Getting it Right - Fentanyl

Getting it Right!Talking Points for Fentanyl

There is still a lot we don’t know about Fentanyl and USU isdoing everything we can to ensure that we have the mostaccurate information available on the subject.

1. The current fentanyl crisis began around 2013 and at this time was mainly sold as an adulterant mixed with heroin. This mixed product was being sold under the banner of “heroin” even though it contains both heroin and fentanyl.

2. Fentanyl is a synthetic opioid that is about 50 x stronger than heroin.

3. Fentanyl is around 100x stronger than morphine

4. Fentanyl has a rapid onset with a shorter duration of effects, so there is some limited evidence that may suggest compulsive use and repeated administration, which increases the risk of fatal overdose.

5. We have found around 33 fentanyl analogs to date

6. Fentanyl is not naloxone resistant and none of the fentanyl analogs are naloxone resistant.

7. Fentanyl cannot be absorbed through the skin.

8. In states like Ohio, crime lab reporting showed that the majority of cocaine and methamphetamine products that were confiscated by law enforcement and tested positive for fentanyl were in seizures under 30 grams; and of those, a majority were in products less than 1 gram. (Although these trends are only recently being reported with great toxicological detail, they confirm that fentanyl adulteration of cocaine and methamphetamine is occurring, but at the end of the supply chain, the place where smaller products are broken down into smaller portions meant for consumption—not distribution—and “cut” with fentanyl.)

9. The information we have lends to our belief that the introduction of fentanyl to the illicit stimulant market is either unintentional and the result of cross-contamination during the process of bagging product for consumption, or intentionally by drug selling entrepreneurs who are mixing opioids with stimulants to produce what they think is a novel product that can better compete in the illicit marketplace.

10. As of May 5th 2019 there are no known cases of marijuana cut with fentanyl causing overdose death.

11. Opioid toxicity (i.e., “overdose” or respiratory depression) from transdermal and airborne exposure to Illicitly Manufactured Fentanyl (IMF) is a near scientific impossibility. This is explained in a recent position paper by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology.

12. Incidents where responders were treated for alleged “exposure” were exhibiting symptoms of what appear to be anxiety or panic: dizziness, rapid heartbeat, sweating, even fainting – which are not symptoms of fentanyl overdose. There are other stories where officers exhibit no symptoms and yet were “treated” as a precaution. There have been stories of officers administering it to themselves, an impossible task if one is actually experiencing fentanyl-related overdose. There have been cases where naloxone was administered to first responders who were not exhibiting any signs of opioid toxicity, and when they “felt better,” it was attributed to the naloxone, a misinterpretation of the event.

13. The fentanyl in the illicit drug supply comes in powder or solid form, and must have direct contact with mucous membranes or the bloodstream via snorting (inhalation), smoking, or injection to take effect. Yes, even carfentanil. IMF is handled with bare skin throughout much of its travels to the end user, and by the end users themselves, causing no adverse reaction until the drug is ingested via the above-mentioned routes—and even then, fentanyl and fentanyl analogs are used routinely and do not always result in overdose.

14. Marijuana burns at combustion temperatures to high for marijuana smokers to be harmed from fentanyl laced marajuana. The combustion temperature of fentanyl is too low.

15. A November 2018 report in the New England Journal of Medicine describes a cluster of overdoses in Philadelphia where 18 patients who had not intentionally ingested opioids presented to medical facilities with apparent opioid overdose. All reported smoking what they believed to be crack cocaine. Four of the patients died and others experienced significant sequelae. All 18 cases occurred in a short period of time and in the same zip code indicating a point source.

16. Fentanyl and its analogs, such as acetyl, butyryl or furanyl fentanyl, are relatively simple and cheap to produce. They’re also incredibly potent at lower concentrations compared to other opioids such as oxycodone (Oxycontin), morphine and heroin. Consequently, there have been significant increases in its presence in the illicit drug supply throughout the United States. Much of this fentanyl is manufactured in China and smuggled by Mexican drug cartels, along the same routes used to traffic heroin. In some cases, it’s also now being manufactured in clandestine drug labs in the U.S. In 2018, DEA agents raided what they thought was a methamphetamine lab in a western Pennsylvania hotel room; it turned out that the room's occupant had been trying to make fentanyl.

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