(Video by Luis Velarde and Peter Stevenson; Animation by John Parks/The Washington Post)
Fentanyl, a powerful painkiller developed nearly 60 years ago, has triggered the deadliest drug epidemic in American history. Synthetic opioids like fentanyl have claimed the lives of more than 67,000 people — more than the number of U.S. military personnel killed during the Vietnam, Iraq and Afghanistan wars combined.
One of the greatest dangers of fentanyl is its potency. A few grains of the drug can cause an overdose. Deaths from the drug began to climb in 2013, when drug traffickers began to mix street heroin with illicit fentanyl. In just a few years, fentanyl began to rival heroin as the deadliest opioid in the United States, prompting the Centers for Disease Control and Prevention to issue a nationwide public health advisory. The alert received little national attention.
Here is what you need to know:
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What is fentanyl?
Fentanyl is a man-made opioid used to manage severe pain. It is typically administered to cancer or surgery patients. The drug was created by a Belgian physician in 1960 and approved for use as an anesthetic in 1972. Pharmaceutical fentanyl is reserved for patients who experience powerful pain that requires a stronger opioid dosage, and most patients who receive fentanyl have already been taking some type of opioid.
Fentanyl is up to 100 times more powerful than morphine and up to 50 times more powerful than heroin. Fentanyl can produce feelings of euphoria similar to heroin. The drug can also cause reduced blood pressure, sedation, dizziness and respiratory depression, according to the Drug Enforcement Administration. Pharmaceutical fentanyl comes in patches, sprays and lollipop-like lozenges. Illicit fentanyl is a white powdery substance and can also be pressed into counterfeit prescription pills.
What makes fentanyl so dangerous?
It takes about 2 milligrams of fentanyl to overdose. Fentanyl also can be combined with street drugs like heroin or cocaine. In some instances, drug users have no idea that fentanyl has been added. More recently, drug dealers have been selling straight fentanyl, which is more profitable for them.
Fentanyl analogues — or chemical variations of the drug — pose a major problem to law enforcement. Chemists can tweak the analogues to make versions of fentanyl that are not banned by law. Thus begins a game of cat and mouse: Federal officials race to identify and ban the new analogues while chemists continue to make new ones.
What is being done to combat the crisis?
Many police officers and paramedics carry naloxone, a drug that can help reverse an overdose. Naloxone can be injected into the body or used as a nasal spray. It works as an antidote, blocking the effects of opioids and helping restore breathing.
Pharmacies are now stocking the nasal spray. Naloxone is available for purchase without a prescription in 46 states. Public health departments, including the CDC, have encouraged more access to naloxone for first responders. In one study, opioid deaths in 19 Massachusetts communities dropped by 11 percent after the state implemented a naloxone distribution and education program.
Yet municipalities still have trouble accessing the drug, partly because of the cost. Narcan, the commercial name for naloxone as a nasal spray, can cost between $70 to $150. But the injectable version, known as Evzio, can cost around $4,000.
Learn more on how first responders use Narcan:
What do you do if you come into contact with someone who is overdosing on fentanyl?
If you suspect someone is experiencing an overdose, the CDC recommends the following:
1. Call 911 immediately.
2. Administer naloxone, if available.
3. Try to keep the person awake and breathing.
4. Lay the person on their side to prevent choking.
5. Stay with him or her until emergency workers arrive.
How many people have died as a result of fentanyl overdoses?
The United States has experienced three major waves of opioid deaths. They began in the late 1990s, when Americans increasingly began to overdose on prescription painkillers, such as OxyContin and Vicodin. The next wave began in 2010 when addicts turned to heroin as supplies of prescription opioids dried up. Beginning in 2013, fentanyl overdoses started to skyrocket.
In 2016, fentanyl surpassed heroin as the opioid most responsible for overdose deaths. That year, 19,720 people died of overdoses related to synthetic opioids, most of which involved fentanyl. In 2017, synthetic-opioid overdoses rose to 28,869.
Which parts of the country are most affected?
Most of the deaths are concentrated in the Northeast and Midwest. Some of the highest death tolls have been recorded in New Hampshire, West Virginia, Massachusetts, Ohio, Maryland, Rhode Island, Maine, Connecticut, Kentucky and Washington, D.C.
The first signs were detected in the spring of 2013 in Rhode Island with a sudden increase in overdose deaths at the state morgue.
Where does illicit fentanyl come from?
Fentanyl manufactured in clandestine labs has been traced to Mexico and China, according to the DEA. In January, U.S. Customs and Border Protection officers in Arizona reported their agency’s largest fentanyl bust ever: 254 pounds seized at a checkpoint on the Southwest border. The drug, along with 395 pounds of methamphetamine, was hidden in false-floor compartment of a truck carrying cucumbers. The driver was a 26-year-old Mexican national, according to authorities.
Some of the illicit fentanyl made in Chinese labs is sent to the United States in small packages through the U.S. postal system or overnight shipping companies, making it difficult to detect. The Department of Justice announced its first-ever indictment against Chinese fentanyl manufacturers in October 2017, when officials in North Dakota charged two Chinese nationals with selling fentanyl over the Internet. The DOJ alleged that one of the suspects operated at least two chemical plants capable of producing tons of fentanyl and fentanyl analogues.
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