Russian roulette involves buying drugs on the street. Life-threatening amounts of the drug Fentanyl can be found in drugs like Xanax and cocaine.
There has been a rise in accidental use of the drug Fentanyl from people buying prescription drugs and adulterating them with it. Fentanyl entered the drug supply when overdoses exploded in my community. Patients who came to the emergency department complaining of a heroin overdose were more likely to have Fentanyl in their drug test results.
I am the Chief of Medical Toxicology at the University of Massachusetts Chan Medical School. Fentanyl has changed the drug market and increased the risk of overdose.
Fentanyl is a synthetic opiate that was originally developed as a pain killer. It has a specific chemical structure with multiple areas that can be altered to form related compounds with different strengths.
Carfentanil is 100 times more potent than it's parent structure. Fentanyl is three times more potent than acetylfentanyl and has led to overdoses in several states.
Fentanyl continues to dominate the drug supply despite the diversity of its analogues. Fentanyl is 50 times more potent than heroin and 100 times more powerful than morphine.
Fentanyl has been used by drug dealers as an adulterant in drug supplies since 1979.
The epidemic of Fentanyl adulteration is much larger than was previously thought. The number of overdose deaths went from 8,050 in 1999 to 33,091 in 2015). More than 100,000 Americans died from drug overdoses from May 2020 to April 2021, of which more than half were due to synthetic opioids.
Fentanyl is manufactured in China, Mexico and India and then exported to the US as pills. The sale of drugs through traditional delivery services has been made easier by the emergence of the dark web and the U.S. Postal Service.
Fentanyl is both sold alone and used as an adulterant because of its high potency, which allows dealers to traffic smaller quantities but still maintain the drug effects buyers expect. Bulking agents, like flour or baking soda, can be added to increase supply. It is more profitable to cut a kilogram of Fentanyl than it is to cut a kilo of heroin.
Even a small amount of Fentanyl can be fatal. This could lead to an overdose if the end user doesn't know the drug they bought has been adulterated.
Fentanyl is an opiate that I give to patients in an acute care setting. When patients need immediate pain relief, I and my colleagues choose Fentanyl.
Fentanyl can reduce breathing rates to dangerously low levels and is the main cause of overdose deaths. There isn't a medical team that can monitor someone's breathing rate in real time for those taking Fentanyl in non medical settings.
One way to prevent overdoses is to give the drug to people. Naloxone can be used to reverse overdoses.
Increasing the availability of buprenorphine and methadone will help people stay in treatment and decrease their use of drugs. The availability of these medications is limited due to restrictions on where and how they can be used and insufficient number of prescribers.
Lowering the entry barrier to addiction treatment is one of the ways to prevent overdose deaths.
Local politics and funding priorities can make it difficult for communities to try out these measures. The number of deaths related to Fentanyl is increasing.
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It was written by a faculty member at the medical school.
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