The Rise of Fentanyl in the Opioid Epidemic

Fentanyl’s journey from medical tool to notorious street drug is a tale of science, medicine, and illicit trade. It was synthesized by a nondescript Belgian chemist named Dr Paul Janssen in 1959 and has become the largest contributor of deaths for people aged 18-45 in recent years.[1]

Originally used as a prescription medication to treat severe pain, especially after surgery and for advanced-stage cancer, its illicit use began in the 1970s, but the drug remained relatively obscure until the late 1990s and early 2000s. As opioid over-prescription intensified, so did the misuse and diversion of painkillers, paving the way for fentanyl to enter the illegal drug market. Innovations in illicit drug manufacturing saw fentanyl being synthesized cheaply and added to heroin or sold as counterfeit pills that mimic other opioids, drastically increasing its availability and misuse.[2][3]

The situation escalated as fentanyl, due to its high potency, began causing a significant rise in overdose deaths. By the 2010s, it had not only become a common adulterant in street drugs but also emerged as a primary driver of the opioid epidemic in the United States. This shift marked a devastating chapter in public health, with fentanyl’s lethal potential catching many users by surprise, leading to a dramatic increase in fatalities.


Pharmacological Profile – What Is Fentanyl?

Fentanyl stands out as one of the most potent opioids available, with a potency approximately 50 to 100 times greater than morphine. Its chemical name is N-phenyl-1-(2-phenylethyl)piperidin-4-amine with propanoic acid. It’s fully synthetic, meaning that it can be completely made from chemicals created in a laboratory, negating the need to grow opium poppies which are required for more traditional opiates like morphine or heroin. It acts rapidly, binding to the body’s opioid receptors, which are located in areas of the brain that control pain and emotions. When fentanyl attaches to these receptors, it can produce pain relief and feelings of euphoria; however, it also depresses the central nervous system, lowering the rate of breathing, which in cases of overdose can lead to death.[4]

The high potency of fentanyl makes it incredibly dangerous, particularly when it’s used without medical supervision. Users often underestimate the dose of fentanyl, leading to a higher risk of overdose. This risk is compounded when fentanyl is mixed with other drugs like benzodiazepines or cocaine, often without the user’s knowledge, which significantly increases the likelihood of a fatal overdose.[5]

Its effect on the brain is potent, as it alters the physical sensation of pain and affects emotional responses. The rapid onset of its euphoric effects makes it highly addictive, contributing to a high rate of dependence among users. Withdrawal from fentanyl can be particularly severe, creating a cycle of addiction that is difficult to break without professional help.


The Spread of Fentanyl Across the Country

Fentanyl’s advancement across the United States illustrates a troubling evolution in the opioid epidemic. This is not uniform, with some areas experiencing a more acute impact than others. Hotspots typically emerge in cities with significant opioid use histories, where users seek stronger substances or cheaper alternatives to heroin. The transition from prescription opioids to heroin and subsequently to fentanyl has been marked by increasing overdose death rates, particularly in regions like the Northeast and Midwest.[6]

In 2015, the increase in fentanyl-related deaths first became noticeable. Over the following years, fentanyl spread widely across the United States, leading to a sharp rise in fatalities. By 2018, approximately 80% of these deaths were occurring east of the Mississippi River. The trend shifted in 2019 as fentanyl penetrated the drug markets of the Western U.S., exposing new populations to its dangers and subsequently increasing the death rates there.[7]

The proportion of US overdose deaths involving both fentanyl and stimulants increased significantly from 0.6% in 2010 to 32.3% in 2021, indicating a rapid escalation of polysubstance use involving fentanyl. Initially, fentanyl was commonly found alongside prescription opioids, benzodiazepines, and alcohol. By 2021, the predominant co-involved substances had shifted significantly to illicit stimulants like cocaine and methamphetamine, particularly in the Northeast and Western regions of the U.S.[8]

International drug trafficking plays a significant role in the distribution of fentanyl within the U.S. The drug is often manufactured in labs overseas, particularly in China and Mexico, before being smuggled across borders. It arrives in the U.S. through various channels, including international mail systems and over land borders, making it a complex issue for customs and border protection agencies.[9]


The Global Spread of Fentanyl

The fentanyl crisis, devastating in its impact, is no longer confined to the United States. Secretary of State Antony Blinken, at a United Nations conference in Vienna, underscored the urgency of the issue, warning that the global community might soon face similar challenges. “In many ways we’ve been a canary in the coal mine, particularly when it comes to fentanyl,” Blinken stated. “It hit us hard, it hit us first, but unfortunately not last. And we can see its ravages taking hold in other countries.”[10]

Canada is already experiencing the lethal repercussions of this crisis. In the first nine months of 2023, 82% of opioid toxicity deaths in Canada involved fentanyl, a figure that has seen a significant rise since national surveillance began in 2016.[11] Meanwhile, in Europe, the UK has witnessed an increase in fentanyl-related fatalities. From just eight deaths in 2008, the number escalated to 135 by 2017, with current trends indicating continued growth, particularly in the North East of England. [12]

This stark rise in fatalities illustrates fentanyl’s growing grip on regions far beyond North America, signaling a dire need for international cooperation and effective intervention strategies.


