedicated to providing access to prevention, treatment and recovery resources. Find the full list at nevadaprc.com/radar-associate-centers.

• For 24-hour help: Crisis Call Center 775-784-8090; crisiscallcenter.org

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