Risk for overdose has never been so high

As the opioid epidemic continues to claim countless lives, we have entered what the Centers for Disease Control and Prevention (CDC) called “the third wave” of the opioid epidemic (Wamsley, 2018). The epidemic began in 2011 with oxycodone being the drug most commonly linked to overdose deaths. From 2012 until 2015, heroin took the title of the drug most associated with overdose deaths. In 2016, fentanyl overtook heroin and is the nation’s deadliest drug. Furthermore, fentanyl overdose deaths consistently doubled each year between 2013 and 2016 – about a 113 percent increase annually (AAFP, 2019).

Originally developed to treat pain in cancer patients, this synthetic opioid is 50 times more powerful than heroin and 100 times more powerful than morphine. Available in three forms including:

• Injectable
• Transdermal patch
• Sublingual lozenge

Although the statistics are alarming, many people were not aware that fentanyl abuse was a thing until the sudden death of Prince in 2016. It’s a sad fact that it takes a death of a celebrity to shed light on an issue that’s been going on for quite a while; fentanyl addiction is a perfect example.

Fentanyl addiction: accidental overdose death is at an all time high

While the statistics surrounding fentanyl and other opioid-related deaths is disheartening, it’s important to note that overdose deaths are primarily a “polysubstance event”, meaning more than one substance was used at the same time. The CDC named the ten most frequently found drugs involved in overdose deaths are fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine and methamphetamine – often found in combination with each other (Inserro, 2018). For example, two in five cocaine deaths also involved fentanyl.

2mg is considered a fatal dose for most users.

Fentanyl-related passive toxicity has also drawn attention to fentanyl. Most notably was a report in 2017 when an East Liverpool, Ohio police officer brushed a white powder off his uniform. The officer lost consciousness with an hour of the incident and required a dose of naloxone to wake him. As a result, the police chief ordered the discontinuation of field testing for fentanyl or other opioids that are found while on duty. In 2018, Massachusetts became the first state prohibiting evidence containing fentanyl or carfentanil (an extra-powerful fentanyl analog) from courtrooms due to the danger of these substances in public settings (Nelson and Perrone, 2018). Although the study documents (unscientifically) that fentanyl isn’t absorbed through the skin, it’s difficult to discount the incident with the aforementioned police officer. Furthermore, fentanyl is available as a transdermal patch, meaning the drug can be transferred through the skin.

While there are drug users who actively seek out fentanyl as their choice for substance abuse, it’s not the primary distribution method. Most drug users take fentanyl without knowing it. It’s usually the drug dealer who has added fentanyl to other drugs, such as heroin, to increase potency and profits as fentanyl comes at a lesser cost. Unsuspecting users may think they’re taking heroin, but in reality, are taking heroin mixed with fentanyl (a cheap and dangerous additive), significantly increasing the chances of overdose and death. If you purchase painkillers such as oxycodone or anxiety medication such as Xanax on the street, you could be purchasing fentanyl disguised as a different medication. This act of deceit is proving deadly. Essentially, it’s like ordering a glass of wine and instead receiving a lethal dose of pure ethanol (Wakeman, 2016).

Wamsley, L. (2018, December 12) Fentanyl Surpasses Heroin As Drug Most Often Involved In Deadly Overdoses. Retrieved from https://www.npr.org/sections/health-shots/2018/12/12/676214086/fentanyl-surpasses-heroin-as-drug-most-often-involved-in-deadly-overdoses
News Staff AAFP (2019, March 27) New Report Details 2011-2016 Fentanyl Overdose Death Rates. Retrieved from https://www.aafp.org/news/health-of-the-public/20190327cdcfentanyl.html
Inserro, A. (2018, December 13) Fentanyl Driving Overdose Deaths in the US, CDC Says. Retrieved from https://www.ajmc.com/focus-of-the-week/fentanyl-driving-overdose-deaths-in-the-us-cdc-says
Nelson, L. and Perrone, J. (2018, December 21) ‘Passive’ fentanyl exposure: more myth than reality. Retrieved from https://www.statnews.com/2018/12/21/passive-fentanyl-exposure-myth-reality/
Wakeman, S. (2016, August 5) Fentanyl: The dangers of this potent “man-made” opioid. Retrieved from https://www.health.harvard.edu/blog/fentanyl-dangers-potent-man-made-opioid-2016080510141