Impact on Public Health

Hospitals and emergency medical services are under immense pressure due to the rise in fentanyl overdoses. The quick onset of overdose symptoms requires fast and effective responses, often involving the administration of naloxone, an opioid antagonist that can reverse the effects of overdose. However, due to fentanyl’s potency, multiple doses of naloxone are sometimes necessary, complicating resuscitation efforts and taxing medical resources.[13]

Fentanyl’s role in the opioid crisis is further complicated by its presence in counterfeit pills and mixtures with other drugs. People unknowingly consume fentanyl, mistaking it for less potent opioids or other substances, leading to a significant rise in lethal overdose incidents, particularly among those without an opioid tolerance. To give an idea of the scale of the problem, in 2018, 42,202 fake pills containing fentanyl were seized by law enforcement. In 2021, this number had risen to 2,089,186, a 4850.44% increase.[14]

First responders and community health programs are on the front lines, advocating for greater access to naloxone and training civilians in its use as part of broader harm reduction strategies. These efforts are highly important in urban areas highly impacted by fentanyl, where community resources are often stretched thin.

To further combat these risks, there’s a growing push for public access to testing kits. Usually given to users of heroin and fentanyl, there is now increased access to people who use traditional “party drugs” such as cocaine and ecstasy which are now heavily contaminated, enabling individuals to identify the presence of dangerous substances like fentanyl before consumption. This preventive approach is a key part of comprehensive harm reduction strategies that aim to safeguard public health amidst the ongoing fentanyl crisis.


Policy and Law Enforcement Challenges

Fentanyl presents unique challenges for both policymakers and law enforcement due to its potency, small volume, and ease of distribution. This opioid’s high potency means it can be trafficked in smaller quantities, complicating detection efforts. Moreover, the emergence of fentanyl analogs – slightly altered chemical variations – poses additional hurdles, as these substances can circumvent existing drug laws, requiring continual updates to regulatory frameworks.

In recent years, international cooperation has seen some success, as highlighted by China’s move to ban the production and sale of fentanyl. However, this has led to the rise of other dangerous substances like xylazine, known as tranq dope, which are used to extend or replace fentanyl, showing the adaptability and resilience of illicit drug markets.[15]


Community and Societal Effects

Fentanyl’s influence extends far beyond the individuals using the substance. Emergency services and healthcare systems are overwhelmed, resources are stretched thin, and the social cost continues to climb as communities struggle to cope with the loss and trauma associated with substance use.

In many areas, fentanyl has led to an increase in crime as people seek to finance their addiction. The costs associated with healthcare, social services, and law enforcement are ballooning, putting significant pressure on local governments and communities. The epidemic has also contributed to a rise in homelessness and a decrease in public safety, creating cycles of poverty and crime that can be difficult to break.

Economically, the opioid crisis has led to increased healthcare costs from emergency room visits, long-term rehabilitation, and the need for increased naloxone distribution to prevent overdoses. There is also a significant impact on workforce productivity and economic output, as individuals struggling with substance use disorder are often unable to maintain steady employment.

Helping Combat the Fentanyl Crisis

Fentanyl is one of the most extreme public health challenges we’ve ever faced. This potent synthetic opioid has drastically reshaped the substance misuse landscape and affects every strata of society; this calls for a society-wide response.

At Crossroads Treatment Center, we recognize the critical nature of addressing this crisis with robust educational efforts and enhanced access to effective treatments. Our approach includes a fully supervised medical detox program that mitigates discomfort and risks associated with withdrawal. It’s highly important that people struggling with fentanyl addiction seek professional help immediately and avoid attempting cessation alone, as the risks can be severe.

Crossroads also provides a comprehensive treatment program and we pride ourselves on providing pain management post-detox, helping people transition to a life free from opioids. Our admissions team consists of clinical experts who work closely with doctors to ensure every client receives the support they need.

If anyone would like to talk through any concerns they may have for themselves or their significant others please call our admissions team; they are clinical experts and work alongside our doctors to ensure we can support you should you decide to seek treatment. Contact Crossroads today to discuss how we can assist you or your loved ones in starting the recovery process.

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