Backstory: Fentanyl is a legal, synthetic opioid, but mixed with street drugs, two grains could mean the difference between life and death

Photo: Fentanyl graphic. (DEA/MGN)

04 April 2022 | James Porteous | Clipper Media News

Fentanyl is a legal, synthetic opioid that was approved for the treatment of severe pain, typically advanced cancer pain.

The mixing of fentanyl in ‘street drugs,’ and the distribution of illicitly produced fentanyl is first thought to have begun in 2011.

Unlike the ‘old days,’ when street drugs were mixed with other harmless substances in order to decrease its potency while at the same time increasing the amount of product available to sell, adding fentanyl is often meant to increase the main drugs’ potency.

Of course the dealers adding fentanyl to their street drugs or selling them as illegally manufactured pills are hardly pharmacists and many would be unaware -or worse yet, not even care- that the difference between an ‘acceptable amount’ and an overdose might be no more than one or two grains per hit.

Studies indicate fentanyl is 30 to 50 times stronger than heroin, but given that the ‘high’ can often be more fleeting, illegal drug users could feel the ‘urge’ to consume the drug 20 or 30 times a day. 

Fentanyl, an opioid that is practically and effectively 50 and 100 times more potent than heroin or prescription opioids, is often used to adulterate heroin, cocaine, methamphetamine and other “street drugs.” Overdose deaths often result from a user’s unwitting purchase and use of fentanyl when believing he or she is purchasing heroin or prescription pills. Fentanyl derivatives such as carfentanil, which is used to anesthetize elephants, is also being used to adulterate heroin, causing cluster overdose deaths.

OPIOID FACTS

In turn, these same users might be ingesting unknown quantities of the drug 20 or 30 times a day, risking an accidental overdose each time, every day.

As you will see in the video below, illegal, manufactured Fentanyl is also being sold in pill form without rather than be added to any street drugs.

These pills are also equally and extremely dangerous for the same reasons: Given that the pills are not ‘manufactured’ by pharmaceutical companies, people purchasing the pills on the street have no way of ascertaining the actual amount of the substance they might be ingesting.

And again, they might be ingesting the pills a number of times a day.

In short, there is no way to safely take illegally produced synthetic opioids.

James Porteous | Clipper Media News


United States Drug Enforcement Administration (DEA)

What is Fentanyl?

Fentanyl is a synthetic opioid that is 80-100 times stronger than morphine. Pharmaceutical fentanyl was developed for pain management treatment of cancer patients, applied in a patch on the skin.

Because of its powerful opioid properties, Fentanyl is also diverted for abuse.

Fentanyl is added to heroin to increase its potency, or be disguised as highly potent heroin.

Many users believe that they are purchasing heroin and actually don’t know that they are purchasing fentanyl – which often results in overdose deaths.

Clandestinely-produced fentanyl is primarily manufactured in Mexico.

Street Names

Apace, China Girl, China Town, China White, Dance Fever, Goodfellas, Great Bear, He-Man, Poison and Tango & Cash,

How is it used?

Intense, short-term highTemporary feelings of euphoriaSlowed respiration and reduced blood pressureNauseaFaintingSeizuresDeath

How does it affect the body?

Similar to other opioid analgesics, Fentanyl produces effects such as relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.


Inside The Fentanyl Crisis | Ten Dollar Death Trip | Documentary Central

Inside The Fentanyl Crisis | Ten Dollar Death Trip | Documentary Central

Fentanyl’s lethal toll continues. Nearly 10 million pills were seized last year

A pill press machine seized by authorities is displayed during a news conference outside the Roybal Federal Building in February 2021 in Los Angeles.
Patrick T. Fallon /AFP via Getty Images

31 March 2022 | MARTIN KASTE | NPR

American law enforcement is seizing fentanyl pills at a rate nearly 50 times greater than four years ago, according to a new study funded by the National Institute on Drug Abuse.

Fentanyl is 30 to 50 times stronger than heroin, and the study’s authors raise the alarm over the danger that users will overdose, especially if they believe the pills are legitimate pharmaceutical products.

“Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as prescription opioids or benzodiazepines in particular are at risk for unintentional exposure to fentanyl,” said the study, conducted by researchers from several universities who participate in the National Drug Early Warning System.

Other experts say the fentanyl pills have become so common in the drug market that most users have come to realize what’s in them and seek them out because they contain fentanyl.

Caleb Banta-Green, principal research scientist at the Alcohol & Drug Abuse Institute (ADAI) at the University of Washington School of Medicine, said awareness of fentanyl pills has risen quickly among users. In a recent survey in Washington State, two-thirds of those who used fentanyl said they did so “on purpose.” They said they consumed fentanyl most often in pill form.

The study noted that nearly 10 million pills were seized in 2021.

Banta-Green says some users may think the pill form of the drug is safer than injected opioids or heroin, especially if the pills are crushed and smoked.

But he said pills are not necessarily safer, because their potency can vary. And because the fentanyl “high” is more fleeting than other drugs, people end up consuming it more often — even 20 or 30 times a day.

