Fentanyl, a highly addictive synthetic opioid, accounted for over 60% of drug overdoses in 2022, claiming the lives of roughly 70,000 Americans. Similar to morphine, fentanyl is a pharmaceutical painkiller with relieving effects 50 times more potent than traditional opioids. Its highly potent pain-relieving attributes contribute to its high rate of addiction. The majority of fentanyl related deaths in America, however, can be attributed to illicit fentanyl artificially produced in drug labs. The illicit fentanyl is distributed in a variety of forms including powder, pills, and mist. The inappropriate and medically unsupervised use of fentanyl has extremely adverse effects on both the human brain and body, leading to imminent death. With its high potency, fentanyl requires only a small concentration to achieve a high, making the drug more accessible and cheaper than any other conventional opioid. With fentanyl at the forefront of the decades-long American opioid epidemic, it is imperative that the public stay informed to stay safe.
To better understand the state of fentanyl in America, I spoke with 30-year police officer and DARE consultant Rob Ullrich who served in Lewiston, Maine for the majority of his career. He now works with the police department in Hendersonville, Tennessee.
What is Fentanyl?
It's first important to distinguish between an opioid and an opiate, terms that have incorrectly become interchangeable and are often misused. An opiate is a fully organic chemical naturally extracted from poppy sap and poppy plant fibers. The poppy is a psychedelic flower native to southern Europe and northern Africa and has been a point of contention and conflict for centuries; common opiates include drugs like morphine and codeine. Naturally, opiates are more difficult to produce and distribute since they are dependent upon the growth cycle and limited sap reserves of the poppy plant. In contrast, an opioid is a more general term that refers to any drug that binds to the body’s opioid receptors, which includes natural opiates and their synthetic opioid copies. An often overlooked fact is that opioids are not foreign substances; the human body naturally produces similar substances called endogenous opioids. These naturally occurring opioids work to modulate pain once the pain-inducing stimuli have stopped, preventing excessive and unnecessary discomfort. Opioids, both exogenous and endogenous, also flood the brain with excessive dopamine, creating a state of euphoria. They achieve this through binding to opioid receptors in the brain stem and stifling the secretion of inhibitory neurotransmitters. Typically, these inhibitory neurotransmitters, specifically a transmitter known as GABA, impede dopamine production, so by blocking these inhibitory transmitters, the brain produces an overwhelming amount of dopamine, resulting in an extreme high. The quantity of dopamine released in the process of fentanyl binding is what makes the drug so attractive. But each individual surge of dopamine requires a larger opioid input, creating a gradual addiction progression in which the longer you use, the more dependent you become. The standard fentanyl molecule is derived from the organic compound piperidine, a colorless liquid chemical with a six-carbon ring. This basic chemical structure can be modified to create samples of varying potencies. Derivatives of the basic fentanyl compound include acetyl fentanyl, furanyl fentanyl, and carfentanil, a chemical used to create elephant tranquilizers.
However, this extreme happiness is accompanied by a number of adverse side effects including nausea, constipation, vomiting, and pupillary contraction.Not surprisingly, more malignant side effects than these can occur when a consumer overdoses on the drug. According to the Drug Enforcement Administration, a 2mg sample of fentanyl, ingested in any form, contaminates the bloodstream and kills the consumer. When ingested above the recommended pharmaceutical amount, fentanyl compromises the respiratory system, blocking sufficient oxygen from reaching the brain, inducing hypoxia, which places the consumer at risk of comas, seizures, and death. Fentanyl affects the consumer in the short-term while also presenting severe long-term issues as well, even if one is able to overcome their addiction. Regular use over a long period of time permanently lowers libido and blood pressure while potentially inducing violent mood instability.
Treatment Methods
The most effective way to combat the negative effects of fentanyl is actually another opioid. Naloxone, commercially available as Narcan, combats the negative respiratory effects of fentanyl and desaturates the respiratory system. Naloxone binds to the same receptors as fentanyl, replacing the malignant fentanyl compounds, but induces no effects on the nervous system, thus reversing the detrimental effects of the illegal drug. Officer Ullrich has administered Narcan (Naloxone) on multiple fentanyl-related occasions, one of which involved a couple who had injected fentanyl-laced heroin in a parking garage. Officer Ullrich described the experience as, “Standing over a dead person. He stopped breathing and was completely unresponsive, but upon administering the Narcan up the nasal canal, he bounced right back; it was like a miracle drug.” Another one of his stories comes from his time working in the department in Lewiston, Maine where a young female overdosed six times in a single week, but on each of those occasions, she was fortunate enough to have an officer nearby to administer the naloxone.
Where is it coming from?
Most of the circulating fentanyl is manufactured in countries like China and Mexico and is being trafficked into the United States. Officer Ullrich commented that most of this foreign-produced fentanyl is shipped through the mail and smuggled onto US bound freight ships, disguised as standard pills. Due to the high potency of fentanyl, only a small concentration is needed to produce a high, meaning that the suppliers can package highly lucrative amounts of high-inducing fentanyl concentrations in a single envelope. China and Mexico both play major roles in supplying and producing this illicit fentanyl. The Chinese usually supply the raw chemicals necessary to produce the compound while Mexican cartel lords refine these chemicals, producing the final product. These cartels then smuggle the drug through the American border by train, boat, and even foot.
