By Bob Hembree
Lake Powell Chronicle
PAGE – An average of 130 Americans die every day from an opioid overdose, according to Centers for Disease Control and Prevention. Fentanyl and its variants became a key player in 2013.
Opioid overdose deaths happen in waves. There are the three overlapping major waves that vary from county to county and there are ripples based on what local drug dealers introduce. Ripples cause sharp spikes in community drug overdoses.
The first wave began with a rise in prescription opioid overdose deaths in the 1990s.The second wave began in 2010 with a rapid increase in heroin overdoses.
The third wave began in 2013 when synthetic opioids gained popularity with illegal drug distributers. Fentanyl and its analogs are synthetic opioids. In 2013, drug overdoses began accelerating exponentially. Increased overdoses and suicides contributed to U.S. life expectancy dropping to 64th among 165 countries.
Where is started
Fentanyl was first produced by Belgian physician, Paul Janssen in 1960. Eight years later, the U.S. approved it for medical use. Janssen held over 100 patents. He also authored or coauthored over 850 scientific publications, and that’s where the problem begins. Scientific discoveries are published for peer review for verification. In other words, scientists must be able to replicate the results to prove or disprove the findings. That’s how science works. With the growth of the internet, anyone can access these publications, including over 140,000 chemical labs in China.
China and Fentanyl analogs
According to U.S. Drug Enforcement Administration’s 2018 National Drug Threat Assessment, 97 percent of fentanyl seized from international mail and shipping companies came from China between 2016 and 2017.
Chemical analogs mimic the effect of another drug by altering molecules. Drug designers tweak molecules to achieve different results. Legitimate pharmaceutical companies do this to create beneficial drugs. Altering molecular structures is also used to bypass laws, escape detection or customize user highs. Fentanyl analogs can be weaker or stronger than fentanyl, which is already 50 times more potent than heroin and 100 times more potent than morphine. Carfentanil is another creation of Janssen. The fentanyl analog is 100 times as potent as fentanyl, 5,000 times as potent as heroin and 10,000 times as potent as morphine. In 2016, a ripple ran through Ohio causing nearly 400 carfentanil-involved deaths between July and Dec.
Molecular structures can determine if a drug is legal or illegal. In the U.S., drugs with the potential for abuse are divided into schedules ranked on abuse and addiction potential, I, II, III, IV, and V. Schedule I substances are the highest risk, schedule V is the least. Schedule I drugs, like heroin, have no currently accepted medical use. Fentanyl is a schedule II drug because it has legitimated medical uses, including pain management and anesthesia. Chinese chemical labs, once a drug becomes identified and determined illegal, are known to tweak the drug’s molecular structure, thereby creating a new, unclassified drug. Many of the fentanyl analogs were at one time legal.
To ship drugs from China to the U.S., products are often labeled “research chemicals” or mislabeled altogether to get through customs. The volume mailed to the U.S. from China is so large that’s it’s not possible for USPS and other shipping services to monitor. Because of its high potency, it is sent in smaller quantities. All that’s needed to ship synthetic opioids into the U.S. is an envelope and a postage stamp. Even a couple grams in an envelope can turn a huge profit for local drug dealers.
Last week, a San Diego man was convicted of using the U.S. Postal Service to send 7,800 packages of fentanyl, methamphetamine and heroin to customers around the U.S.
Mexico and Drug mixing for market
Mexico, a major supplier of heroin to the U.S. It's also a large distributor of Fentanyl and its analogs. Drug cartels find it more profitable and less risky than heroin, which depends on large, labor-intensive, conspicuous poppy fields subject to crop failure. At first, they used fentanyl to boost potency to heavily cut heroin. More and more, the market is moving to fentanyl, which they get from China in its pure form, or the inexpensive chemicals needed to produce their own in makeshift labs.
Although the Mexican fentanyl is heavily cut with cheaper substances, it’s unevenly mixed. This means doses are inconsistent. One dose could have two grains of fentanyl, while the next could have three or four times as much. It only takes a few table-salt-sized grains to kill someone. Doug Coleman, Phoenix Special Agent in Charge for the DEA said, “Just throwing these chemicals into a mix and stir it up with a spoon. The pill that you take one time has 1 milligram on fentanyl in it, and you’re fine. The next pill that you take that came from that same batch has 6 milligrams of fentanyl in it, and you’re dead.”
Synthetic Cocktails and The Fourth Wave
Synthetic opioids like fentanyl and its analogs are mixed with other drugs, most commonly with cocaine and heroin. Inaccurate and uneven mixing leads to fatal overdoses. Victims, believing they are using cocaine, are poisoned by the fentanyl mix.
There are many reasons a drug dealer might mix fentanyl with other drugs. It increases the high, for one, but it can also increase the value of poor-quality drugs. Fentanyl can be mixed with anything.
For example, if a dealer gets a batch of weak pot, synthetic drugs mixed with water and sprayed on the pot could make it more marketable. There’s also a niche group creating designer highs, like variations of the euphoric 80s drug, ecstasy.
Recent studies show a resurgence of methamphetamine overdoses, and it’s often mixed with fentanyl. Cocktails make it more difficult for emergency workers to assess and treat.
As chemists in China and other parts of the world create new drugs, it’s impossible to predict what the future holds. It puts law enforcement and medical professionals in a bad position when the next ripple hits their community.
This coupled with media misinformation and people anxious to discredit those who voice the warnings, compounds the risk. For example, there are several well-publicized stories about law enforcement warning their communities about fentanyl-laced pot. In one case, Canadian police came to this conclusion because using Narcan, which is used for opioid overdoses, was effective. This wasn’t enough to establish how the opioid was ingested.
Another case in New York gained national attention for the same cocktail. The sheriff’s department tested confiscated pot that tested positive for fentanyl. The sheriff issued a warning to the community. A second testing produced a different result, so, despite their good intentions, they were accused of crying wolf. Communities need to know what’s going on and following legal procedures can delay important, life-saving information. While some are quick to criticize and point out inaccuracies, it doesn’t mean the wolves aren’t there.