What Is the Difference Between Street Fentanyl and Pharmaceutical Fentanyl?

By The Fix staff 09/08/21

Every state has reported a spike or rise in fatal overdoses during the COVID pandemic, largely driven by the increased availability of fentanyl.

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Fentanyl is used as a cheap additive to boost the potency of drugs like heroin, cocaine, MDMA, or methamphetamine.

Statistics regarding the number of overdoses and fatalities involving the synthetic opioid fentanyl continue to paint a grim picture in the United States. The Centers for Disease Control and Prevention released preliminary data showing that overdose deaths in the United States rose 29.4% in 2020 to an estimated 93,331, including 69,710 involving opioid drugs, mainly fentanyl. Every state has reported a spike or rise in fatal overdoses during the COVID pandemic. One prevalent issue is that the COVID crisis is now getting worse due to the abundance of illicit fentanyl and fentanyl analogues on our streets.

Furthermore, the Centers for Disease Control and Prevention noted that drugs like fentanyl are the primary reason for a 38% increase in overdose deaths between May 2019 and May 2020. During that same time period, 18 U.S. jurisdictions with available data on synthetic opioids saw increases of more than 50%, while 10 Western states reported a 98% increase. Adding to mounting concerns is the reduced availability of treatment options due to the COVID-19 pandemic.

Fentanyl continues to be at the heart of the overdose epidemic, mainly illicit but also in prescription form. Fentanyl analogues are made from raw materials originating primarily in China and manufactured and sold to the United States by Mexican drug cartels. Though both forms are extremely powerful and possibly lethal, variants found in illicit mixtures are far more dangerous and affect users differently.

The prescription form of fentanyl is a Schedule II controlled substance, which means that the medication is considered a drug "with a high potential for abuse, with use potentially leading to severe psychological or physical dependence," as noted in the Controlled Substances Act, which is overseen by the U.S. Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA). Prescription fentanyl is used primarily to treat patients enduring severe pain from surgery, cancer, or significant traumatic injuries.

Illicit fentanyl comes from two sources: it is diverted from prescription medication and sold on the street, or manufactured from other chemical sources, and then sold. Diverted fentanyl can be obtained by extracting the drug from the patch and then converted to injectable form, or by prescriptions obtained illegally from a medical professional or a person with a valid prescription. While diverted fentanyl poses serious dangers to illicit users, the illegally manufactured form fentanyl has a myriad of ways to harm individuals. The raw materials produced in China are made without quality controls imposed on the pharmaceutical variety; two milligrams of the drug can be enough to cause a fatal overdose, depending on the individual's tolerance and other health factors. The DEA has reported seizing counterfeit medication containing 5.1 milligrams of fentanyl per tablet – twice the lethal amount and more than capable of killing multiple users.

Even users who seek to avoid using fentanyl may inadvertently ingest the drug. Numerous state and federal investigations have found fentanyl used as a cheap additive to boost the potency of drugs like heroin, cocaine, MDMA (also known as ecstasy or molly), or methamphetamine. It has also been found in counterfeit analogues of prescription opioids such as oxycodone. Combining such potent narcotics in a single dose has caused fatal interactions in increasingly high and frequent numbers.

Symptoms of fentanyl overdose are similar to those experienced with other narcotics: chest pain, labored breathing, vomiting, pale or bluish color to the face, fingernails, and lips. Seizure or unconsciousness frequently follows, and unless treatment is immediately sought and revival is attempted with the opioid overdose reversal drug Naloxone (Narcan), the afflicted individual can lapse into a coma or possibly even suffer a fatal overdose. Additionally, recent scientific data suggests that the toxic effects of fentanyl and its analogues may include compromised pulmonary function due to mechanisms not reversible by naloxone alone. Immediate comprehensive medical care is needed for every suspected drug overdose situation.

How to combat this rising tide of fentanyl overdose? Although addiction is a multi-facet condition, Clare Waismann, a substance use disorder counselor, addiction specialist, and the founder of Waismann Method, an opioid treatment program and rapid detox center, believes that mental health care and medically assisted detox should be accessible not just to those who can afford it but also to those who are in need. In today's world, we are living through such an unsettling reality. Additionally, so many people have to deal with the trauma and consequences caused by COVID and its attendant restrictions— medical treatment for opioid dependence must be available in public hospitals along with necessary psychological support, says Mrs. Waismann. Additionally, we need a more substantial commitment to combating the rise of opioids, especially the influx of fentanyl to every corner of our country.

"We have the medical science and resources to help those suffering from fentanyl addiction. Now we need the right priorities." - Clare Waismann. 

 

https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

https://www.cdc.gov/niosh/topics/fentanyl/risk.html

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