Fighting the Fentanyl Crisis

Journalist | Jungeun Kim | dragon22@yonsei.ac.kr Designer | Youngseo Park | selly4577@yonsei.ac.kr

What is Fentanyl?

Fentanyl is a synthetic opioid, originally for use as an analgesic and anesthetic. It is 50 times more powerful than heroin and 100 times more potent than morphine. Fentanyl can be given in various routes: a shot, a transdermal patch, or lozenges. Similar to other opioid drugs, fentanyl binds to the body’s opioid receptors in parts of the brain that control pain and emotions. Repetitive intake of opioids allows the brain to adapt to opioid drugs. Fentanyl produces effects including drowsiness, nausea, confusion, sedation, hallucinations, extreme happiness, unconsciousness, constipation, etc. Most importantly, an overdose of fentanyl can decrease the amount of oxygen reaching the brain, resulting in hypoxia. The consequences of hypoxia can result in a coma, permanent brain damage, and even death.

There are two types of fentanyl: pharmaceutical and illicitly manufactured. Pharmaceutical fentanyl can be given to a patient only when prescribed by a doctor, especially after surgery and for advanced-stage cancer. Recently, however, illicitly manufactured fentanyl has been sold through black markets for its heroin-like properties. In the illegal drug market, fentanyl is a profitable product due to its high potency and low cost of production.

Illicit fentanyl is produced in clandestine laboratories worldwide without any official oversight and restrictions. Drug dealers also mix fentanyl with other illegal drug substances to increase addictiveness. Thus, people consuming an illicit drug might not be aware of the fact that it contains fentanyl. Fentanyl is lethal even with just 2mg. It also comes in a variety of bright colors, shapes, and sizes. Illicit fentanyl is found in all street drugs these days, and it has also been identified in counterfeit prescription pills. Actions must be taken to resolve this fentanyl crisis.

Overdose Crisis in the US

In the past few years, fentanyl analogs have been responsible for overdose deaths in the US, especially in areas linked to illegally-made fentanyl. The COVID-19 pandemic has accelerated the crisis, with an increasing share of the supply coming from Mexico. According to the Texas Department of State Health Services, there has been a 120% increase in fentanyl-related deaths in Texas. The CDC reported that 107375 people in the US died of drug overdoses in the 12 months period ending in January 2022. Of which, 67% of those deaths were due to synthetic opioids like fentanyl and fentanyl mixed with other illicit drugs. The fentanyl crisis can be seen as one of the worst-ever drug crises in the US.

The United States Drug Enforcement Administration (DEA) has also reported an increase in the threat of xylazine and illicit fentanyl. A mixture of xylazine (a non-opioid sedative, analgesic, and muscle relaxant) and fentanyl can cause the blood vessels to constrict, leading to tissue necrosis and deadly soft tissue ulcers. What makes xylazine more deadly than fentanyl is that it is not an opioid, and it has no medication to adverse the effect. Therefore, a mixture of this deadly xylazine and fentanyl, death tolls can be fatal.

Actions Needed for Combatting the Fentanyl Crisis

Many global leaders refer to the fentanyl overdose crisis as an “epidemic”. However, fentanyl is not a viral pathogen. Its increase is simply a response to the market demand. The fentanyl crisis is now a global crisis, one that requires collaborative global actions.

The Center for Disease Control and Prevention (CDC) has issued a Health Alert Network Advisory recommending the actions appropriate against fighting fentanyl. These actions include:

1. Expanding the distribution and use of naloxone and overdose prevention education

2. Expanding awareness and access to and availability of treatment for fentanyl use disorders

3. Intervening early with individuals high at risk

4. Improving the detection of overdose outbreaks to facilitate a more effective response

Furthermore, May 10th has been designated as the National Fentanyl Awareness Day in the US in order to educate the public about the threats that fentanyl poses. DEA has also observed August 21st as National Fentanyl Prevention and Awareness Day. Facing Fentanyl is a campaign providing prevention education, and honoring those who lost their lives to a fentanyl overdose.

The US government has consistently made efforts to cut both foreign and domestic supplies of opioids by limiting the number of prescriptions and providing counternarcotics assistance abroad. Regulations are increasing related to the production of fentanyl around the world. Additionally, infrastructures for fentanyl test strips as well as naloxone are increasing. Naloxone is a life-saving medication that can reverse an overdose from opioids when given in time. Recently, some LA schools have allowed students to carry Narcan (Intranasal Naloxone Spray) after a series of teen opioid overdose cases. Experts are looking towards other states to do the same.

Conclusion

Over the past few decades, drug overdose deaths have claimed far too many lives. Still, the fentanyl crisis is ongoing and its prevalence is driving many deaths around the world. The CDC has worked relentlessly to prevent overdose and to help people with addiction to recover. The scientific community is also actively looking for alternatives that offer similar therapeutic benefits of fentanyl, while minimizing the toxic risks. To further prevent fentanyl overdose cases, a persistent, coordinated effort across multiple countries will be vital. B