Deadly Fentanyl Behind America’s Dramatic Doubling Of Synthetic Opioid Death Rates
President Donald Trump took a few minutes in his State of the Union address to acknowledge what he called the “terrible crisis of opioid and drug addiction – never been has it been like it is now”.
The American President told Congress that “we have to do something about it”, stating that 174 drug-addiction caused deaths a day meant that “we must get much tougher on drug dealers and pushers”.
This should come as no surprise. The crisis, which claimed well over 100,000 lives between 2015 and 2016, is now so widespread and catastrophic it was declared a public health emergency by President Trump in October.
The rate of American deaths caused by overdoses of heroin-like synthetic opioids has doubled since 2015, in a tragic symptom of the opioid epidemic ravaging the United States.
The US’s Centre for Disease Control and Prevention has published figures showing that the rate of deaths due to synthetic opioids excluding methadone, such as fentanyl and tramadol, jumped from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016.
The total number of deaths due to opioid overdoses also climbed from 52,400 to 63,600, a 21 per cent increase – marking a steady rise since 1999.
Synthetic opioids are the biggest killers
The dramatic rise in the use of synthetic opioids owes more to practicality than demand, Dr David Herzberg, a University of Buffalo expert in the history of drug addiction, told The Telegraph.
“Fentanyl [the most widely used synthetic opioid] is much easier to smuggle than heroin because you need less of it,” he said.
Since synthetic opioids are made in labs rather than from plants, like traditional heroin, they can be made anywhere in the world, and vary dramatically in strength.
Fentanyl is around 50 times stronger than heroin – and some new strains are up to 10,000 times stronger.
This huge variation in potency is what makes makes synthetic opioids so deadly, since users are often completely unaware of the strength of the substance they are injecting, said Dr Jon Zibbell, a Senior Public Health Scientist at RTI International, a nonprofit that funds opioid research.
“I know a kid who buys carfentanil [a newer strand of fentanyl] online and that’s all he injects; he argues it’s totally safe but people mixing it with other stuff don’t really know what they’re doing.
“It’s not the drugs themselves that are killing people but the inability of people to adapt to the uneven potency in the illicit market,” he said.
The rise in fentanyl dates back to 2013, when drug traffickers in Mexico started adding it to heroin to stretch their product further to meet growing demand.
Now fentanyl has also grown in popularity with small drug dealers within the US who buy it online from China, which Dr Zibbell said has led to a bloated supply of fentanyl with no standardization of strength.
Rise of drug overdose death most pronounced among men
Fentanyl is not the only heroin-like drug experiencing a boom in users in the US; the country’s mushrooming opioid crisis is well documented, with the overall rate of opioid drug overdoses increasing every year since 1999.
This owes much, Dr Herzberg said, to a history of over-prescription of painkillers dating back more than three decades to the Reagan administration, when tight controls on opioid sales were relaxed: “Opioid markets were opened up to the full range of strategies drug companies use to sell their products. So a large volume of these drugs were pumped into the market without adequate warnings about the risks.”
A recent paper by Dr Zibbell published in the American Journal of Public Health demonstrated that those regions of the US particularly ravaged by the opioid epidemic have also seen an outbreak of new cases of the degenerative blood disease hepatitis C.
While the rate of death by opioid overdose is lower for women, the rate of new hepatitis C cases developing is much higher. This is particularly concerning as researchers have also documented a large increase in babies born to infected mothers, along with a rise in neonatal abstinence syndrome (babies born physically dependent on opioids).
The trouble in poor, white states may be spreading
Rust belt states such as Ohio, Pennsylvania and West Virginia – with an astonishing rate of 52 drug overdose deaths per 100,000 – have shouldered the brunt of the opioid crisis.
This is partly due to the poverty of these states, but race is also a huge factor – areas with large white populations are disproportionately impacted since the epidemic is rooted in prescription drug abuse, said Dr Herzberg.
“Studies prove that physicians are less likely to prescribe opioids to African Americans or other racial minorities – even when they need them – because of the stereotypes associating them with drug abuse,” he said.
There are signs, however, that the problem has spread to other communities. The mostly non-white District of Columbia, for example, had a rate of death by drug overdose of 38.8 per 100,000 – almost most twice the national average of 19.8.
Dr Zibbell’s research also found high rates of drug treatment and new hepatitis C cases among hispanics. “That was a big deal because the epidemic has been described as mostly affecting the white population,” he said.
Experts say the spread of the opioid crisis beyond the mostly white rust belt states is particularly worrying as it highlights the nationwide extent of the crisis.
“The Trump administration is not putting action or money behind its pronouncements on the problem. If the present trajectory continues it will claim many more young lives,” he said.
President Trump remained defiant in his speech, however.
“The struggle will be long and it will be difficult,” he acknowledge, before adding “we will succeed”.