Spread all across the news has been a drug crisis across the U.S. that only seems to be escalating out of control. In 2016, nearly 64,000 people died from drug overdoses in the U.S.
In 2017, according to the Centers for Disease Control and Prevention (CDC), that number rose to more than 72,000. While the general consensus is that this whole crisis got to this stage largely because of the erroneous over-prescription of opioid painkillers, this problem has gone well beyond being a painkiller issue.
The fact is that this spike in overdose-related deaths in recent years has been fueled by the spike in proliferation of lethal, laboratory-synthesized drugs across the country.
The Major Culprit: Fentanyl
Fentanyl, a highly potent synthetic opiate, has been a major driving force behind such a largely growing death toll in the last few years. In 2016, nearly 20,000 casualties of the opioid crisis occurred because of intravenous injection of fentanyl. This number of fentanyl-related deaths rose to almost 30,000 in 2017.
Fentanyl is a drug with a potency 50 times that of heroin, which has permeated into the market and bodies of Americans in two ways. Firstly, the major source of this fentanyl is China, where the drug is synthesized in clandestine laboratories, purchased through the black market, and smuggled into the United States, usually through Mexico (Chicago Tribune, 2017).
What happens is that fentanyl is added to heroin to maximize its potency at a low cost to drug dealers and traffickers. This same heroin is then sold on the black market, and is becoming more and more sought after for victims of an on-going opioid epidemic.
As tolerance increases and potency for painkillers and opioids wanes, patients feel a need to pursue more potent drugs for the same analgesic, ‘feel good’ effects. Many opioid users seek out heroin. However, as a result, many have now been unwittingly incorporating traces of fentanyl into their bodies.
While much of the proliferation of fentanyl has been through its incorporation with illicitly sold heroin, fentanyl is also mixed with other widely used medications. These include oxycodone and hydrocodone (two well-known opioid painkillers), and even anxiolytics such as alprazolam (Xanax ®) (Kuczyńska et al., 2018).
The Proliferation of Fentanyl Analogues
In the process of generating fentanyl, a number of fentanyl analogues, many of which are significantly more potent, have also entered the U.S. market.
For instance, carfentanil, which is 100 times more potent that fentanyl, has been implicated in a number of overdose deaths across the U.S. within the last two years. Casualties related to unwitting consumption of carfentanil within heroin samples have been particularly high in states such as Wisconsin and Ohio. (TIME, 2016).
Just to gauge how deadly fentanyl and its derivatives can be, this is a drug which, in August 2018, was actually used to carry out the execution of a prisoner, Carey Dean Moore, via lethal injection (Washington Post, 2017).This is also the drug implicated in the death of the iconic musician, Prince (New York Times, 2016).
Interestingly enough, fentanyl and carfentanil were also was found to be utilized by Russian security forces to incapacitate the perpetrators of the infamous Moscow theater hostage crisis in 2002. In the end, there were several casualties, many of whom were actually the victims being held hostage (Riches et al., 2012).
And now, these deadly drugs are finding their way intravenously into the bodies of more and more Americans each day.
The Proliferation of Another Synthetic Drug K2 (Synthetic Marijuana)
The black mark of synthetic drugs has transcended analgesics and opioids, as shown by the recent proliferation of K2, a synthetic cannabinoid that mimics much of the effects of tetrahydrocannabinol (THC) found in marijuana. This drug, which first permeated the U.S. recreational drug market in the early 2000s, has a number of severe side effects, such as psychoses and seizure and it can even be fatal.
It has continued to spread even more today (Cooper, 2016).
As recently as summer 2018, there was a major incident in New Haven, Connecticut, in which 71 people overdosed from K2 (CBS News, 2018).
It’s clear that the synthetic drug crisis is no longer just an opioid crisis. And much like with the fentanyl issue, many victims of K2’s side effects are unwittingly incorporating this compound into their bodies, thinking that they are using conventional marijuana.
The Response More Punitive in Nature
The problem with tackling what was predominantly an opioid crisis is the fact that the current U.S. administration has sought to treat the issue as a criminal justice issue more than a health emergency. Its adopted punitive measures instead of seeking to treat the victims and prevent more at-risk individuals from losing their lives to drug overdoses.
Adopting strategies like increasing the availability of naloxone and buprenorphine to treat overdoses is essential. Moreover, increasing the number of medical and health care professionals would go a long way in addressing this issue as well.
In fact, as a medical student, I can say that the American Association of Medical Colleges (AAMC) worked with some senators on Capitol Hill to propose an addition to the Opioid Workforce Act of 2018, to add an extra 1,000 federally funded medical resident positions dedicated to addiction medicine, psychiatry, and pain management.
However, the politically divide nature of Congress meant that this addition to the bill, which would have increased the number of doctors to tackle the drug crisis, did not materialize. Moreover, with K2 and other synthetic cannabinoids only spreading more on the black market, the synthetic drug crisis is only becoming more complex and multi-faceted in nature.
As a result, the country remains in an increasingly helpless position to tackle what is a worsening drug crisis. We are at a point where overdose-related deaths from synthetic drugs are taking more lives in the country than HIV/AIDS and homicides. My concern, as a physician in training, as a mental health advocate, and as a U.S. citizen, is that this crisis will continue to get worse, both now, and for months and years to come.
CBS News. (2018, August 16). New Haven overdoses highlight K2 synthetic marijuana dangers. Retrieved from https://www.cbsnews.com/news/new-haven-overdoses-k2-synthetic-marijuana-dangers/
Centers for Disease Control and Prevention (CDC) (2017). 12 Month-ending Provisional Number of Drug Overdose Deaths. Retrieved from https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Chicago Tribune (2018, August 17). Record overdose deaths in U.S. shows danger of fentanyl, other synthetic drugs. Retrieved from http://www.chicagotribune.com/lifestyles/health/ct-overdose-deaths-synthetic-drugs-fentanyl-20180817-story.html
Cooper, Z. D. (2016). Adverse Effects of Synthetic Cannabinoids: Management of Acute Toxicity and Withdrawal. Current Psychiatry Reports, 18(5). doi:10.1007/s11920-016-0694-1
Kuczyńska, K., Grzonkowski, P., Kacprzak, Ł, & Zawilska, J. B. (2018). Abuse of fentanyl: An emerging problem to face. Forensic Science International, 289, 207-214. doi:10.1016/j.forsciint.2018.05.042
New York Times. (2016, June 12). Prince Died From Accidental Overdose of Opioid Painkiller. The New York Times. Retrieved from https://www.nytimes.com/2016/06/03/arts/music/prince-death-overdose-fentanyl.html?_r=0
Riches, J. R., Read, R. W., Black, R. M., Cooper, N. J., & Timperley, C. M. (2012). Analysis of Clothing and Urine from Moscow Theatre Siege Casualties Reveals Carfentanil and Remifentanil Use. Journal of Analytical Toxicology, 36(9), 647-656. doi:10.1093/jat/bks078
TIME. (2016, September 12). Heroin Is Being Laced With a Terrifying New Substance: What to Know About Carfentanil. Time Magazine. Retrieved from http://time.com/4485792/heroin-carfentanil-drugs-ohio/
Washington Post. (2017, December 9). States to try new ways of executing prisoners. Their latest idea? Opioids. The Washington Post. Retrieved from https://www.washingtonpost.com/