America’s Fentanyl Crisis

Every day 91 Americans fatally overdose on an opioid drug. It may be a prescription analgesic or heroin–4 to 8 percent of people who misuse painkillers transition to heroin–but increasingly it is likely to be heroin’s much more potent synthetic cousin fentanyl. In the space of only two years, fentanyl has tragically escalated the opioid crisis. This drug is 50 to 100 times more potent than morphine and able to enter the brain especially quickly because of its high fat solubility; just 2 milligrams can kill a person, and emergency personnel who touch or breathe it may even be put in danger. Unfortunately, many people addicted to opioids as well as other drugs like cocaine are accidentally being poisoned by fentanyl-laced products.

Although fentanyl is a medicine prescribed for post-surgical pain and palliative care, most of the fentanyl responsible for this surge of deaths is made illicitly in China and imported to the United States via the mail or Mexican drug cartels. Its high potency and ease of manufacture make it enormously profitable to produce and sell. According to the Drug Enforcement Agency (DEA), one kilogram of fentanyl can be purchased in China for $3,000 to $5,000 and then generate over $1.5 million in revenue through illicit sales in America. Thus, distributors of illicit drugs are eager to adulterate heroin or cocaine powder with fentanyl or put it in counterfeit prescription drugs, such as pills made to look like prescription pain relievers or sedatives. Last month, for example, a wave of deaths in Florida was linked to fake Xanax pills containing fentanyl.

Deaths from fentanyl and a handful of other synthetic opioids tripled from 3,105 in 2013 to 9,580 in 2015, and those numbers are likely underestimates; some medical examiners do not test for fentanyl and many overdose death certificates do not list specific drugs involved. Thus far, New Hampshire has recorded the most fentanyl overdoses per capita; an NIDA-funded study found that in 2015, almost two-thirds of the 439 drug deaths in that state involved fentanyl. Although most who fatally overdose on fentanyl are unaware of what they have taken, news of such fatalities has unbelievably driven some people with severe opioid addictions to seek it out. Part of the cycle of an opioid use disorder is increased tolerance, causing diminished response to the drug, which leads users to seek products with higher potency so they can experience the euphoria they initially felt. Roughly one-third of opioid users interviewed as part of the study in New Hampshire knowingly sought fentanyl.

The fentanyl problem is already a high priority for policymakers. Last month, NIDA’s Deputy Director Wilson Compton testified before Congress on the science of fentanyl, accompanied by representatives from the DEA, the Office of National Drug Control Policy (ONDCP), the CDC, and other agencies. Diplomatic and law enforcement efforts to cut off the supply of illicit fentanyl and the chemicals needed to manufacture it will be important, but the emergence of very high potency opioids–which can be transported in smaller volumes–will make addressing supply increasingly difficult. Thus, a public health strategy to address the opioid crisis and overdose epidemic is more important than ever.

First, we must improve pain management and minimize our reliance on existing opioid pain medications. Second, treatment centers and healthcare systems must make much wider use of available, effective medications for opioid addiction (Buprenorphine, Methadone, and extended-release Vivitrol). Third, the opioid-overdose reversing drug naloxone needs to be made as widely available as possible, both to emergency first responders as well as to opioid users and other laypeople who may find themselves in a position to save a life. In cases of fentanyl overdose, multiple doses of naloxone may be needed to reverse an overdose, and additional hospital care may be needed. All individuals who overdose on opioids need to be linked to a treatment program to prevent it from happening again.

From the blog of Dr. Nora Volkow, Dir., National Institute on Drug Abuse
April 6, 2017

Overdose Deaths In Susquehanna Valley, Pennsylvania

The following was published in The Sunday Item, April 3, 2016, Sunbury, Pennsylvania regarding the rash of overdose deaths in the Susquehanna Valley.

Jan. 6, Female, 39, Shamokin, mixed-drug toxicity/prescriptions
Jan. 10, Female, 45, Zerby Township, mixed-drug toxicity/prescriptions
Feb. 4, Male, 27, New Columbia, heroin
Feb. 5, Male, 63, Mount Carmel, mixed-drug toxicity/prescriptions
Feb. 6, Male, 56, Sunbury, mixed-drug toxicity/heroin
Feb. 7, Female, 48, Mifflinburg, mixed-drug toxicity/prescriptions
Feb. 17, Female, 40, Shamokin, mixed-drug toxicity/prescriptions
Feb. 26, Male, 35, McClure, mixed-drug toxicity/heroin
Mar. 10, Male, 60, Mount Carmel, meth
Mar. 11, Female, 27, Shamokin, heroin
Mar. 13, Female, 33, Allenwood, heroin
Mar. 15, Male, 21, Shamokin, heroin
Mar. 21, Male, 37, West Chillisquaque, heroin

-Source: County Commissioners

Drug Overdose Deaths Hit Record Numbers

The Centers for Disease Control and Prevention announced that drug overdose deaths hit record numbers in 2014, with more than 47,000 deaths nationwide. CDC has outlined steps for stopping the overdose death epidemic. Pennsylvania Department of Drug and Alcohol Programs Secretary Gary Tennis issued the following statement in response:

Like the rest of the nation, Pennsylvania is in the throes of the worst overdose death epidemic ever. In 2014, nearly 2,500 Pennsylvanians died from a drug overdose. With one in four families in the Commonwealth suffering with the disease of addiction, Pennsylvania, at the direction of Governor Tom Wolf, has made addressing this epidemic a priority. The Department of Drug and Alcohol Programs is working hard with its partners in the Department of Health and the Department of Human Services and other agencies to execute a plan to stem the rising tide of overdose deaths.

We have become a nation awash in prescription opioids due to the historic and ill-fated medical movement toward overprescribing for pain over the past two decades. Opioid prescribing has quadrupled, and today four out of five individuals with heroin addiction start out with prescription opioids. Our initiatives therefore focus largely on prescription opioids, as well as preventing overdose deaths and expanding access to clinically appropriate treatment.

“The record level of opioid overdose deaths around the country and here in Pennsylvania is tragic,” said Department of Health Secretary Dr. Karen Murphy. “My department is working expeditiously to address this crisis on all fronts. Our primary goal is to work at prevention as well as providing treatment for those in need.”

The Pennsylvania Department of Health is leading an effort to build upon the prescribing guidelines already created, including guidelines to address emergency department pain treatment with opioids, opioids in dental practice and opioids to treat chronic non-cancer pain. These guidelines give healthcare providers direction for safe and effective pain relief practices, with greater emphasis on non-opioid therapies and greater caution to prevent addiction and diversion.