HEALTH


From left to right: heroin, OxyContin, fentanyl


benefits of fentanyl – an even stronger opioid that was cheap and promised significant profit margins when mixed with heroin. Now, illicitly produced fentanyl- laced heroin is rife on the streets in the US, with many users not even realising they may be taking tainted heroin. ‘Fentanyl is making the epidemic worse because it is so potent and so strongly desired by the users,’ says Melvin Patterson, a US Drug Enforcement Administration (DEA) spokesman. ‘[It] exacerbates an existing problem.’ Franklin agrees, saying fentanyl has the potential to make the death rate even worse. There is now evidence that


fentanyl analogues and other dangerous synthetic opioids are making their way onto the black market.


The US-based Partnership for


Safe Medicines says there are more than 40 fentanyl analogues – for example, furanyl-fentanyl, acryl-fentanyl, acetyl-fentanyl, 3-methylfentanyl and carfentanil – with varying degrees of strength, manufactured to evade detection and prosecution. Carfentanil is of particular


concern. Used as a tranquiliser for large animals, the drug is 10,000 times more potent than morphine; just 0.02mg can kill a human. Patterson says that the taking


of these synthetic opioids ‘more often than not is deadly’. ‘The fact that most people abusing these substances do not appreciate or understand how dangerous the substances actually are, leads to thousands of overdoses annually’, he adds.


Pharma to blame? Many fingers have pointed at big pharma for its role in spurring the opioid epidemic. According to Franklin, pharma companies were


Overdoses and deaths from counterfeit drugs containing fentanyls will increase as users continue to inaccurately dose themselves with imitation medications.


Containing Fentanyls: A Global Threat, July 2016, US Drug Enforcement Administration


adept at false marketing, claiming addiction was rare, while pushing for increased prescribing. In 2007, Purdue Pharma, the maker of OxyContin, admitted marketing misconduct and agreed to pay $600m to settle a federal lawsuit. Now, there are moves to


clampdown on the industry again. Several states, including Ohio, Illinois and Mississippi, are suing some opioid manufacturers for aggressive marketing and for downplaying the risks of


Counterfeit Prescription Pills


addiction. Insys Therapeutics, the maker of the fentanyl product Sybsys for cancer pain, has been accused in a recent report by US Senator Claire McCaskill of stoking the epidemic through dodgy business tactics to encourage prescriptions. The firm’s founder John Kapoor has since been arrested, accused of racketeering, conspiracy and fraud. A number of US politicians are calling for tighter regulations. Insys Therapeutics and the US pharmaceutical trade body PhRMA were approached for comment for this article, but both declined to be interviewed. However, PhRMA has previously made statements on the epidemic. In September 2017, the trade body said it supported policies that would limit the supply of opioids to seven days for acute pain treatment: ‘We are taking this step because we believe the worsening opioid epidemic demands additional solutions, with new protections for patients.’ The group believes a multifaceted solution is needed to address the crisis, including improved prescriber education, monitoring programmes and efforts to combat drug diversion. It has also committed to working with the government to accelerate the development of non-opioid pain-relieving treatments.


Turning to counterfeits But Big Pharma is not solely blamed for the epidemic. Fingers have also been pointed at the DEA and the US Food and Drug Administration for not cracking down earlier, while a recent


report by the Washington Post and 60 Minutes claimed distributors that shipped pills to pharmacies turned a blind eye to diversion. While these parties may share responsibility for initiating and facilitating the opioid epidemic, however, a new culprit is now adding fuel to the fire: counterfeit prescription opioids. These opioids look identical to their prescription counterparts but are laced with illicit fentanyl, and they have become increasingly common over the past three years. Pop star Prince, who died in 2016, reportedly overdosed on counterfeit painkillers containing fentanyl. According to the DEA, illicit


fentanyl powder and counterfeit pills are sourced from China and Mexico and then smuggled into the US, often through the post in small packages to avoid detection by the authorities. In some cases, the drugs are bought via the dark web but access to the counterfeit pills has expanded as a result of bogus online pharmacies that market the fake prescription opioids to an unsuspecting public, easily providing access to cheap opioids without a prescription. There are fears that measures to crack down on the abuse of prescription opioids might drive users to the internet to purchase the drugs online, not realising the drugs they receive may be counterfeit and laced with potentially dangerous levels of fentanyl. Marvin Shepherd, president


of the Partnership for Safe Medicines (PSM), and professor emeritus, College of Pharmacy at


20 10 | 2017


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