“Every time you’re using, you also have a risk of overdose,” says Banta-Green. “It’s one of the reasons we’re seeing these death rates that are so high, because there are so many more opportunities for a person to overdose, because they’re using so much more frequently.”

The NIDA-funded study recommends more close monitoring of the illicit fentanyl market in order to provide early warning to the public about what forms the drug is taking.


Fentanyl Warning

Lake Washington School District | Redmond, WA

Sadly, there has been a recent increase in overdose deaths in King County, driven largely by fentanyl found in illicit pills and powders. According to the health department, these deaths are occurring more frequently among people 18 or younger.
We are sharing this information from Public Health – Seattle & King County so that you are aware of the danger and can discuss this information with your students:

WARNING:

  • Beware of counterfeit pills that may look like prescription drugs. They likely contain fentanyl.
  • Do not consume any pill that you do not directly receive from a pharmacy or your prescriber. 
  • Pills purchased online are not safe.
What is fentanyl?

Fentanyl is a powerful synthetic opioid drug that is approximately 100 times more powerful than other opioids. Fentanyl is often added to illicit street drugs such as fake pills and white powder. Fentanyl and other opioids cause overdose by slowing breathing and eventually can cause death.
Where has fentanyl shown up locally?

  • In King County, fentanyl is most commonly seen in blue, greenish, or pale colored counterfeit pills. There may be other colors. These pills may be marked as “M30” and sometimes as “K9,” “215,” and “v48.” Fentanyl may also be in white powders.
  • Oxycodone pills that are sold on the street or online likely contain fentanyl.
  • You can’t smell or taste fentanyl. You can’t tell if there’s fentanyl in the pills by looking at them.
  • The amount of fentanyl can vary between pills, even within the same batch. While a single pill might get a person high without killing them, another pill could be fatal.
What to do to prevent fatal overdoses:
  • Know the signs of an overdose or excessive opioid use. Someone may be overdosing if they:
    • Won’t wake up or it’s difficult to awaken them
    • Have slow or no breathing
    • Have pale, ashy, cool skin
    • Have blue lips or fingernails
    • Abnormal snoring pattern (e.g., unusually loud)
    • Extreme drowsiness
  • If you witness an overdose, call 9-1-1 right away. Washington State’s Good Samaritan law will protect you and the person who is overdosing from drug possession charges.
  • Give naloxone (Narcan), a nasal spray that counteracts the life-threatening effects of an opioid overdose. Find out where you can get Narcan at stopoverdose.org

•    Get rid of unused or expired medications. Find a drop-box near you: www.medicinereturn.org or text MEDS to 667873
•    If you think someone is overdosing, do not let them fall back asleep.

Treatment works

Many different treatment options are available across King County, including medications to treat opioid use disorder. Visit the Washington Recovery Help Line www.WArecoveryhelpline.org or call 1-866-789-7511.  


States look for solutions as US fentanyl deaths keep rising


FILE -A display of the fentanyl and meth that was seized by Customs and Border Protection. (Mamta Popat/Arizona Daily Star via AP, File)

03 April 2022 | GEOFF MULVIHILL  | AP via ABC News

As the addiction and overdose crisis that has gripped the U.S. for two decades turns even deadlier, state governments are scrambling for ways to stem the destruction wrought by fentanyl and other synthetic opioids.

In statehouses across the country, lawmakers have been considering and adopting laws on two fronts: reducing the risk to users and increasing the penalties for dealing fentanyl or mixing it with other drugs.

Meanwhile, Republican state attorneys general are calling for more federal action, while some GOP governors are deploying National Guard units with a mission that includes stopping the flow of fentanyl from Mexico.

“It’s a fine line to help people and try to get people clean, and at the same time incarcerate and get the drug dealers off the streets,” said Nathan Manning, a Republican state senator in Ohio who is sponsoring legislation to make it clear that materials used to test drugs for fentanyl are legal.

The urgency is heightened because of the deepening impact of the drugs. Last year, the U.S. Centers for Disease Control and Prevention reported the nation had hit a grim milestone. For the first time, more than 100,000 Americans had died of drug overdoses over a 12-month period. About two-thirds of the deaths were linked to fentanyl and other synthetic drugs, which can be 50 to 100 times more potent than morphine, heroin or prescription opioids.

The recent case of five West Point cadets who overdosed on fentanyl-laced cocaine during spring break in Florida put the dangers and pervasiveness of the fentanyl crisis back in the spotlight.

The chemical precursors to the drugs are being shipped largely from China to Mexico, where much of the illicit fentanyl supply is produced in labs before being smuggled into the U.S.

While users sometimes seek out fentanyl specifically, it and other synthetics with similar properties are often mixed with other drugs or formed into counterfeit pills so users often don’t know they’re taking it.

Advocates say test strips can help prevent accidental overdoses of drugs laced with fentanyl. The strips are given out at needle exchanges and sometimes at concerts or other events where drugs are expected to be sold or used.

Thomas Stuber, chief legislative officer at The LCADA Way, a drug treatment organization in Ohio that serves Lorain County and nearby areas, has been pushing for the test strip legislation. It also would ease access to naloxone, a drug that can be used to revive people when they’re having opioid overdoses.

