Russian roulette is a game of buying drugs on the street. Drug purchases in non-medical settings can contain life-threatening amounts of the drugfentanil.
There has been a rise in the use of prescription drugs that have been adulterated with Fentanyl. Fentanyl entered the drug supply when overdose numbers exploded in my community.
Patients who came to the emergency department reporting a heroin overdose were more likely to have Fentanyl in their drug test results.
As the Chief of Medical Toxicology at the University of Massachusetts Chan Medical School, I have studied the drug for many years. Fentanyl has changed the drug market and raised the risk of overdose in the US.
Fentanyl was originally developed as a painkillers for surgery. It has a specific chemical structure with multiple areas that can be modified, often covertly, to form related compounds with marked differences in potency.
Carfentanil is 100 times more potent than its parent structure. acetylfentanyl is three times less potent than fentanyl and has led to overdoses in several states.
Fentanyl continues to dominate the illegal drug supply despite the number and diversity of its analogs. Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.
Fentanyl has been used as an adulterant in drug supplies since 1979 with overdoses occurring in individual cities.
The epidemic of Fentanyl adulteration is much broader than just the number of deaths. Overdose deaths went from 8,050 in 1999 to 33,091 in 2015.
More than 100,000 Americans died from a drug overdose from May 2020 to April 2021, of which 64 percent were due to synthetic opioids.
The CC BY-NC-ND is used by Christopher Ellis and his associates.
Fentanyl has a chemical structure in the center that can be changed with different functional groups and colored circles.
Fentanyl is manufactured in China, Mexico, and India and then exported to the United States as powder or pressed pills.
The sale of drugs through traditional delivery services, including the US Postal Service, has been made easier by the emergence of the dark web.
Fentanyl is often used as an adulterant because of its high potency, which allows dealers to traffic smaller quantities but still maintain the drug effects buyers expect.
Adding bulking agents, like flour or baking soda, may increase supply without adding costs. It is more profitable to cut a kilogram of fentanyl than it is to cut a kilogram of heroin.
Even a small amount of Fentanyl can prove deadly. If the end user doesn't know that the drug they bought has been adulterated, it could lead to an overdose.
Fentanyl is an opiate that I give to patients in an acute care setting. When patients need immediate pain relief or anesthesia, I and my colleagues choose Fentanyl.
Fentanyl can reduce breathing rates to dangerously low levels, the main cause of overdose deaths, even in the controlled conditions of a hospital.
There is no medical team available to monitor someones breathing rate in real time for those taking Fentanyl in non-medical settings.
One way to prevent overdoses is to give the drug to bystanders. Naloxone can be used to reverse an overdose.
Increasing the availability of buprenorphine and methadone will help people stay in treatment and decrease drug use.
Despite the track records of these medications, their availability is limited by restrictions on where and how they can be used and inadequate numbers of prescribers.
Fentanyl test strips, supervised consumption sites, and even prescription diamorphine are some of the strategies to prevent overdose deaths.
Local politics and funding priorities often limit whether communities are able to give these measures a try. The number of Fentanyl-related deaths is increasing.
Professor of Emergency Medicine at the University of Massachusetts Chan Medical School.
This article is free to use under a Creative Commons license. The original article is worth a read.
All Rights Reserved © 2024
