Fentanyl: The Pervasive Poison

By Katherine Schwartz '19

According to the National Institute on Drug Abuse, the sharpest increase in drug overdose deaths in recent years has been among those related to fentanyl (NIH). Used to treat chronic pain, fentanyl is a synthetic opioid, meaning it is man-made. Like other opioids, it works by crossing the blood-brain barrier and binding to the brain’s μ-opioid receptors, where it then produces analgesic and euphoric sensations (Walton). But unlike other opioids, fentanyl’s potency is far higher and faster-acting, making overdose more likely.

For example, it is proven to be up to 50 times stronger than heroin, as well as estimated to be up to 50 to 100 times stronger than morphine, according to the Drug Enforcement Administration (Christiansen). In fact, it is even measured in micrograms instead of milligrams. To put it in perspective, a milligram of a drug is about the size of a pinhead, while a microgram is about a thousandth of that (Walton). However, drug dealers responsible for dosage often do not understand this difference in potency.

As a result, federal data found that the rate of overdose deaths involving fentanyl increased by nearly 54 percent in 2017 for people ages 55 to 64 (Goodnough). From 2016 to 2017, the fatal overdose rate from fentanyl and other synthetic opioids increased by 61 percent among black Americans (Goodnough). And in Philadelphia, there was a 300% rise in fentanyl deaths from 2013 to 2014 (Walton).

One of the most dangerous, physical effects of opioids that often proves fatal is respiratory depression. Opioids are designed to slow one’s breathing, sometimes to a stop. This process happens faster with fentanyl because it binds to opioid receptors and crosses the brain’s blood-barrier rapidly, producing immediate effects rather than circulating through the bloodstream first, like other drugs. During this respiratory depression, the brain receives less oxygen, resulting in a condition known as hypoxia (NIDA). Hypoxia can cause comas, irreversible brain damage, or death (NIDA). In addition, injecting fentanyl intravenously can also result in a condition known as “wooden chest syndrome,” in which “the chest and abdomen muscles tighten and become so rigid that even doing CPR is difficult if not impossible” (Christiansen).

Beyond these effects, however, perhaps the most deadly aspects of fentanyl are its secrecy and frequency in the drug world. Many drug dealers mix cheaper fentanyl with other drugs like heroin, cocaine, MDMA and methamphetamine to increase their profits (NIDA). While heroin is first originally grown in poppy fields, where it is then harvested and eventually refined into a powder before it embarks on a chain of shipments, fentanyl can be ordered from China or manufactured with chemicals in a lab, producing “far more doses with far less labor” (Goodnough). It increasingly arrives as either powder or pressed into counterfeit pills disguised as Percocet or Xanax. Because its potency allows it to be “diluted with more filler” than drugs like heroin can, it is most often cut with other drugs (Goodnough). Jon DeLena, associate special agent in charge of the D.E.A.’s New England field division said, “At the dealer level right now, fentanyl is like a magic dust — it’s a moneymaker” (Goodnough).

What makes fentanyl more dangerous than heroin is that it is most often not bought intentionally. Someone on the market for cocaine might find that it was cut with fentanyl, or worse yet, only fentanyl, increasing the statistic of overdose deaths. And because it has also been found in counterfeit pills, it can be inadvertently ingested by those taking opioid painkillers (Walton). In New Hampshire, only four of the 397 opioid deaths last year involved heroin, according to preliminary data. But 363 involved fentanyl (Goodnough). That is by no means to say that heroin is safe or mild, but if understanding what a dangerous drug heroin is in itself, then seeing how much more deadly fentanyl is in comparison is simply all the more startling.

One of the ways to stop its circulation is not by attempting to identify and cut off fentanyl chains and laced drugs, but by improving the nation’s medical and pharmaceutical industries such that individuals do not find themselves addicted to opioids in the first place. “De novo use is always going to be around–kids are curious and they try something–and the DEA can’t really do anything about that. It’s a Sisyphean task. But stopping the other addicts that form–those who get addicted through prescribing practices–happens by improving the way we practice medicine” (Walton).

Bibliography:

Christiansen, Thomas. “Fentanyl Addiction.” The Recovery Village, 15 Feb. 2019, www.therecoveryvillage.com/fentanyl-addiction/#gref.

Daly, Max. “The Truth About Drug Dealers Lacing Cocaine with Fentanyl.” Vice, VICE, 5 Apr. 2019, www.vice.com/en_us/article/8xyzkp/the-truth-about-drug-dealers-lacing-cocaine-with-fentanyl.

Goodnough, Abby. “In Cities Where It Once Reigned, Heroin Is Disappearing.” The New York Times, The New York Times, 18 May 2019, www.nytimes.com/2019/05/18/health/heroin-fentanyl-deaths-baltimore.html.

National Institute on Drug Abuse. “Fentanyl.” NIDA, USA.gov, Feb. 2019, www.drugabuse.gov/publications/drugfacts/fentanyl.

NIDA. "Fentanyl." National Institute on Drug Abuse, 6 Jun. 2016, https://www.drugabuse.gov/drugs-abuse/fentanyl. Accessed 21 May 2019.

Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427

United States Drug Enforcement Administration. “Fentanyl.” DEA, U.S. Department of Justice, www.dea.gov/factsheets/fentanyl.

Walton, Alice G. “Why Fentanyl Is So Much More Deadly Than Heroin.” Forbes, Forbes Magazine, 11 Apr. 2016, www.forbes.com/sites/alicegwalton/2016/04/09/why-fentanyl-is-so-much-more-deadly-than-heroin/#369120117f6a.

“Why Is Fentanyl so Dangerous? – Column Health.” Column Health, columnhealth.com/blog_posts/why-is-fentanyl-so-dangerous/.