Why is Fentanyl so Dangerous?
There are multiple factors that contribute to the alarmingly high danger level of fentanyl, the most prominent being its addictive properties, availability, and drug cross-contamination. The astronomically high potency level of fentanyl makes the drug far more addictive than substances like codeine or cocaine. Users are able to achieve an intense high with only a fraction of a milligram, and with its potent pain suppressing capabilities, patients easily become dependent on the drug, creating an almost irreparable addiction. In fact, the addictive properties of fentanyl are so strong that users experience severe withdrawal symptoms after an hour without usage. Withdrawal symptoms include depression, insomnia, appetite loss, and severe hyperventilation. For a frequent fentanyl user, their neurons are not accustomed to processing and transmitting pain signals, since the opioids would typically suppress and hinder those signals. So when that individual stops using the drug, any sensation received by those neurons confuses them, resulting in mundane sensations becoming excruciatingly painful. For someone battling withdrawal, the sensation of shirt fabric brushing the skin becomes unbearable. Often, the daunting notion of withdrawal deters fentanyl abusers from ever seeking help, making the crisis much more difficult to alleviate. Another contributing factor to the emerging American fentanyl crisis is availability. Since the drug is artificially mass produced in clandestine drug laboratories, Fentanyl is both cheap and easy to acquire. This ease of acquisition and low cost makes fentanyl overdose deaths far more common and pervasive. The sheer amount of circulating and produced fentanyl also makes it far more difficult for government agencies to regulate and prevent drug use and distribution. The third major issue with fentanyl is drug contamination and deceptive packaging. Fentanyl is now being mixed with other opioids like codeine and heroin. According to Officer Ullrich, “There are traces of fentanyl in almost every sample of any illicit opioid, fentanyl is getting mixed in with everything.” This makes it impossible for the buyer to decipher the identity of the drug they have purchased. And since fentanyl is over fifty times more potent than heroin, a larger sample of fentanyl-contaminated heroin will undoubtedly kill the consumer. Finally, illicitly manufactured fentanyl is often produced to appear exactly similar to a standard prescription pill. This makes the drug both easier to smuggle into the country and easier to sell to an uninformed buyer who may think they are purchasing prescription pills at pharmaceutically safe concentrations. Officer Ullrich also mentioned that his first fentanyl overdose death was caused by medically prescribed fentanyl patches which are often used to lessen the pain of cancer victims. When I asked him his take on why fentanyl is so dangerous, he answered with, “It is so easy to acquire and abuse and so difficult to regulate and prevent.”
Statistics
As the graph to the left displays, drug-related deaths have been steadily increasing since the turn of the century. In fact, the number of DRDs (drug-related deaths) in 2021 is over five times the tally in 2000. The American drug crisis has also disproportionately affected males, since the statistic has been recorded. But over the past few years, the disparity between female and male DRD’s has drastically increased.
Of the 106,699 overdose deaths in 2021, 67,325 (60%) of them can be attributed to preventable fentanyl overdoses. Here in Tennessee, there were 3814 opioid related deaths in 2021, 2,734 of which were fentanyl related. The age range in which fentanyl usage is most common was found to be ages 35 to 44 at 1106 deaths. Surprisingly, only 21 of the 2734 dead were under 18, but this number is expected to increase in the following years, to which Officer Ullrich agrees. When analyzing the Tennessee statistics, it was found that males were twice as likely to overdose on fentanyl as compared to females, which correlates with the national trend. Furthermore, 80% of those fentanyl victims were white, while the remaining 20% were predominantly African-American. When asked why this racial disparity exists, Officer Ullrich expressed, “From my experience, the African-american population tends to abuse crack cocaine rather than synthetic or semi-synthetic opioids.”
Rob’s Advice on How to Avoid
To close the interview, I asked Officer Ullrich his advice on how as teenagers, we can avoid unintentionally consuming fentanyl or falling into a dangerous cycle of dependence. This is what he had to say:
“Fentanyl abuse, especially within teens, starts with underage drinking which then escalates to marijuana and then finally, opioid abuse. Kids that develop addictive personalities are constantly trying to find the next big high, a search that culminates in opioid dependence since they are so damn potent. The scary and dangerous part about fentanyl is that it is being mixed in with other drugs, so a kid might think he’s only buying a bag of marijuana, but in reality, there are traces of fentanyl in the sample. I’m a firm believer in gateway drugs so the biggest advice from me, although it sounds so simple and easy, is to stay off all illegal drugs and avoid developing inappropriate drinking habits. And if you're a medical patient who requires pain suppressants, just be weary of the possible side effects and addictive habits that may develop. And remember, your parents can only protect you so much.”
- Hudson Honeybone
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