From the Drug Policy Alliance

It doesn’t come from poppies like good old heroin. It’s a synthetic narcotic that is now widely sold on the street after being cooked up in a dirty warehouse with no chemist overseeing the mixing, no quality control supervisor inspecting the pills. And it’s killing our neighbors and their children as fast as it’s getting them high.

The fact that, milligram for milligram, the synthetic narcotic is 100 times stronger than morphine raises the stakes. Some shoddy mixing before the pills gets stamped could make half the batch lethal and the other half impotent. Or a little too much solvent in the batch might make the usually short acting drug into a long-acting analog. The risks for the folks wanting to get high just shot up.

Last year Idaho saw a doubling of Fentanyl overdose deaths. Nationally, in 2020, all overdose deaths, not just Fentanyl climbed 30% in one year. Over 90,000 US citizens died from drug overdoses that year. One Idaho narcotic treatment company details that 42% of their new patients test positive for fentanyl, over a doubling from the year before.

So, it’s the new drug we need to deal with.

I remember when I first saw the Duragesic patch prescribed for chronic pain. Fentanyl was enclosed in a plastic stick-on patch. The side against the skin was semi-permeable, letting a fixed amount through every hour. It was formulated to last for three days. This product was developed in the 1980’s to treat chronic pain, especially cancer pain, in patients who had become tolerant to oral narcotics. But getting the right dose could be tricky. And many patients described suffering withdrawal symptoms from the high narcotic dose in the third day as the patch dose faded.

You’d think it was safe from abuse, wouldn’t you? Can’t roll up and smoke a plastic patch. But in the 1990’s back when I was a county coroner, I was called to a death scene. The deceased was slumped in the bathroom, the needle still in his arm. There on the washstand next to him was a patch with the corner cut off where he’s rinsed out the fentanyl into the syringe still in his arm. It’s a very fast acting and powerful drug.

But what’s available on the streets now are easier to consume pills for swallowing or smoking. The drug (if it’s fentanyl) quickly attaches to the opioid receptors in our body. If it’s too much, we stop breathing. That’s how we die.

Most people don’t understand that simple but necessary connection in our biology. The signal for pain, which many of us want to avoid at great costs, is closely linked to the signal to breathe.

Fentanyl was and is used regularly in the operating room to block pain. But the anesthetist can control the patients breathing mechanically. And the pharmaceutical grade fentanyl wears off very quickly so the IV drip can be slowed or shut off and the patient can start breathing on their own.

But the street pills being bought and sold, swallowed or smoked, might contain longer acting analogs. Remember, this is warehouse chemistry, no quality ensured. Even scarier, maybe there’s some of the derivative carfentanil in this batch, 100 times more sedating than fentanyl. That makes it 10,000 times as strong as morphine. It’s so strong it was considered for use as a bioweapon. It’s like letting grade school kids play with automatic weapons.

It’s a dangerous world we are in. But I hope you folks can all keep breathing. Take a deep breath and commit yourselves to a healthy life, a healthy community. May we all accept enough pain in our lives to keep us alive.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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