Pandemic

Fentanyl and Opioid-Drugs Research Paper: Biochemistry, Overdose, and the Pandemic

Academic Lizzy Rager

Nominated by Professor Sheena Turner-August

Abstract

This paper will provide a general overview of fentanyl and opioid drugs. More specifically, it focuses on the topics of cognitive conditioning, other opioids as compared to Fentanyl, Fentanyl overdose rates, Fentanyl laced drugs, China exports of Fentanyl, and drug addiction recovery. There is a focus on the COVID-19 period, as it relates to the rise of Fentanyl imports and overdose rates. The purpose of this paper is to inform readers of the dangers of Fentanyl and opioid drugs to raise awareness and spread caution. Studies that were conducted in San Francisco were reviewed for the literature review, and Workit Health Substance Abuse Counselor Ezra Lockhart provides insight about the Fentanyl market and drug addiction recovery in an interview.

Fentanyl and Opioids Research

Fentanyl is a synthetic opioid similar to morphine but is 50 to 100 times more potent (NIDA, 2021) and is prescribed as an anesthetic for patients with severe pain. When prescribed by a doctor, it comes in the form of a shot, patch, or a lozenge (like cough drops) (NIDA, 2021). Illegal production of Fentanyl made in labs can come in the form of powder, dropped on blotter paper, put in eye droppers or nasal sprays, or made into pills that look like other prescription opioids (NIDA, 2021). According to Pharmacology by Whalen (2015), “The drug is highly lipophilic and has a rapid onset and short duration of action (15 to 30 minutes)”. This means the drug hits fast and doesn’t last for very long. This makes it more addictive in the long-term, as users will experience extreme highs in short bursts and because of its potency, it is a target for highly tolerant opioid users.

There are specific processes that go on inside your brain when you continuously take opioids. When opiates travel through the bloodstream to the brain, the chemicals attach to proteins called mu-opioid receptors on the surface of brain cells (Korsen & George, 2002) and activate the mesolimib (midbrain) reward system which generates signals in the brain called the ventral tegmental area (VTA) that result in the release of dopamine (Korsen & George, 2002). Dopamine releases to the nucleus accumbens (NAc), causing feelings of pleasure (Korsen & George, 2002). Other areas of your brain record the experience as a memory that associates the good feeling with the circumstances and environment they occur. These are called conditioned associations (Korsen & George, 2002). These lead to cravings for drugs when the person is in the presence of the conditioned associations. This drives abusers to seek out more drugs despite many obstacles.

Individual and environmental factors influence whether an individual who experiments with opioids will continue taking them long enough to become addicted or dependent (Korsen & George, 2002). Repeated exposure to opioid dosages quite literally alters brain function. The brain of an individual with a history of abusing opioids will function normally when on the drug, and abnormally when off the drug (Korsen & George, 2002). The result of this is withdrawal symptoms, drug dependence, which makes becoming sober very difficult for the individual. A tolerance is developed because the brain cells that have opioid receptors become less and less responsive to opioid stimulation (Korsen & George, 2002). Wakefulness, breathing, blood pressure, general alertness, and other functions are affected by drug dependence. Repeated use of drugs can result in irreversible damage to brain function.

Late-stage drug addiction, when tolerance to the substance develops and dependence occurs, disrupts cognitive and other processes responsible for successful abstinence. Signals carried by neurotransmitters from the prefrontal cortex, the part of our brain responsible for rationale and judgment, are altered by drug induction 198

(Gould, 2010). According to Psychologist Ezra Lockhart, “The first time that you get high is the highest you'll ever be. And you're always chasing that high, right? Because you've built up a tolerance for the chemical, but also you've damaged that action potential” (E. Lockhart, personal communication, November 12, 2021). The same level of happiness will never be achieved after that first high, and as you use more, the resulting high is continuously diminished. The structure of drugs like Heroin and Marijuana mimics that of a natural neurotransmitter, so the drugs attach to neurons and send abnormal messages through the network (NIDA, 2020). Much like how one adjusts the volume to a loud radio, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit. Or, they reduce the number of receptors that can receive signals (NIDA, 2020). Through these processes, the brain cannot produce the same “good” chemicals again without substance aid.

The appeal of Fentanyl and other Opioid drugs may be related to the fast rate of return upon taking it. Other drugs like hallucinogens (i.e. Marijuana, LSD, DMT) may take 30 minutes or more to produce a high and can be different with the type of high they produce. Hallucinogens may cause sensory distortions, producing images and sensations that are not real (NIDA, 2019). Opioids, on the other hand, trigger the release of endorphins that muffle your feelings of pain and boost feelings of pleasure, creating a temporary but powerful sense of well-being (Mayo Clinic Staff, 2018). This feeling is similar to those of pleasure when you engage in activities such as eating and sex. Heroin is similar to Fentanyl in that it is made from morphine and comes in the form of white or brown powder, or a sticky black substance called “black tar” (Roper, Taylor, & Bielecki, 2020). Drug dealers will sometimes sell Fentanyl and label it as Heroin, or lace Heroin with Fentanyl. This issue is contributing to a large number of Fentanyl overdoses, especially for beginning drug-users who don’t have a very high tolerance.

Fentanyl is inexpensive and easy to make. Drug labs will spike other drugs with Fentanyl without the buyer’s knowledge, or market Fentanyl as other drugs. According to Dr. Lockhart, “People have a substance of choice, thing they prefer to take” (E. Lockhart, personal communication, November 12, 2021). They will not be seeking Fentanyl but another substance, that they know their tolerance and reaction to. So somebody inexperienced may seek out

MDMA, but be receiving Fentanyl. Youth, who are biologically predisposed to spontaneous risk-taking behaviors, may not have the information to assess the risks of drug experimentation. Fentanyl-laced pills will look identical to pills prescribed by doctors. It is tasteless, odorless, and impossible to see, making identification near impossible (Spitzer, 2021). An amount of Fentanyl comparable to a grain of rice can be lethal, increasing the risk of overdose exponentially.