“This is a harm-reduction approach that has received a lot of acceptance,” he said. “We cannot treat somebody if they’re dead.”

Since last year, at least a half-dozen states have enacted similar laws and at least a dozen others have considered them, according to research by the National Conference of State Legislatures.

In West Virginia, the state hardest hit by opioids per capita, lawmakers passed a bill this month to legalize the testing strips. It now heads to the governor.

The measure was sponsored by Republican lawmakers. But state Delegate Mike Pushkin, a Democrat whose district includes central Charleston, has also been pushing for more access to fentanyl strips. He said the situation got worse last year when a state law tightened regulations on needle exchanges, causing some of them to close.

Pushkin, who also is in long-term addiction recovery, is pleased with passage of the testing strip bill but upset with another measure passed this month that would increase the penalties for trafficking fentanyl. That bill also would create a new crime of adding fentanyl to another drug.

“Their initial reaction is, ‘We have to do something,’” he said. “It’s not just about doing something, it’s about doing the right thing that actually has results.”

But for many lawmakers, making sure that tough criminal penalties apply to fentanyl is a priority.

California Assemblywoman Janet Nguyen, a Republican, introduced a measure that would make penalties for dealing fentanyl just as harsh as those for selling cocaine or heroin. The Republican represents Orange County, where there were more than 600 reported fentanyl-related deaths last year.

“This is sending messages to those who aren’t afraid of selling these drugs that there’s a longer, bigger penalty than you might think,” said Nguyen, whose bill failed to advance from her chamber’s public safety committee in a 5-2 vote last week. She said after the bill failed that she was considering trying again.

She said committee members stressed compassion for drug users, something she said she agrees with.

“The less available these pills are out there, the better it is,” Nguyen said. “And that is going after the drug dealer.”

The same day her measure failed to advance, a Democratic lawmaker in California announced a different bill to increase fentanyl-dealing penalties.

The National Conference of State Legislatures found 12 states with fentanyl-specific drug trafficking or possession laws as of last year.

Similar measures have been introduced or considered since the start of 2021 in at least 19 states, the Associated Press found in an analysis of bills compiled by LegiScan. That does not include measures to add more synthetic opioids to controlled substance lists to mirror federal law; those have been adopted in many states, with bipartisan support.

Fentanyl has been in the spotlight in Colorado since February, when five people were found dead in a suburban Denver apartment from overdoses of fentanyl mixed with cocaine.

Under state law, possession with intent to distribute less than 14 grams of fentanyl is an offense normally punishable by two to four years in prison. But fentanyl is so potent that 14 grams can represent up to 700 lethal doses, under a calculation used by the U.S. Drug Enforcement Agency.

“It’s making it impossible to hold the dealer accountable for the deadliness of the drugs they’re peddling,” Colorado House Speaker Alec Garnett, a Democrat, said in an interview.

He and a bipartisan group of lawmakers last week unveiled a bill also backed by Democratic Gov. Jared Polis that would increase penalties for dealers with smaller amounts of fentanyl and in cases where the drug leads to a death. The legislation also would increase the accessibility of naloxone and test strips while steering people who possess fentanyl into education and treatment programs.

Maritza Perez, director of national affairs at the Drug Policy Alliance, a group that advocates for harm-reduction measures, is skeptical of the legislation that would increase criminal penalties.

“We have the largest incarceration rate in the entire world and we’re also setting records in terms of overdose deaths,” she said.

Democratic governors are focusing primarily on harm reduction methods. Among them is Illinois Gov. Jay Pritzker, who released a broad overdose action plan last month.

Several Republican governors and attorneys general have responded to the rising death toll with administrative enforcement efforts and by pushing for more federal intervention.

Last year, Texas Gov. Greg Abbott and Arizona Gov. Doug Ducey called for states to help secure the border with Mexico. Along with trying to keep people from entering the U.S., stopping the flow of fentanyl was cited as a reason. Several other Republican governors have sent contingents of state troopers or National Guard units.

The Texas Military Department said that from March 2021 through earlier this month, its troops near the border confiscated more than 1,200 pounds (540 kilograms) of fentanyl. By comparison, federal authorities reported confiscating about 11,000 pounds (4,990 kilograms) in 2021 — still a fraction of what entered the country.

Last year, the U.S. Department of Justice filed about 2,700 cases involving crimes related to the distribution of fentanyl and similar synthetic drugs, up nearly tenfold from 2017. Even so, Republican state officials are critical of federal efforts to stop fentanyl from entering the country.

In January, 16 GOP state attorneys general sent a letter to U.S. Secretary of State Antony Blinken calling on him to exert more pressure on China and Mexico to stop the flow of fentanyl. Those are steps that Dr. Rahul Gupta, the director of National Drug Control Policy, said are already being taken.

In March, West Virginia Attorney General Patrick Morrisey called on U.S. Attorney General Merrick Garland for more enforcement on fentanyl trafficking and harsher penalties.

“Fentanyl is killing Americans of all walks of life in unprecedented numbers,” Morrisey said in a statement emailed to the AP, “and the federal government must respond with full force, across the board, using every tool available to stem the tide of death.”