A new tyrant in the opioid lineage is ascending the throne in the U.S.: fentanyl is the crown jewel of the epidemic, and the very analgesic that killed Prince and King of Pop, Michael Jackson.
Fentanyl is 50-100 times more potent than morphine and 25-50 times more potent than heroin, according to a recent statement by the Drug Enforcement Administration (DEA). A lethal dose of heroin is equivalent to about 30 milligrams while a 3-milligram dose of fentanyl is all it takes to kill an average-sized adult male.
Lewis Nelson, MD, medical toxicologist and emergency physician at NYU’s School of Medicine, told Forbes that what makes the drug more potent than other opioids is how quickly and tightly it binds to the μ-opioid receptors in the brain.
In the hands of trained professionals—and with laboratory-grade equipment—this makes fentanyl an effective anesthetic. In fact, the drug has a relatively wide therapeutic index, or range within which the drug is both effective and safe.
In the wrong hands, fentanyl is perhaps the biggest concern beleaguering the addiction treatment field today. Who are the players responsible?
American healthcare practitioners are inadvertently mass-producing opioid addicts at an alarming rate. Patients are being overprescribed opioids, only to have them withheld or become too expensive to procure. With an addiction in place, these individuals are increasingly turning to heroin–a shift that’s created an epidemic of heroin use in whole new groups of people.
De novo use by the curious is always going to be a reality, and that’s not something the DEA can feasibly manage. Stopping the other addicts that form, however, happens by improving the way we practice medicine. Changing our irresponsible prescribing practices would prevent many more addictions than any other avenue.
For dealers, heroin is as hard to produce as ever, involving a lengthy growth, extraction, conversion, and transportation process.
Fentanyl is so much easier on dealers because it’s a synthetic opioid, and its potency per unit means that volumes are much easier to transport. Fentanyl for street sale often seems to be made in China and imported to the U.S. through Mexico, so a more cost-effective mode of transportation—a plane and a car, say—is more attractive than a boat and a truck.
Not all customers come by fentanyl intentionally–many are in the market for heroin or cocaine, but these are now increasingly cut with fentanyl without the buyer’s knowledge. Why? It’s cheaper than either drug, and much stronger. In the worst cases, the buyer is unwittingly procuring pure fentanyl.
Overdoses are preposterously common because the dose is relatively uncontrolled with street fentanyl. Worse yet, heroin and fentanyl look identical—with drugs purchased on the street, you’re playing a game of Russian Roulette.
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