What are Fentanyls
~100 times a more potent analgesic than morphine (1)
and ~40 times more so than heroin, Fentanyl is a powerful opioid used
for pain treatment, first in the 1990s as a patch and now as a spray. An
example of its potency, David Juurlink an opioid researcher at the University of Toronto says he'd give a hospital patient 10mg of morphine but only 0.1mg of fentanyl (2).
Widely considered too dangerous for humans, carefentanil
is fentanyl's much more potent analog (similar chemical structure) and
used as an elephant tranquilizer. So potent is carfentanil some
countries including the US have even considered its use as a chemical
weapon in war (3).
Fentanyls are so dangerous in overdoses because they can even negate Naloxone - Wikipedia, which is usually used to reverse heroin overdoses.
For example, where typically just one naloxone dose can reverse painkiller or heroin overdose, fentanyl overdose requires several
naloxone doses. This is because of fentanyl's much higher affinity for
the mu opioid receptor in the brain, which it accesses much more easily
than morphine or heroin, given its much higher fat solubility (4).
Fentanyls can be so deadly (see photo below from 4), first responders need to be trained to protect themselves from accidental overdoses themselves (5).
Why Fentanyls have become a new front in the current US opioid crisis
Recent steep climbs in US fentanyl overdose deaths and seizures personify the Balloon effect - Wikipedia (2). How to optimally deal with drug abuse? Need strategies to deal with both supply and demand.
US
history shows it tends to crack down hard on the supply side while
doing little to tamp down demand. Arguably, tamping down hard on the
supply side would reduce future demand but what happens to current
demand if it isn't a priority of drug control policy? Just as air in a
half-inflated balloon moves to another part of the balloon when it's
pressed, when supply's squeezed without equivalent effort to reduce
demand, users and traffickers figure out other means for getting high (2).
How opioid demand was created.
Starting in the late 1990s, US doctors began handing out opioids like
candy. Apparently both they and the FDA were taken in by opioid
manufacturers' false claims these opioids weren't addictive. This
practice both created and nurtured the growth for opioid demand. Supply
wasn't a problem either for many years. However, starting in the early
2010s, people started dying in unprecedented numbers from opioid abuse
overdose. Law enforcement started cracking down on prescribing doctors
and pill mills, though interestingly not the pharmas making these
opioids. As supply started drying up, users and traffickers diversified,
first to heroin then to heroin laced with fentanyls.
Rationale for fentanyls.
Given its easy access, drug traffickers started adding fentanyl to
heroin to juice it up. Economic argument for fentanyl made itself.
Fentanyl and carfentanil are just two of many fentanyls, all relatively
easy to make in a lab, a far more simpler and cheaper approach than
growing the opium poppy plant, extracting from it morphine and
converting that to heroin. They also give a better and cheaper high than
even heroin. Dealers can make more money from fentanyl-laced heroin (2). Dealers add fentanyl of questionable purity to the heroin they sell using scales and balances of questionable accuracy (3).
Problem is users are unaware when their heroin is laced with fentanyl
so injecting a usual heroin dose can lead to fentanyl overdose. The
ensuing tragedy writes itself.
How opioid supply keeps creating new products to stay ahead of crackdowns. US law enforcement believes most fentanyl comes from labs in China (3),
easily made there in bulk quantities without US regulatory or law
enforcement supervision and then shipped into US via Latin America. On
March 1, 2017, China banned manufacture and sale of fentanyl and some of
its analogs including carfentanil (6), adding more analogs to the ban a couple of months later (7),
making restrictions on a total of 138 compounds. However, chemists keep
coming up with newer fentanyl analogs (see below from 6), making their control by regulators and law enforcement a case of Whac-A-Mole - Wikipedia.
Bibliography
2. Vox, German Lopez, May 16, 2017. How an elephant tranquilizer became the latest deadly drug in the opioid epidemic
3. Associated Press, Erika Kinetz, Desmond Butler, October 1, 2016. Chemical weapon for sale: China's unregulated narcotic
4. STAT news, Allison Bond, September 29, 2016. Why fentanyl is deadlier than heroin, in a single photo
5. The Atlantic, Sarah Zhang, May 15, 2017. Fentanyl Is So Deadly That It's Changing How First Responders Do Their Jobs
6. Science, Kathleen McLaughlin, March 29, 2017. Underground labs in China are devising potent new opiates faster than authorities can respond
7. Associated Press, June 19, 2017. China bans more synthetic opioids blamed for U.S. drug deaths
https://www.quora.com/Why-have-fentanyl-deaths-and-seizures-climbed-so-steeply-540-in-the-last-three-years-Fentanyl-is-now-the-number-one-cause-of-drug-overdoses-in-the-US/answer/Tirumalai-Kamala
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