The world is no stranger to opioid abuse. Worldwide statistics estimate between 26.4 and 36 million people abuse opioids (1). In the United States alone, deaths from overdose of prescription painkillers have more than quadrupled since 1999 (1). While the battle against opioid and heroin use has been raging for decades, a new danger has emerged. Fentanyl, the drug recently found to have been responsible for the musician Prince’s death, is a painkiller 50 to 100 times more potent than morphine and 30 to 50 times more powerful than heroin (2)(3). Although commonly prescribed to cancer patients, the drug is not being sourced from hospitals. Instead, the drug is being trafficked from Mexico and China to the US or is being illicitly manufactured (2)(3). The small amount of data on the drug makes it difficult to track. Therefore, it is difficult to know just how much fentanyl is being circulated, but the rising overdose deaths related to the drug show that its presence is increasing on the market, with many people who may not even know their purchase to be fentanyl.
Several factors may be contributing to fentanyl’s increasing presence and destruction. For one thing, the drug is much cheaper to make illegally, known as illegally manufactured fentanyl (IMF), and can be used by dealers to stretch supplies of heroin or other drugs (2). Therefore, many overdoses are tolled on unsuspecting addicts who may not know IMF was in their supply and are unaware of its extreme potency compared to other drugs.
In addition to its low-cost manufacture, the drug is also easy to make and laboratories in China have become adept in its production. The DEA also claims that these laboratories produce legitimate materials, which veils their illicit activities and complicates tracking measures (4). From China, the drugs are trafficked into the US, mainly through Mexico. In addition, many drug producers have been able to purchase precursor chemicals and produce the drugs in the US, Canada and Mexico, due to loose regulations (4). A kilogram of fentanyl costs a few thousand dollars. After the production of a couple thousand pills, the profit can soar into millions, proving to be an extremely lucrative business (4). This profitability is pulling in more traffickers and producers, increasing IMF’s presence in the drug market. Pure heroin, in fact, is being swept off the market by fentanyl-laced heroin, a cheaper but more potent product.
Due to an inability to distinguish between illegally manufactured fentanyl and pharmaceutical fentanyl, it is difficult to analyze the nature of the market. However, the CDC contributes most of the rising overdoses to IMF (3). Still, there is no question that increasing dependency on prescription drugs is changing the market for the United States. The demographics of overdoses relating to opioid abuse have increased in age and income class (3). More people are becoming dependent on prescription drugs and turning to the black market after being denied painkillers by their medical provider.
It is difficult to combat a drug that is so widely and easily distributed. While many US Senators have voiced concern, and the US has held counter-narcotic meetings with China and Mexico, it will be a while before real progress is seen, as the drug has already become incredibly dispersed. The efforts to combat the footing already made by traffickers needs to be hard hit and focused. The future seems even bleaker after Republican Congress members denied funding to the Comprehensive Addiction and Recovery Act (CARA) (5). While the funding would have expanded the availability of prescription drug monitoring programs, treatment centers and naloxone, a drug used to combat opioid addiction, this legislation would only be addressing a side effect of loose regulations on precursor chemicals and lack of monitoring for imported goods. Closely monitoring suspicious laboratories in China, as well as developing effective tracking and logging systems for chemicals coming in from overseas, would cut the head off of the snake and drain the availability of the drug in North America.
(1) Volkow, Nora D. "America’s Addiction to Opioids: Heroin and Prescription Drug Abuse." National Institute on Drug Abuse. May 14, 2014. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse.
(2) Kounang, Nadia. "A Dramatic Surge in Fentanyl Cases Fuels Opioid Epidemic." CNN. August 26, 2016. http://www.cnn.com/2016/08/25/health/dea-fentanyl-increase-cdc/.
(3) Peterson AB, Gladden RM, Delcher C, et al. Increases in Fentanyl-Related Overdose Deaths — Florida and Ohio, 2013–2015. MMWR Morb Mortal Wkly Rep 2016;65:844–849. DOI: http://dx.doi.org/10.15585/mmwr.mm6533a3.
(4) LaSusa, Mike. "Mexico, China Are Key Nodes in Fentanyl Trade: DEA." Insight Crime. July 27, 2016. http://www.insightcrime.org/news-briefs/mexico-china-are-key-nodes-in-fentanyl-trade-dea.
(5) De Leon, Jessica. "White House to Buchanan: If You Want Funding for Heroin-fentanyl Epidemic, Look to Fellow Members of Congress." Brandenton Herald. September 9, 2016. http://www.bradenton.com/news/local/heroin-epidemic/article100853477.html.
Image: © Pureradiancephoto | Dreamstime.com - Ogden utah: july 16, 2016: oxycontin bottle on pharmacy shelf