HEALTH
deathdrug T
he US is in the midst of a healthcare epidemic. Tens of thousands of people are dying each year from opioid drugs, including overdoses from prescription painkillers such as oxycodone and the illicit street drug heroin, and each year the numbers rise. In 2016, overdose deaths increased by 21% to 64,070 according to the National Centre for Health Statistics (NCHS), and experts anticipate a further rise in 2017.
The opioid epidemic is
currently killing almost twice as many people as shootings or motor vehicle accidents , with overdoses quadrupling since 1999. According to Gary Franklin, medical director of the Washington State Department of Labour and Industries and a professor of health at the University of Washington, the opioid epidemic is ‘the worst man-made epidemic in modern medical history in the US’. Incredibly, an influx of
synthetic opioids is making the problem worse. Fentanyl, a licensed drug to treat severe pain, is increasingly turning up on the street as illicit fentanyl, often mixed with heroin. According to the NCHS, fentanyl and synthetic opioids are blamed for 20,145 of the 64,070 overdose deaths in 2016. Heroin contributed to 15,446 deaths, while prescription opioids caused 14,427. In 2015, overdose
An influx of synthetic opioids, and particularly the drug fentanyl, is making the US opioid epidemic even worse, Katrina Megget reports
deaths from synthetic opioids registered just under 10,000. It’s becoming a ‘fentanyl crisis’, says the US Drug Enforcement Administration (DEA).
Potent opioid Fentanyl (C22
H28 N20 ), a lipophilic
phenylpiperidine opioid agonist, was first synthesised in 1959, with the first formulation, marketed as Sublimaze, approved as an intravenous anaesthetic in the 1960s. Since then, the drug has been formulated as a transdermal patch, lollipop and dissolving tablet. Like the opioids derived from opium poppies, such as mor- phine, fentanyl binds to opioid receptors in the brain and other organs of the body, specifically the mu-receptor. Such binding mimics the effects of endogenous opiates (endorphins), creating an analgesic effect, as well as a sense of well-being when the chemical binds to receptors in the rewards region in the brain. Drowsiness and respiratory depression are other effects,
which can lead to death from an overdose. Repeated use of opioid drugs
reduces the production of endog- enous opioids, which can cause the unpleasant drug withdrawal symptoms. Tolerance, as a result of the desensitisation of the brain’s natural opioid system, also occurs with repeated use, where higher doses are needed to achieve the same effect, in- creasing the risks of overdose.
Rise of illicit fentanyl Fentanyl itself is a fat-soluble fast-acting opioid, with a potency 50-100 times greater than morphine. A mere 2mg of fentanyl – equivalent to 1/50th of 0.1g of heroin – can be lethal. Since the 1970s, prescribed fentanyl – a US Schedule 2 prescription drug – has been known to be abused but since about 2012, illicit fentanyl – in powder, tablet, liquid and blotter paper form – has been making its way onto the streets and changing the face of the US opioid epidemic. The opioid epidemic can be
traced back to the 1990s when pharmaceutical companies began producing a new range of opioid painkillers, including OxyContin (oxycodone), touting them as less prone to abuse. In addition, prescribing rules were relaxed, while advocates championed the right to freedom from pain. Soon, opioids were being prescribed at alarming rates and increasing numbers of patients were becoming hooked. ‘We saw a trend where as dose
went up, people moved from Schedule 3 codeine to Schedule 2 OxyContin,’ says Franklin, who was the first person to report, in 2006, on the growing death rate from prescribed opioids. ‘OxyContin is only a few atoms different to heroin – I call it pharmaceutical heroin.’ A crackdown on prescribing
was inevitable. But then, with a shortage of prescription opioids, addicts turned to illicit – and cheaper – heroin. According to Franklin, 60% of heroin users became addicted via a prescribed opioid. ‘You don’t have to take these drugs for very long before it’s very hard to get off,’ he says: ‘Just days to weeks.’ Heroin use soared and with it increased tolerance, leading users to seek out more potent highs. By 2013, there were almost 2m Americans struggling with an opioid-use disorder.
Then dealers realised the
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RICHARD E. AARON/GETTY
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