Fentanyl’s rise in the US drug market is part of a much bigger, longer-term strategy from global trafficking groups, according to a new report.
The drug – 30 to 100 times stronger than heroin – is driving the rise in overdose deaths in the US.
It is sold straight, but it is also cut into all kinds of drugs, from heroin to Percocet, and there is no way of users detecting whether it’s there until they try it.
Five years after the US declared an addiction epidemic, things are turning around, with prescription rates on the downturn and more education about the risk of addiction from prescription drugs.
But the one thing that still stumps health officials is fentanyl: how did it spread so far in the US, and why do Americans take it?
According to a new report, published today in the journal Addictions, there isn’t (and never has been) significant user demand for fentanyl specifically among US drug users.
More importantly, it seems, fentanyl was the easiest and cheapest drug for manufacturers and traffickers to produce fast enough to meet America’s rapidly rising demand for opioids.
CDC figures show fentanyl drove up the rate of overdoses in 2017. Donald Trump said on Monday that China will curtail supply. A new UCSF reports explores how fentanyl took off in the US
Questions surrounding fentanyl are not new, but reached new heights last week, when the CDC published new data showing another rise in overdose deaths in 2017, primarily driven by the synthetic drug.
According to the Drug Enforcement Agency, most of the supply is routinely traced back to wholesalers in China.
On Monday, President Donald Trump addressed that, promising (again) that China would curtail its supply, though offering few details on how that would happen.
But the fact remains that fentanyl is now ubiquitous in the US drug market (just last month two 19-year-old boys died after taking a Percocet that they didn’t know was laced with fentanyl), and its not clear how to weed it out.
To explore the big question on everyone’s lips, researchers at the University of California, San Francisco, went to areas where fentanyl use and overdoses are highest – the Northeast and Midwest – to find out from users why they felt the market was thriving.
Some people said they did seek out fentanyl specifically. Those tended to be longer-term heroin or opioid users, who had built up a tolerance to the effects. Fentanyl’s effects are shorter but stronger. They cut through the body’s resistance to give them a feeling of euphoria.
But overall it seemed fentanyl was not high in demand.
There is no widely-used slang term for fentanyl, suggesting there isn’t much ‘hype’ around the drug.
And many users they spoke to were more scared by its potency than enamored. Just two milligrams of fentanyl is enough to kill someone. And yet, there is no way of knowing whether a drug or prescription pill on the black market contains fentanyl, and if it does, how much. There is no consistency to how much fentanyl is cut into any given drug – it could be a pinch, it could be 50 percent.
In fact, even their dealers couldn’t say how much fentanyl was in any given batch. It’s all down to guess work.
‘Fentanyl is rarely sold as fentanyl,’ said Sarah Mars, PhD, a researcher in the Department of Family and Community Medicine at UCSF and the first author of the paper.
‘The dealers selling fentanyl directly to the users often don’t know what’s in it. Not only is this particularly dangerous, but it also means penalizing low level dealers isn’t going to make any difference in the fentanyl poisoning epidemic.’
Fentanyl, the synthetic opioid 100 times stronger than morphine, was the driving culprit, alone accounting for a 45 percent increase in deaths between 2016 and 2017
Those interviews left Mars and her co-author Daniel Ciccarone, a professor of family and community medicine at UCSF, confident that there is, actually, not much demand among users.
From a wholesaler’s perspective, though, there are plenty of upsides.
As prescription rates skyrocketed in the US over the last three decades, demand for any kind of opioid soared. A classic scenario, documented across the country, was that patients would be prescribed highly-addictive opioids, but then wouldn’t be able to afford more. So they would turn to heroin.
It was a dramatic shift in a very short space of time.
But heroin is timely and complicated to make. It is beholden to the poppy-growing season, and can be susceptible to pests.
Fentanyl, meanwhile, is entirely lab-made. It can be produced year-round at a much cheaper rate – and it’s 40 times stronger.
‘The full motives of wholesale suppliers still remain hidden, but there are significant incentives for them to shift over partially or completely to fentanyl, even though it often causes users to overdose,’ the researchers said, adding: ‘It may just be a matter of time before fentanyl takes over more of the illicit US and worldwide drug market, as has already happened in Estonia.’