“The problem is those drugs that become much more potent will require ever higher doses of the Narcan to reverse the overdose and at some point you won’t be able to give enough of the naloxone, that Narcan, to effect an overdose by one of these really potent drugs, so that is a real problem the emergency medical community and the medical community is facing.” ~ Dr. Jerry Goldbaum, Snohomish County Health District When the Centers for Disease Control and Prevention originally referred to the “opioid epidemic” in the United States, they were referring to the overprescription of and addiction to prescription painkillers such as Vicodin or Percocet. As a result, regulations became much more stringent, here in Washington State and throughout the country. Under the new guidelines, it is much harder to obtain prescription opioids to abuse. As an unintentional side effect, however, now that prescription drug use has largely plateaued, opioid abusers are finding other, more dangerous ways to satisfy their addiction.
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One of the more dangerous alternatives in Washington State is fentanyl, which is 100 times stronger than morphine. DEA administrator Michele Leonhart calls fentanyl a “significant threat to public health and safety.” How fast is the fentanyl problem growing? In 2012, there were 618 fentanyl drug seizures throughout the country. In 2014, that number was 4585.
Fentanyl – What You Need to Know
Fentanyl is the most potent opioid available for medical use in humans, and it has three major medical uses:
- Terminal cancer patients and those living with a chronic level of baseline pain that morphine cannot control.
- During surgery
- By paramedics as a response to extraordinarily-painful traumatic injuries
Fentanyl was created in 1960 by Dr. Paul Adriaan Jan Janssen, one of the most renowned chemists in the world. Before his death, Dr. Janssen was awarded 22 honorary doctorates and won 80 medical prizes.
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Opioid Statistics in Washington State
Unfortunately, tracking Fentanyl abuse in Washington State is difficult, because until recently, law enforcement wasn’t really aware that there was a problem. Many fatal overdoses were attributed to heroin. But by examining local heroin abuse trends in Washington and by including the information that IS available about fentanyl, a reasonable picture can be extrapolated. For example, take a look at 2015 drug trends in King County:
- For the first time, treatment admissions for heroin surpassed those for alcohol.
- For the past two years, heroin has been the most-commonly-identified drug in overdose deaths – 132 in 2015.
- There were 2100 calls to the Helpline mentioning heroin in 2015 – nearly double 2012’s total.
- Illicit synthetic opioids such as acetyl fentanyl have begun being detected in overdose deaths AND in police evidence. The first such death in King County was recorded in 2015.
- In May of 2016, King County reported two overdose deaths involving acetyl fentanyl.
If at first glance, the number of heroin deaths doesn’t seem too worrisome, consider what is happening elsewhere in the United States:
- In 2015, 16% of all confirmed drug overdose deaths in New York City involved fentanyl.
- Never before had fentanyl accounted for more than 3% of overdose deaths.
- During the first six months of 2016, 39% of overdose deaths in NYC were fentanyl-related.
- Since July 1, that percentage has climbed to 47%.
- In 2013, Ohio saw 92 fentanyl-related deaths, but by 2015, that number skyrocketed to 514.
- In 2013, there were 58 fentanyl-related overdoses in Maryland. In 2014, that number was 185.
- During the same timeframe, fentanyl-involved deaths in Florida went from 185 to 397.
Why is Fentanyl Abuse in Washington State Such a Public Health Hazard?
There are several reasons why fentanyl is so dangerous to Washington State opioid abusers and those around them:
- It’s AVAILABLE – Washington State is suffering an increase in the amount of inexpensive heroin coming in from Asia and, especially, Mexico. The main reason for this is an increasingly-legal status of marijuana in America. As medical and recreational marijuana use becomes decriminalized in this country, there is less of a demand for black market marijuana from other countries.
But cultivating opium poppies is expensive, both in terms of land and in labor. This is not the case with fentanyl, which is entirely synthetic and can be made in a lab. Around 2006, drug trafficking organizations in Mexico realized that they could cut their low-grade heroin with fentanyl and boost their profit margin.
One gram of pure heroin can be cut into around 7000 doses suitable for sale on the street.
- It’s POWERFUL—Fentanyl 100 X times stronger than pure morphine and has 50 X the potency of laboratory-grade heroin. At this strength, a “normal” high and a fatal overdose are separated by a few nanograms.
Dr. Philip Coffin, of the University of Washington, says, “That’s always the danger with really potent stuff. Imagine you’ve got a big pot of drugs and you’re starting it up. Some of that is inevitably going to clump. And some clumps are going to be weaker and some clumps are going to be MUCH stronger.”
- It’s ADDICTIVE – Like all opioids, fentanyl affects the pleasure centers of the brain. Fentanyl abusers say that it gives them a “sharp, crisp high” reminiscent of cocaine. One abuser said, “If you’re on F and you smoke H, it just doesn’t work.”
- DEPRESSES BREATHING—All opioids can suppress respiration at high doses, but with fentanyl, this affect is both worse and longer-lasting.
Part of the reason is because of how fentanyl is metabolized, but also because fentanyl does not produce as much of a “sedating effect” as other opioids. Inexperienced fentanyl users mistakenly think that they are still “okay” – that it is safe to take more – leading to a deadly miscalculation.
Epidemiologist Dr. Caleb Banta-Green, of the University of Washington’s alcohol and drug abuse Institute, says that “And when there is a death, more than 80% of the time, alcohol is involved.”
- It is frequently MISLABELED – What drug dealers in Washington State may say is pure heroin has often been cut or replaced with far-deadlier fentanyl.
Increasingly, the substitution is occurring with the black market, illicit prescription pills, as well.
Tragically, this is what occurred in the death of music legend Prince. Law enforcement officers found counterfeit fentanyl pills that had been mislabeled as Watson 385 – hydrocodone and paracetamol – in his home.
The Columbia River Drug Task Force reports that there is no simple way to tell if a particular batch of illicit pills or heroin has been adulterated with fentanyl.
- It can mean administering the WRONG ANTIDOTE—When first responders believe that a person is overdosing on heroin, they inject them with an anti-overdose drug such as naloxone.
But when the drug of overdose is actually fentanyl, then the dosage of naloxone becomes inadequate and cannot reverse the effects of fentanyl, which requires double or even triple the normal amount.
And in the case where the drug has been mislabeled, the repercussions can be deadly. For example, naloxone injections are not given when the cause of the overdose is suspected to be Xanax.
This means that the person overdosing on fentanyl could die because emergency personnel won’t know the true drug that was used.
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What Does All of this Information about Fentanyl Abuse in Washington State Mean?
When you look at opioid abuse as a continuum – prescription misuse to heroin addiction to fentanyl abuse – it is easier to understand why Washington State’s laws changed in 2015 to allow non-licensed people – social services staff, volunteers, etc. – to administer the life-saving drug naloxone. This is also why the Washington State Interagency Opioid Work Plan was created in 2015, to change out opioids are prescribed for patients in acute or chronic pain. Joanne Peterson, the executive director of a Massachusetts-based support network for families who have been impacted by fentanyl addiction, says, “At least with heroin, there is a chance that if someone relapses, they can get back into recovery.” It’s different with fentanyl, she says, because it can be only a matter of moments until they die.