SAFE GC Coalition: Fentanyl Third Wave in Opioid Epidemic

A recent study published by the Centers for Disease Control and Prevention (CDC) Prevention, highlights the start of the third wave of the nation's opioid epidemic. The first was prescription pain medications, such as oxycontin, then heroin, which replaced pills when they became too expensive, and now fentanyl.

Fentanyl is a powerful synthetic opioid that can shut down breathing in less than a minute, and its popularity in the U.S. began to surge at the end of 2013. For each of the next three years, fatal overdoses involving fentanyl doubled. The study shows a 113 percent average annual increase from 2013 to 2016 (when adjusted for age).

Researchers maintain increased trafficking of the drug and increased use are both fueling the spike in fentanyl deaths. For drug dealers, fentanyl is easier to produce than some other opioids. Unlike the poppies needed for heroin, which can be spoiled by weather or a bad harvest, fentanyl's ingredients are easily supplied; it's a synthetic combination of chemicals, often produced in China and packaged in Mexico, according to the U.S. Drug Enforcement Administration. And because fentanyl can be 50 times more powerful than heroin, smaller amounts translate to bigger profits. One kilogram of fentanyl, driven across the southern U.S. border, can be mixed with fillers or other drugs to create six or eight kilograms for sale.

For drug users, fentanyl is more likely to cause an overdose than heroin because it is so potent and because the high fades more quickly than with heroin. Drug users say they inject more frequently with fentanyl because the high doesn't last as long — more frequent injecting adds to their risk of overdose. Fentanyl is also showing up in some supplies of cocaine and methamphetamines, which means that some people who don't even know they need to worry about a fentanyl overdose are dying.

There are several ways fentanyl can wind up in a dose of some other drug. The mixing may be intentional, as a person seeks a more intense or different kind of high. It may happen as an accidental contamination, as dealers package their fentanyl and other drugs in the same place. Or dealers may be adding fentanyl to cocaine and meth on purpose, in an effort to expand their clientele of users hooked on fentanyl. The picture gets more complicated as dealers develop new forms of fentanyl that are even more deadly. The new CDC study shows dozens of varieties of the drug now on the streets. This intentional addition of fentanyl is cause for consideration by state authorities.

The highest rates of fentanyl-related overdose deaths were found in New England, according to the study, followed by states in the Mid Atlantic and Upper Midwest. But fentanyl deaths barely increased in the West — including in Hawaii and Alaska — as of the end of 2016.

Researchers have no firm explanations for these geographic differences, but some people watching the trends have theories. One is that it's easier to mix a few white fentanyl crystals into the powdered form of heroin that is more common in eastern states than into the black tar heroin that is sold more routinely in the West. Another hypothesis holds that drug cartels used New England as a test market for fentanyl because the region has a strong, long-standing market for opioids.

Researchers hope that some of the other characteristics of the wave of fentanyl highlighted in the study will help shape the public response. Men are dying after opioid overdoses at nearly three times the rate of women in the United States. Overdose deaths are increasing faster among black and Latino Americans than among whites. And there's an especially steep rise in the number of young adults ages 25 to 34 whose death certificates include some version of the drug fentanyl.

Additionally, the overdose death rate among men is nearly three times the rate of overdose deaths among women. Why is this? Some research points to one particular factor - men are more likely to use drugs alone. In the era of fentanyl, that increases a man's chances of an overdose and death while women are more likely to buy and use drugs with a partner and women are more likely to call for help and seek treatment.

As to why fentanyl seems to be hitting blacks and Latinos disproportionately as compared with whites, researchers point to the higher incarceration rates for blacks and Latinos. Those who formerly used opioids heavily face a particularly high risk of overdose when they leave jail or prison and inject fentanyl, because they have lost their tolerance to high levels of the drugs. There are also reports that African Americans and Latinos are less likely to call 911 because they don't trust first responders, and medication-based treatment may not be as available to racial minorities. Many Latinos say bilingual treatment programs are hard to find.

The CDC is a federal agency that conducts and supports health promotion, prevention and preparedness activities in the United States, with the goal of improving overall public health. To learn more about the CDC please visit www.cdc.gov.

The SAFE Glen Cove Coalition is conducting an opioid prevention awareness campaign entitled, "Keeping Glen Cove SAFE," in order to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.