The statistics are sobering: Drug overdoses killed 64,116 Americans in 2016, and opioids, a category of pain relieving drugs that include morphine and heroin, were responsible for 8 of every 10 of these deaths. That’s more than the number of Americans who lost their lives to HIV at the epidemic’s 1995 peak, and more than those killed by drunk drivers for the past 5 years combined.
"It's American carnage," Bill Bennett, the former director of the Office of National Drug Control Policy, explained. He is now a senior adviser for Americans for Responsible Drug Policy, a group formed to address the opioid epidemic in this country.Instinctively, we cast the blame on prescription pain relievers, the physicians who continue prescribing them, and the pharmaceutical companies that billed opioids as the panacea to chronic pain. But as the Centers for Disease Control and Prevention continues releasing data on the opioid epidemic’s climbing death toll, an uncomfortable truth is emerging. While opiates like Vicodin, Percocet and OxyContin sparked a national epidemic in the late 1990s, prescription painkillers are no longer driving America’s opioid problem. Illicit fentanyl and other synthetic opioids are the new grim reaper.
As of August 2016, fentanyl and its analogs (drugs that mimic chemical structure and therefore effect) are consistently killing more people than either heroin or prescription opioids. But it's the rate at which these deaths are amassing that’s so concerning. As the New York Times reported in September, fentanyl deaths were up 540 percent over the last three years. The CDC’s most recent data, available just 3 months after the Times exposed the skeletons in fentanyl’s closet, shows that rate climbing over 600 percent.Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. Just a few grains — barely more than what it takes to cover Abe Lincoln’s chin on the head of a penny — is enough to kill.Commercial fentanyl is available as a prescription drug. But unlike its predecessors in the current epidemic, the CDC doesn’t attribute the rapid overdose increase to physicians overprescribing; a likely result of limiting fentanyl’s medical use to surgical anesthesia and reserving prescriptions for patients on end-of-life care, and for those facing severe chronic pain that other opioids can no longer treat.Almost all the fentanyl available on the streets is illegally manufactured in China and Mexico, and is available direct-to-consumer over U.S. mail. The ease with which fentanyl can be acquired over the dark web has contributed to a seven-fold increase in synthetic opioid overdoses in teenagers in 2015. According to Assistant U.S. Attorney Joseph Pinjuh, the sheer volume of packages entering the U.S. from China prohibits the federal government from getting ahead of the epidemic.Since the drug is synthetic and doesn’t rely on the cost of labor and production of an opium crop like heroin, it's cheap, too.So cheap, that it’s far more cost-effective for drug dealers to cut a poor quality batch of other powdered drugs with small amounts of fentanyl. In fact, drug overdoses involving cocaine had been on a sharp decline until fentanyl hit the streets around 2013.
If current trends hold, more than 40,000 Americans could fall to fentanyl overdoses this year. If we are to be good stewards of public health, we must ensure the national narrative is keeping pace with the data. This means devoting more attention to illicit synthetic opioids like fentanyl at a time when the number of opioid prescriptions, and their share in overdose deaths, are dropping. Continuing the judicious prescription of opioids must be part of the solution, but doctors alone cannot curb America’s opioid crisis. The media must do its part to educate the public about what is really killing us. And other stakeholders in communities across America, from educators, law enforcement, and faith leaders.
Most important, we can learn from past successes. "We can beat this thing, and we can get the numbers down," Bennett explained. "A lot of people don't know this, but we got the numbers down once before on the drug-abuse front in the 1980s — everything from heroin to cocaine to PCP. We cut the number of people using illegal drugs in half in the 1980s and early 90s, and we can do it again."
Dr. Joseph Perrone is the Chief Science Officer at the Center for Accountability in Science.
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