The fentanyl crisis in America continues to escalate, with a significant rise in deaths attributed to this highly potent synthetic opioid. Synthetic opioids, including fentanyl, have witnessed an alarming surge, resulting in a nearly 7.5-fold1 increase in drug overdose deaths from 2015 to 2021. The data unequivocally indicates that drug-related overdose deaths have substantially increased in recent years, largely due to the prevalence of synthetic opioids. Because of this, fentanyl has emerged as one of the deadliest drug threats ever encountered in the United States.
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Understanding the Situation at the Federal Level
The severity of the issue has drawn the attention of the White House, prompting officials from the Biden administration to issue warnings about the ongoing surge of illicitly manufactured fentanyl in America, which continues to claim lives. These concerns were echoed during a crucial Senate panel, which included key drug enforcement officials. The Senate Foreign Relations Committee has actively sought ways to impede the flow of fentanyl into the country.
Where Does Fentanyl Come From?
The dual sourcing of fentanyl, from both legal and illegal channels, has contributed to the alarming increase in deaths associated with this potent synthetic opioid. Pharmaceutical fentanyl, utilized for pain relief in medical contexts, and illicit fentanyl from the black market are the two primary sources of this drug.
What is Fentanyl?
Fentanyl stands out as an extraordinarily dangerous illicit drug due to its immense potency. This synthetic opioid can be 50-100 times stronger than morphine, meaning that even a minute quantity can prove lethal. Merely two milligrams, approximately the size of five grains of salt, can induce severe negative health effects, overdose, or even death. This inherent potency also makes prescription fentanyl, commonly used for treating severe pain, particularly hazardous. The DEA emphasizes the ease with which prescription fentanyl can be diverted for abuse.
Furthermore, the fact that fentanyl lacks taste and odor adds to the danger it poses. It is often impossible to determine if a drug has been laced with fentanyl without specialized test strips or laboratory analysis. Fentanyl is available in both powdered and liquid forms, with the powdered variant being more common. Powdered fentanyl is white in color and visually indistinguishable from many other drugs. Liquid fentanyl, although rarer, can be combined with formulas for nasal sprays, eye drops, or even added to small food items like candy.
Drug dealers frequently mix fentanyl with other substances such as heroin, cocaine, and methamphetamine to enhance their potency. These dangerous combinations may also be pressed into pills that resemble prescription opioids. Given its prevalence, there is a significant risk that any illegal drug may be contaminated with fentanyl, whether intentionally or unintentionally.
Recognizing the signs of a fentanyl overdose is crucial. These signs include small “pinpoint” pupils, loss of consciousness, shallow or absent breathing, choking or gurgling sounds, limp body parts, cold skin, and discolored skin, particularly noticeable in the nails and lips.
If someone is suffering from fentanyl overdose, contact a hospital immediately. Overdose is always dangerous and requires a medical professional to treat it, but in the case of fentanyl overdose it is absolutely essential. Overdoses on fentanyl are often fatal, but the person still has a chance if a medical professional can administer fast and effective treatment.
Fentanyl on the Black Market
Illicit fentanyl is predominantly purchased and distributed illegally, often smuggled into the US via Mexico, similar to many other dangerous substances. However, the supply chain and trafficking routes for fentanyl are more intricate than expected. The Drug Enforcement Administration (DEA) has uncovered that transnational criminal organizations (TCOs) in Mexico manufacture fentanyl using precursor chemicals sourced from China.
Subsequently, these organizations traffic the majority of fentanyl through routes connecting Mexico to California or Arizona. Each kilogram of fentanyl distributed has the potential to cause the deaths of 500,000 individuals. Fentanyl is frequently pressed into pills that closely resemble prescription opioids. However, its presence extends beyond counterfeit pills, as fentanyl is commonly found laced with other illicit drugs like heroin, cocaine, and methamphetamine, amplifying their potency. The Sinaloa and New Generation Jalisco cartels are identified as major producers of this hazardous synthetic opioid, exerting control over the global supply chain. Additionally, the DEA recognizes India2 as an emerging source of both fentanyl and the precursor chemicals required for its production. The Biden administration is committed to utilizing foreign policy tools to impede these cartels and prevent the influx of fentanyl, thereby reducing overdose deaths.
Regardless of its origin, fentanyl is an inherently dangerous substance. Even pharmaceutical fentanyl, when used, must be approached with caution due to its immense potency. This synthetic opioid can be 50-100 times stronger than other commonly employed pain relief drugs, such as morphine. Even a minuscule dose of two milligrams can result in severe adverse health effects, overdose, or fatality.
Actiq, Duragesic, and Sublimaze are among the prominent prescription drugs containing fentanyl, available in various forms such as tablets, injectable liquids, transdermal patches, and lozenges. These medications are commonly prescribed to manage pain following surgery. While these drugs contain only a minimal amount of fentanyl, it takes a small dose to be lethal. A mere 2 micrograms constitute a lethal dose of fentanyl, and prescription drugs can contain anywhere from 400 to 1,600 milligrams, depending on their strength. 3 Given that there are 1,000 milligrams in 1 microgram, patients who unintentionally exceed the recommended dosage within a specific timeframe can inadvertently ingest a lethal amount.
Dependence often leads to addiction, and the relief and euphoria provided by these prescription drugs can prompt individuals to experience withdrawal symptoms upon discontinuation. This may drive individuals with no prior history of illegal drug use or abuse to seek out illicit forms of fentanyl or attempt to acquire another prescription from different healthcare providers. In such cases, the risk of obtaining and consuming counterfeit prescription pills laced with a deadly dose of fentanyl becomes alarmingly high. According to estimates from the Drug Enforcement Agency, six out of every ten fentanyl-laced prescription pills are potentially lethal doses of this synthetic opioid.
The Fentanyl Crisis in America
The fentanyl crisis in America carries not only a devastating loss of lives but also significant economic implications. Estimates reveal that the epidemic has incurred a staggering cost of nearly $1.5 trillion in 20204, equivalent to 7% of the Gross Domestic Product (GDP). With the rise in overdoses, it is likely that the fentanyl crisis in America continues to financially burden the country more with each passing year.
As with previous drug crises in American history, fentanyl disproportionately impacts impoverished, marginalized, and underprivileged communities. Disturbingly, the rate of opioid-related deaths among Black and American Indian or Alaska Native populations exceeds the national average. 5 Fentanyl also stands as a leading cause of death among individuals experiencing homelessness, particularly in major urban centers like Los Angeles. 6
Interestingly, the highest rates of opioid overdose deaths primarily afflict states on the east coast. 7 In 2021, all ten states with the highest rates are located on the eastern seaboard. New Mexico and Arizona are the sole western states surpassing the national average for opioid overdose rates. However, this does not imply that the fentanyl crisis in America is absent as an issue in other states or that citizens in those regions are immune to its impact.
Between 2016 and 2021, fentanyl overdose deaths in Los Angeles County saw an astonishing increase of 1,280%.8 While commonly associated with low-income, underserved, and inner-city communities, the impact of fentanyl extends to small towns surrounding central Los Angeles. However, in these areas, the risk stems not from illicit fentanyl use but from the use of prescription medications prescribed for severe acute and chronic pain.
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5 Source: https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?dataView=1¤tTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
7 Source: https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?dataView=1&activeTab=map¤tTimeframe=0&selectedDistributions=overall&sortModel=%7B%22colId%22:%22Overall%22,%22sort%22:%22desc%22%7D