Keeping track of the latest drug craze can be exhausting, but occasionally, one of these drugs pushes the boundaries of typical street behavior and creates a serious public health concern. It happened with crack and crystal meth, and now a new drug is poised to shake up the American drug trade and cause an explosion in fatalities, fentanyl. Doctors should already be familiar with this prescription painkiller often used in cancer treatment, but fentanyl is showing up on streets for the first time.
Fentanyl, commonly known on the street as "China White" or "China Girl", is an extremely powerful opioid that may have caused the recent death of singer Prince. This is only the most high profile fatality in an epidemic that is still in its early stages, but one that could tax the American health care system as it intensifies.
The growing use of fentanyl is symptomatic of widespread opioid abuse problems in the U.S. In 2014, more than 28,000 Americans died from opioid overdoses. Fentanyl-related deaths, however, are the fastest growing segment of these fatalities. The number of fentanyl overdoses doubled to 5,500 in 2014 in just a year's time.
In its street form, fentanyl may be a hundred times more powerful than morphine, and 50 times stronger than heroin. The drug is so potent that law enforcement officials must wear hazmat suits to prevent exposure. Fentanyl can be absorbed through the skin, and only a few micrograms is enough to cause a fatal reaction.
There is a brisk trade in Fentanyl, which is thought to be produced in China but distributed by American drug cartels, because how little is required to produce a similar high to heroine as well as cheap production costs. Compared to other opioids, fentanyl can sell for up to 300 times as much for comparable amounts, making it an enormously profitable product.
Fentanyl is becoming so popular and so available that many municipal authorities are now encouraging drug users to carry with them Narcan (also known as naloxone) which can act as a counteracting agent in case of opioid overdose. In the wake of 75 fentanyl-related deaths in July of 2015, San Francisco's Department of Public Health even took the unprecedented step of training people in how to use Narcan as an injection or nasal spray.
The lethality of this drug is often masked by its similar appearance to common medications like Xanax, or even, Pez candy. Many dealers try to substitute other drugs with fentanyl, contributing to a surge in overdose fatalities in states like Maryland, Florida and Ohio. While motivations remain unclear, it is suspected that some suppliers are trying to create a greater demand for fentanyl by cutting other popular drugs with it.
Law enforcement officials are deeply concerned with the steep rise in use. The number of fentanyl drug seizures multiplied seven-fold from 2012 to 2014, culminating in 4,585 seizures. In recent years, most of the criminal activity around fentanyl has been centered on the East Coast, but there have been spikes of use in certain western localities, and distribution is expected to ramp up in the western states.
Article written by:
Robert Moghim, M.D.
CEO, Health Carousel Locum Tenens