Assassins, Drug Dealers Share Fondness for Fentanyl

Assassins, Drug Dealers Share Fondness for Fentanyl
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The toxic agent used by assassins in the Middle East and in counterterrorism operations in Moscow is now wreaking havoc with the havoc already created by America's prescription drug and heroin crisis.

The potent drug making a resurgence on the streets is fentanyl, a synthetic opioid we've been prescribing for decades for patients with severe, chronic pain (such as cancer pain) or breakthrough pain after surgery. The illicit form is manufactured by clandestine labs and is up to 100 times more powerful than morphine and 30 to 50 times more powerful than heroin. Just a pinch of it sprinkled into a batch of heroin can kill rapidly. Hence the street names "Drop Dead" and "Breaking Bad."

It's not the first time dealers have gotten their hands on it. Between 2005 and 2007, over 1,000 U.S. deaths were blamed on fentanyl. The surge ended when the source of that fentanyl, a single illicit lab in Mexico, was shut down.

According to a new report by the U.S. Centers for Disease Control and Prevention, the growing use of fentanyl was likely a major contributor to the record increase in opioid deaths in 2014. And in fact, the entire increase in drug-related deaths in the last two years in New Hampshire can be traced to overdoses involving fentanyl, according to the Union Leader, which said in an editorial that "no legislative solution can be taken seriously if it doesn't address fentanyl."

Last spring, the DEA released a nationwide alert on fentanyl after state and local drug labs reported seeing 3,344 fentanyl samples in 2014, up from 942 in 2013.

Widespread Damage

Here are other recent examples of the toll the drug is taking across the United States, the DEA says:
  • New Jersey saw a huge spike in fentanyl deaths in 2014, reporting some 80 deaths in the first six months of the fiscal year.
  • Rhode Island and Pennsylvania have also seen huge increases since 2013. In a 15-month period, about 200 deaths were reported in Pennsylvania related to fentanyl.
  • In the St. Louis area, fentanyl was the only drug attributed as a primary death factor in 44% of overdose cases.
Some addicts are deliberately taking fentanyl, a drug so deadly
sprayed it into the ear of a Hamas leader in a botched assassination attempt in 1997 and
used it in an attempt to rescue some 900 hostages held by Chechen rebels in 2002. (The drug proved more lethal in the hands of the Russian rescuers, as more than 100 of the hostages were fatally poisoned by the fentanyl-based gas.) Fentanyl was also reportedly considered for tactical roles in Vietnam.

"Heroin is bad enough, but when you lace it with fentanyl, it's like dropping a nuclear bomb on the situation," Mary Lou Leary, a deputy director in the White House's Office of National Drug Control Policy, recently told NPR. "It's so, so much more dangerous."

Obama Highlights Epidemic in State of the Union

The spot we find ourselves in today is so dire that the prescription painkiller and heroin overdose epidemic was mentioned at the very outset of President Obama's State of the Union address earlier this month, before even terrorism. "I hope we can work together this year on bipartisan priorities like ... helping people who are battling prescription drug abuse and heroin abuse," the president said.

Fighting terrorism and fighting the scourge of opioid abuse have much in common. They both strike unpredictably, as an addict can unknowingly be exposed to fentanyl or any number of additives in a bag of heroin at any time. Both kill indiscriminately, without regard to race or social status. Once the scourge of the inner city and the poor, 90% of the people who tried heroin in the last decade were white and an increasing number are middle-class or wealthy. And like the war on terror, the battle is often waged on foreign soil. Global opium poppy cultivation in 2014 reached its highest level since the late 1930s, while illicit fentanyl is coming out of Mexico.

Our neighbors to the north are fighting the same foe. The Canadian Centre on Substance Abuse reports that within the last six years, the number of deaths involving fentanyl in Canada's four largest provinces has increased markedly, doubling in some subdivisions and increasing more than 20 times in others.

It's heartening to hear from the president that he wants to make the prescription drug and heroin overdose epidemic a priority in this country. The government has so far used a multipronged approach, including cutting off the supply of drugs from abroad, reassessing opioid prescribing practices and making the antidote naloxone more widely available.

I also like the approach prosecutor Joe Coronato in Ocean County, New Jersey, is taking. Believing (correctly) that to quell the epidemic, we must break the cycle of addiction, Coronato will begin stationing "interveners" at local hospitals to persuade drug overdose victims brought in for treatment to enter rehab. Another step forward would be for the Food and Drug Administration to approve a new, experimental implant designed to deliver a steady dose of medication that would control cravings for heroin or prescription painkillers.

But without evidence-based comprehensive addiction treatment that cares for the whole person and the total condition, not just the symptoms, we'll surely see overdoses continue to mount. Some 22.7 million people 12 and older needed treatment for an illicit drug or alcohol use problem in 2013, but only 11% got it. A study published in March in the American Journal of Public Health found "significant gaps" between the need for treatment and capacity in the U.S.

Recent developments in genetic, pharmacology and neurophysiology research have helped establish that addiction is a brain disease instead of a moral failing. While the 2016 presidential race has gone a long way toward lessening the stigma of addiction as the candidates reveal their personal stories, we need more beds for intensive treatment and more funds for the support of addicts once they reach recovery. There's no time for stigma. Fentanyl has taken this difficult battle to a ridiculously dangerous new level.

Jason Powers, M.D., is the chief medical officer at Promises Austin drug rehabilitation program and The Right Step network of addiction treatment centers in Texas. He is the pioneer of Positive Recovery, an approach to addiction treatment that helps people discover meaning and purpose in their lives.

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