Fentanyl and opioid-related overdose fatalities have been on the rise. The Center for Disease Control (CDC) reports that “approximately 81,230 drug overdose deaths occurred in the United States in the 12-months ending in May 2020” (CDC HAN, 2020). The main driver in these deaths is synthetic opioids. “The 12-month count of synthetic opioid deaths increased 38.4% from the 12 months ending in June 2019” (CDC HAN, 2020), and Fentanyl is the primary drug responsible for synthetic opioid-related overdoses. Illicitly manufactured Fentanyl deaths are concentrated in 28 states east of the Mississippi River, where the drug market is dominated by Heroin (CDC HAN, 2020). Dr. Lockhart, who presides in Colorado, found that “during the lockdown phase, you would think that the access to illegal substances would decrease but in fact, it increased during that time” (E. Lockhart, personal communication, November 12, 2021). The lockdown did not stop any of these networks or people accessing these networks, and pandemic isolation would drive many people to start using or use again.

The major exporter of Fentanyl, China, is able to bypass international protections. They use a “complex network of corporate entities registered in far-flung cities along China's interior, where they use sophisticated shipping methods to bypass screening measures,” they can find loopholes and exploit them (Feng, 2020). Not only that, but as drug operations use the internet as a primary communication platform, it is hard for authorities to crack down on activities. This is due to the internet’s anonymity, convenience, openness, and cross-border accessibility. The early Pandemic created circumstances for an extremely prolific market. Since there was more demand for drugs at this time, drug prices could increase. A convicted distributor of Fentanyl and crystal meth-

amphetamine says, “An ounce of opioids went up to $1700 from $1500”(Mathew et al., 2021). Due to the increase of government stimulus because of Covid-related unemployment, drug-users could use their checks toward drugs. One government stimulus check, The Canada Emergency Response Benefit, helped him increase profits, “Before CERB, he was making $400 to $600 a day. The week after CERB came, he made $1000 a day” (Mathew et al., 2021). Some people would spend entire checks on drugs, despite needing them for living necessities. Yet once you are dependent on drugs, they are essentially a living necessity.

In an experiment addressing drug overdose deaths before and after shelter-inplace orders in San Francisco, there had been a “50% increase in weekly median overdose deaths” and “between March 17[,] [2020] and November 30, 2020, San Francisco recorded 537 drug overdose deaths, while recording 169 deaths due to COVID-19 in the same time period” (Appa, Rodda, & Cawley, 2021). Before COVID-19, there had been an increasing trend in overdose deaths in 2019 because of Fentanyl but stay-in-home orders contributed to a large rise in deaths in 2020 (Appa, Rodda, & Cawley, 2021). The main takeaway of this experiment was that homeless individuals, Black individuals, and people who use Fentanyl and stimulants are the most impacted groups. Many individuals addicted to Fentanyl first received a medical prescription. People who do not live near medical hospitals are limited to prescriptions for treatments. Not only that, but they may not be able to afford more extensive care. Dr. Lockhart explains, “Out of doing risk-taking behaviors in combination to opioids, they are at a higher predisposition for addiction” (E. Lockhart, personal communication, November 12, 2021). Many serious injuries stem from risk-taking behaviors, but sometimes people’s lifestyle calls for risky activities. Many people who enjoy risk-behaviors like climbing were limited due to the pandemic lockdown. With increased feelings of loneliness and depression, they may turn to drugs to fulfill that missing thrill. The circumstances of the pandemic may have caused such a monumental lifestyle shift that individuals who would normally refuse to use substances would begin to use.

The pandemic has increased the likelihood of individuals in recovery to relapse. Dr. Lockhart describes the stages of change model (of recovery) as “an individual moves through precontemplative, where they don’t think that they have a problem but they’re starting to think about it. Then they move all the way into passing that denial ... realizing they have a problem ... reaching out to support, getting support, and then trying to work through their ambivalence and behavior change ... and start to move into, ultimately, a maintenance within recovery” (E. Lockhart, personal communication, November 12, 2021). The shift in daily routine from the lockdown disrupts that maintenance and has caused many to relapse. Outlets for support are harder to access, of course, with limited physical contact. Although, during this time, there has been an effort to destigmatize drug addiction through campaigns. Because of the overflow of patient intake for COVID-19, many hospitals have separate facilities for psychiatric support. Lockhart states the most common reason for relapse is peer pressure. “People have built like social networks, in order to not just access drugs, but to partake in drugs … People have a hard time leaving that [drug] network, leaving that culture behind,” Dr. Lockhart said (E. Lockhart, personal communication, November 12, 2021). Due to the societal stigma — labeling addicts as “junkies,”,pushing them out of jobs and not giving them a chance to be productive in society —those in recovery will be tempted to use to feel happy.

Fentanyl is a highly lethal drug, and the pandemic has increased its consumption. It is used as cheap, potent lace to drugs like Heroin or advertised as another drug altogether. Drug dependence and relapse rates rose throughout 2020-2021, and opioid drugs are the main contributor to overdose. Individuals depending on drugs will have trouble recovering, as long-term consumption of opioids permanently alters brain function causing one to rely on substances for feelings of happiness and satisfaction they cannot get naturally. When society doesn’t give those in recovery a chance, they may feel hopeless. The pandemic has only heightened those feelings of hopelessness. As drug addiction destigmatization campaigns have increased in the past couple of years, one can only hope more will seek recovery, and Fentanyl and other opioids will see less and less destruction.

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