Thus someone who’s on maintenance but seeking one last ‘high’ often looks to fentanyl as a way around the medication. That’s risky in the extreme.

Fentanyl-pt3Thought I’d call your attention to an article in the New York Times on fentanyl as it moves into large swaths of the eastern US and into Canada.

This of course isn’t a new epidemic, but merely an extension of the current one. That began, remember,  in the late 90’s, with the increased reliance on opioids for the treatment of chronic pain, and the introduction of potent products such as Oxycontin. As the nation woke up to the escalating death toll from prescription drugs, and began to restrict availability, heroin emerged as a ready alternative. Pretty soon we were reading about the heroin epidemic, as if it were a separate phenomenon (it isn’t). Drug dealers had been selling heroin cut with fentanyl for many years, under the name ‘China White’, so it wasn’t a stretch for them to make and sell fentanyl on its own. It can be sold as its weaker cousin (heroin), or in tablet form, pretending to be Oxycontin.

For a description of what happens when fentanyl becomes a common street drug, see the article.

We read about fentanyl’s exceptional potency (perhaps 50 times the strength of heroin), but a big reason for its popularity is that it’s cheap to make and distribute. The US variety appears to come from Mexico, making use of the same transport system that Sam Quinones describes in his book Dreamland— which just won the 2016 National Book Critics Circle prize for nonfiction (so if you haven’t read it, do). Fentanyl in Canada is thought to come mostly from Asia.

Domestic production of fentanyl does exist but is not yet common. Of course, if there were to be an interruption in the foreign supply, local production would no doubt ramp up quickly to replace it.

Because fentanyl dissolves with exceptional ease in fat tissue, it penetrates the central nervous system quickly to produce an intense if relatively short-lived effect. That’s another reason for the overdose fatalities– the user is often deceased before a rescue can be attempted.

Another thing to consider: Fentanyl’s potency means it can overcome the blockade provided by even high doses of buprenorphine. Thus someone who’s on maintenance but seeking one last ‘high’ often looks to fentanyl as a way around the medication. That’s risky in the extreme.

If I had to guess, I’d worry about another surge in ODs wherever fentanyl penetrated the markeplace. I just hope that a year or two from now, we won’t look back on heroin as the lesser of evils.


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