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Fentanyl is a powerful synthetic opioid, or narcotic, that is posing an increasing worldwide public health risk. First synthesized in 1960, fentanyl was and still is used for general anesthesia in operating rooms. It is 50 to 100 times more potent than morphine. It is also used in hospice settings for pain relief. It is available as an injectable liquid, pill, spray, oral lozenge, white powder, and patch (Duragesic). Unfortunately it is appearing in the illegal street drug market where it is causing a rise in overdose deaths. Prince died of a fentanyl overdose and thousands of counterfeit pills were found in his house, many containing fentanyl.

Fentanyl causes respiratory depression by suppressing the respiratory drive center located in the mid-brain. This respiratory suppression is much stronger with fentanyl than with any other opiate. Many people who die of a fentanyl overdose appear to have been unaware they were taking the drug. Heroin wholesales for $65,000 a kilogram while fentanyl can be bought for about $3,500 a kilogram, which is why many drug dealers are mixing fentanyl with heroin and cocaine. Recently two illicit labs were found in California and Utah where they were making counterfeit Xanax and OxyContin pills using fentanyl. Canada has declared a public health crisis because of illicit fentanyl. Most illicit fentanyl in Canada enters the country from the west coast where it is known as “China white.” In the U.S., most illegal fentanyl is smuggled over the Mexican border. Fentanyl is also being sold as MDMA (methylenedioxymethamphetamine), aka ecstasy.

From 2012 to 2014 the number of reported deaths from fentanyl more than doubled going from 2,628 to 5,544. Also it is estimated that 41 percent of the 7,100 heroin-related deaths during this period involved fentanyl. Traditional drug-enforcement policies emphasize use reduction. Cracking down on illegal laboratories and other links in the supply chain will probably help disrupt the fentanyl market. Other enforcement policies can sometimes have unintentional public health harms however. For example, targeting buyers caught with syringes may increase needle sharing, raising the risk of HIV transmission. Some police departments and prosecutors have sought a non-traditional strategy of holding individuals and organizations (i.e. gangs) liable for selling drugs containing fentanyl, even if these drugs did not cause immediate harm.

Drug treatment programs may pose risks to those individuals who continue to use at some level by reducing tolerance. There is a high incidence of overdoses in those just released from prison, jails, and other secure locations because of reduced tolerance. There have also been inadvertent overdoses in children who are exposed to legal fentanyl patches, which is why the recommendation on disposing of a patch is to fold it over on itself with the sticky surfaces facing in. Naloxone, which reverses narcotic overdoses, must be used in higher doses for a longer period in fentanyl overdoses. First responders carry naloxone kits and these kits should be available to the general public and especially to users, but more education of both first responders and the public is needed.

For more information go to www.dea.gov/divisions/hq/2016/hq061016.shtml


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