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Sunday, May 29, 2022

What Is Fentanyl and Why Is It Behind the Fatal Rise in US Drug Overdose? A medical toxicologist explains

Buying drugs on the street is a game of Russian roulette. From Xanax to cocaine, drugs or counterfeit pills purchased in a nonmedical setting can contain life-threatening amounts of fentanyl.

Physicians like me have unwittingly noticed a rise in fentanyl use by people who buy prescription opioids and other drugs containing, or adulterated, fentanyl. Heroin users in my community in Massachusetts discovered that fentanyl had entered the drug supply when an overdose occurred. In 2016, my colleagues and I found that patients who came to the emergency department reporting a heroin overdose often had only fentanyl present in their drug test results.

As the Head of Medical Toxicology at UMass Chan Medical School, I have studied fentanyl and its analogs over the years. As fentanyl has become ubiquitous across the US, it has transformed the illicit drug market and increased the risk of overdose.

Fentanyl and its analogs

Fentanyl is a synthetic opioid that was originally developed as an analgesic – or pain reliever – for surgery. It has a specific chemical structure with many regions that can be modified, often illegally, to form related compounds with marked differences in potency.

The chemical backbone (structure in the center) of fentanyl consists of several regions (colored circles) that can be replaced with different functional groups (colored boxes around the edges) to change its potency.
Christopher Ellis et al., CC BY-NC-ND

For example, carfentanyl, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is about three times less potent than fentanyl, but still caused clusters of overdoses in several states.

Despite the number and variety of its analogs, fentanyl itself continues to dominate the illicit opioid supply. Milligram per milligram, fentanyl is approximately 50 times more potent than heroin and 100 times more potent than morphine.

Replacing or replacing medications with fentanyl

Drug dealers have used fentanyl analogs as an adulterant in the supply of illicit drugs since 1979, including fentanyl-related overdoses in individual cities.

The modern epidemic of fentanyl adulteration is far more widespread in its geographic distribution, production and number of deaths. Overdose deaths have roughly quadrupled, from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, more than 100,000 Americans died from drug overdoses, of which more than 64% were caused by synthetic opioids such as fentanyl and its analogs.

Illegally manufactured fentanyl is synthesized internationally in China, Mexico and India, then exported to the United States as powder or pressed tablets. Additionally, the emergence of the dark web, an encrypted and anonymous corner of the Internet that is a haven for criminal activity, facilitated the sale of fentanyl and other opioids shipped through traditional delivery services, including the US Postal Service. Is.

Fentanyl is driving the increasing number of opioid overdose deaths.

Fentanyl is sold both alone and is often used as a tincture because its high potency allows a small amount of traffic to dealers but maintains the drug effect buyers expect. Manufacturers can also add bulking agents such as flour or baking soda to fentanyl to increase supply without adding cost. As a result, it is more profitable to cut one kilogram of fentanyl than one kilogram of heroin.

Unfortunately, the high potency of fentanyl means that even small amounts of it can prove fatal. If the end user is not aware that the medicine they have purchased is adulterated, it can easily lead to an overdose.

Preventing fentanyl deaths

As an emergency physician, I give fentanyl as an analgesic, or pain reliever, to relieve severe pain in an acute care setting. My colleagues and I choose fentanyl when patients require 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 cause breathing rates to drop 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 one’s breathing rate in real time to ensure their safety.

One measure to prevent fentanyl overdose is distributing naloxone to an audience. Naloxone can reverse overdose as it occurs by blocking the effects of opioids.

Another measure is increasing the availability of opioid agonists such as methadone and buprenorphine that reduce opioid withdrawal symptoms and craving, help people stay on treatment and reduce illicit drug use. Despite the life-saving track record of these drugs, their availability is limited in where and how they can be used and the insufficient number of prescribers.

Naloxone can rapidly reverse an opioid overdose.

Other strategies to prevent overdose deaths include lowering the entry barrier to addiction treatments, fentanyl test strips, supervised consumption sites and even prescription diamorphine (heroin).

Despite the evidence supporting these measures, local politics and funding preferences often limit whether communities are able to try them. Courageous strategies are needed to prevent the ever-increasing number of fentanyl-related deaths.

World Nation News Deskhttps://www.worldnationnews.com
World Nation News is a digital news portal website. Which provides important and latest breaking news updates to our audience in an effective and efficient ways, like world’s top stories, entertainment, sports, technology and much more news.
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