Posted on 11/17/2023 11:16:56 AM PST by Red Badger
Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in nonmedical settings may contain life-threatening amounts of fentanyl.
Physicians like me have seen a rise in unintentional fentanyl use from people buying prescription opioids and other drugs laced, or adulterated, with fentanyl. Heroin users in my community in Massachusetts came to realize that fentanyl had entered the drug supply when overdose numbers exploded. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often only had fentanyl present in their drug test results.
As the Chief of Medical Toxicology at UMass Chan Medical School, I have studied fentanyl and its analogs for years. As fentanyl has become ubiquitous across the U.S., it has transformed the illicit drug market and raised the risk of overdose.
Fentanyl and its analogs
Fentanyl is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.
Fentanyl’s chemical backbone (the structure in the center) has multiple areas (the colored circles) that can be substituted with different functional groups (the colored boxes around the edges) to change its potency. Christopher Ellis et al., CC BY-NC-ND
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For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states.
Despite the number and diversity of its analogs, fentanyl itself continues to dominate the illicit opioid supply. Milligram per milligram, fentanyl is roughly 50 times more potent than heroin and 100 times more potent than morphine.
Lacing or replacing drugs with fentanyl
Drug dealers have used fentanyl analogs as an adulterant in illicit drug supplies since 1979, with fentanyl-related overdoses clustered in individual cities.
The modern epidemic of fentanyl adulteration is far broader in its geographic distribution, production and number of deaths. Overdose deaths roughly quadrupled, going from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, more than 100,000 Americans died from a drug overdose, with over 64% of these deaths due to synthetic opioids like fentanyl and its analogs.
Illicitly manufactured fentanyl is internationally synthesized in China, Mexico and India, then exported to the United States as powder or pressed pills. China also exports many of the precursor chemicals needed to synthesize fentanyl.
Additionally, the emergence of the dark web, an encrypted and anonymous corner of the internet that’s a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through traditional delivery services, including the U.S. Postal Service.
During the 2023 Asia-Pacific Economic Cooperation summit, U.S. President Joe Biden and Chinese President Xi Jinping reached an agreement to combat fentanyl trafficking.
VIDEO AT LINK...........
Fentanyl is both sold alone and often used as an adulterant because its high potency allows dealers to traffic smaller quantities but maintain the drug effects buyers expect. Manufacturers may also add bulking agents, like flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to cut a kilogram of fentanyl compared to a kilogram of heroin.
Unfortunately, fentanyl’s high potency also means that even just a small amount can prove deadly. If the end user isn’t aware that the drug they bought has been adulterated, this could easily lead to an overdose.
Preventing fentanyl deaths
As an emergency physician, I give fentanyl as an analgesic, or painkiller, to relieve severe pain in an acute care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery.
But even in the controlled conditions of a hospital, there is still a risk that using fentanyl can reduce breathing rates to dangerously low levels, the main cause of opioid overdose deaths. For those taking fentanyl in nonmedical settings, there is no medical team available to monitor someone’s breathing rate in real time to ensure their safety.
One measure to prevent fentanyl overdose is distributing naloxone to bystanders. Naloxone can reverse an overdose as it occurs by blocking the effects of opioids.
Another measure is increasing the availability of opioid agonists like methadone and buprenorphine that reduce opioid withdrawal symptoms and cravings, helping people stay in treatment and decrease illicit drug use. Despite the lifesaving track records of these medications, their availability is limited by restrictions on where and how they can be used and inadequate numbers of prescribers.
Other strategies to prevent overdose deaths include lowering the entry barrier to addiction treatment, fentanyl test strips, supervised consumption sites and even prescription diamorphine (heroin).
Despite the evidence supporting these measures, however, local politics and funding priorities often limit whether communities are able to give them a try. Bold strategies are needed to interrupt the ever-increasing number of fentanyl-related deaths.
This article was updated on Nov. 16, 2023 to note developments regarding fentanyl at the Asia-Pacific Economic Cooperation summit.
Illegal aliens the end
I saw a report that the Taliban had reduced the cultivation of opium by 96%. The report didn’t say, but I suspect their method was to kill the farmer if he didn’t stop growing. The Taliban gave the farmers one year to comply. The upshot of this was that opium became largely unavailable. It is being replaced by other drugs. Those drugs are substantially more deadly. The same report outlined how much opium cultivation had gone up while the Americans were there. I understand, but it isn’t a good look for the US.
What is fentanyl
A substance that should be distributed to every homeless camp on Friday nights
Don’t understand the business model. If you’re selling drugs to someone isn’t the point an addicted customer who always needs the next hit? If you give them something that kills them with the first use doesn’t that kind of mess up the model?
Back in the 1990’s “designer” drugs were hitting the street. They were drugs modified from fentanyl’s chemical composition that, since it wasn’t exactly fentanyl, wasn’t illegal. One of the fentanyl based designer drugs lead to a Parkinson’s like condition that rapidly progressed to death. I haven’t heard much about designer drugs in a while. The thing with fentanyl is that you rapidly build a tolerance. With large doses the drug sequesters in the lungs. After several hours it leeches out of lung tissue and can lead to respiratory depression and death.
Druggies and their suppliers aren’t that bright at business math..............
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It’s directly correlated to the crackdown on prescription opiates. People who got hooked or otherwise abused them moved to cheaper heroin, which then got more laced with even more cheaper fentanyl. Now a typical heroin junkie can’t get high on heroin. It’s the fentanyl they are addicted to. So is it better or worse than when they had to go to a doctor and pharmacy to get pills?
Complete order is easy if the government is willing and powerful enough to impose it.
“Chewing gum is banned in Singapore so leave it at home when packing your bags. Importation of chewing gums into the country, even if it is not for trading, is illegal.”
“Not flushing the toilet is more than just a breach of propriety in Singapore, you will be breaking the law if you do so.”
When I worked around SE Asia in the 90s I loved Singapore for the order, cleanliness and safety. I always got nervous though when entering the country because of the drug penalty of death... they mean it... every word. My fear was being planted unwillingly and unwittingly as a mule coming in from a country in the region. It happened to some but fortunately not me. In all my travels I never checked luggage no matter how long I was going to be on the road and kept an eye on my stuff all the time. One large soft side expandable briefcase and one faithful rectangular roll-on. Sometimes awkward, sometimes irritating but always an advantage to me. Business class seating facilitated my travel style.
This is a self correcting problem. It requires zero taxpayer dollars.
In some areas, Fentanyl is being mixed with a large animal tranquilizer to give it more strength. This will eventually cost 500,000 deaths a year I will bet.
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